Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Washington for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Washington only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Washington (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Benjamin Reiss (NPI 1659637668)

Field	Value
Entity Type	Individual
Organization	Benjamin Reiss
Address	125 3rd St Ne Ste 200
City	Auburn
State	WA
ZIP	98002
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	April 3, 2012

Payer Source	Total Paid
Medicare	$1.9M
Medicaid	$0

Key Findings

This provider is effectively a retina-focused ophthalmologist whose Medicare billing is dominated by intravitreal pharmacotherapy and retina imaging: the largest revenue codes are J0178 and J2777 (anti-VEGF/biologic injections) and 67028 (isolated intravitreal injection), together accounting for 74.1% of total Medicare revenue. The code mix — heavy on drug injection codes (J0178, J2777, J2781, J7312, J9035) plus high-volume retinal imaging (92134) — is consistent with a practice model centered on in-office injection therapy and retina disease monitoring rather than office-based primary eye care or high-volume surgical retina work.

Revenue concentration is high: the top 3 Medicare codes by revenue account for 74.1% of this provider's total Medicare revenue, with J0178 contributing $827.9K (44.4% of total Medicare revenue) and J2777 contributing $450.7K (24.2% of total Medicare revenue). This level of concentration indicates that a small set of intravitreal drug administrations drives the majority of billed Medicare dollars for this provider.

Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $1.9M while Medicaid shows none on file ("none below — this provider has no Medicaid billing on file"). Operationally, that means analyses of commercial/Medicaid exposure, dual-eligibility patterns, or Medicaid risk are not supported by the claims data available here.

Competitive standing on leading drug codes is modest to typical nationally: J0178 ranks #1080 of 3204 providers nationally (66th percentile; typical, unremarkable volume) and J2777 ranks #687 of 2039 providers nationally (66th percentile; typical, unremarkable volume), so this provider is a routine, not dominant, national participant for the two largest drug codes. Conversely, retinal imaging with 92134 is a clear national outlier toward higher volume — it ranks #1442 of 26868 providers nationally (95th percentile; notably above typical national volume) — indicating above-typical utilization of OCT-style diagnostic imaging relative to peers.

Several other codes reflect a diversified retina service mix but not market dominance: 67028 (984 claims, $102 avg paid/claim, $102.3K revenue) sits at a typical national level (67th percentile), J2781 (pegcetacoplan) appears with $59.5K revenue but ranks #279 of 490 providers nationally (43th percentile; typical, unremarkable volume), and surgical procedures such as 67042 and 67108 appear at low counts and revenue, consistent with a practice that emphasizes injections and imaging over frequent major retinal surgery.

There are targeted statistical outliers that suggest specific operational emphases: 92134 is described as "notably above typical" national volume (95th percentile), and the new-patient E/M code 99204 is also described as "notably above typical" national volume (98th percentile), which together suggest higher-than-typical use of advanced retinal imaging and of longer, complex new-patient evaluations in this clinician's Medicare cohort. Other common codes (e.g., 92014, 92012, J3490) are reported at typical national volumes.

Operational details in the claims support an in-office, procedure-forward workflow: the presence of high counts for intravitreal drug codes (J0178: 1.2K claims; J2777: 15.5K claims) alongside substantial imaging (92134: 1.6K claims) and a moderate number of E/M visits (92014: 617 claims; 92012: 472 claims) aligns with a retina practice model where injections and imaging visits form the bulk of patient encounters. Occasional higher-reimbursement procedural codes (e.g., 67042 at $23.5K revenue, 67108 at $12K revenue) appear but do not materially shift the revenue mix.

Provider tenure is long enough to evaluate trend stability: the NPI was enumerated on 2012-04-03 (~14 years ago), indicating over a decade in the Medicare billing dataset and supporting longitudinal comparisons of procedure mix and payer exposure if historical data are available.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,210	$680	$827.9K
J2777	Injection, faricimab‑svoa, 0.1 mg	15,540	$30	$450.7K
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	980	$100	$102.3K
J3490	Unclassified drugs	90	$910	$85.2K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	620	$100	$62.9K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	500	$120	$59.5K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	1,570	$30	$53.4K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	250	$160	$38.7K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	470	$80	$35.9K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	190	$130	$25K

Showing 1–10 of 22

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Washington Distribution

Benjamin Reiss — 2 of 22 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. state median

22 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2777	21	50	12,780	$30	$599.7K
J0178	30	90	470	$680	$597.2K
J2781	10	10	650	$120	$88.6K
67028	40	110	550	$90	$72.9K
J3490	21	70	70	$50	$51.2K
J7312	9	20	270	$160	$46K
67042	18	40	30	$1,190	$39.2K
67108	16	20	20	$1,180	$29.6K
92242	9	20	50	$210	$19.7K
92014	62	790	110	$80	$16.8K

Showing 1–10 of 22

Related Providers

Other providers that share a Tax Identification Number (TIN) with Benjamin Reiss, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Retina Institute, PLLC	WA	Retina Specialist (Ophthalmology) Physician	$0	$5.5M
Brenda Myers Powell	WA	Retina Specialist (Ophthalmology) Physician	$2.2M	$0
Rahul Mandiga	WA	Retina Specialist (Ophthalmology) Physician	$1.9M	$1.3K
George Ko	WA	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Kenneth Fung	WA	Ophthalmology Physician	$1.6M	$0
Pnw Eye PLLC	WA	Ambulatory Surgical Clinic/Center	$1M	$85.4K
Joseph Pham	WA	Ophthalmology Physician	$332.2K	$0
Minhee Cho	NV	Ophthalmology Physician	$326.6K	$0
Christopher Chapman	MI	Ophthalmology Physician	$297.2K	$0
Niraj Patel	WA	Ophthalmology Physician	$269.6K	$0

Nearby Providers

Other providers in the same ZIP code as Benjamin Reiss, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
We Care Daily Clinics LLC	WA	Methadone Clinic	$166.2K	$260.6M
Apple Physical Therapy, LLC	WA	Physical Therapist	$0	$31.3M
Healthpoint	WA	Federally Qualified Health Center (FQHC)	$0	$14.5M
Healthpoint	WA	Federally Qualified Health Center (FQHC)	$0	$3M
Eid, Jaber, Jassar, PLLC	WA	Dental Clinic/Center	$0	$2.7M
South Sound Surgery, PLLC	WA	Ambulatory Surgical Clinic/Center	$137.6K	$457K
Joshua Frenkel	WA	Ophthalmology Physician	$306.8K	$0
Ashish Trivedi	WA	Specialist	$295.5K	$0
Richard Beller	WA	Ophthalmology Physician	$293.2K	$0
Alan Chen	WA	Specialist	$99.9K	$0

Benjamin Reiss — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References