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    OpenPayerNPI Medicare & MedicaidHoward Cummings
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    Howard Cummings — Billing Profile & Reimbursement Data

    NPI 1669478996 · Kingsport, TN · Retina Specialist (Ophthalmology) Physician

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    Howard Cummings is a retina specialist (ophthalmology) physician provider located in Kingsport, Tennessee. This profile covers 15 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationHoward Cummings
    Address2412 N John B Dennis Hwy
    CityKingsport
    StateTN
    ZIP37660
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedJune 22, 2005

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$2.2M
    Medicaid$0

    Key Findings

    HOWARD CUMMINGS is a retina-focused ophthalmology physician with a long Medicare billing history and an NPI enumerated ~21 years ago (2005-06-22), indicating sustained participation in Medicare over two decades. The service mix and top codes are consistent with a practice concentrated on intravitreal injections and retina imaging/repair rather than general ophthalmology office care.

    Medicare dominates this provider's public payer volume: Total Medicare revenue is $2.2M while there is no Medicaid billing on file, making the practice effectively single-payer (Medicare) in the available dataset. Analysts should treat Medicaid-related competitor or utilization comparisons as not applicable for this provider.

    Revenue concentration is high: the precomputed top 3 Medicare codes account for 87.4% of this provider's total Medicare revenue. This concentration underscores that a handful of intravitreal injection products (J0178, J2778, J2777) drive the vast majority of billed Medicare dollars, which has implications for supply chain, reimbursement risk, and service-line planning.

    The largest single revenue source is J0178 (aflibercept) with $966K, representing 44.8% of Medicare revenue; this positions the provider as a meaningful, but not extreme, national participant for that drug (rank #903 of 3204, 72nd percentile). Alongside substantial volume for J2778 (ranibizumab, $474.3K) and J2777 (faricimab-svoa, $445.4K), the practice’s injection-heavy profile suggests a retina clinic focused on treating wet AMD and related neovascular conditions.

    While most procedural and office visit codes show typical national volumes, one imaging code stands out: 92134 (retinal computerized diagnostic imaging) is notably above typical national volume (95th percentile) with $48.8K in revenue. This suggests the provider performs a high rate of OCT retinal imaging relative to peers, aligning with an intravitreal injection practice that relies on imaging for diagnosis and treatment monitoring.

    Several surgical retina codes (67028, 67113, 67041) are present but represent small shares of total revenue (67028 at $117.6K is 5.4% of Medicare revenue, while 67113 and 67041 are each under 1%). This indicates the practice primarily provides injection-based medical retina care and imaging, with episodic surgical interventions rather than a surgery-first practice model.

    Office evaluation codes (92014, 99214, 99213, 92004) contribute modestly to revenue and generally rank in typical percentiles nationally, reinforcing that the clinic’s billing is procedure- and drug-focused rather than based on high volumes of E/M visits. These lower shares of E/M revenue are consistent with a specialty ambulatory retina practice where procedural treatments drive income.

    Competitive standing across the top drug codes is mixed: J2778 ranks at the 89th percentile nationally (rank #139 of 1208) indicating relatively high national volume for ranibizumab, while J2777 and J0178 ranks are in the middle tiers (66th and 72nd percentiles respectively), denoting a strong but not dominant national presence. Overall, the provider should be viewed as a regionally established retina specialist with concentrated Medicare revenue tied to intravitreal therapies and advanced retinal imaging.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    15 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg1,400$690$966K
    J2778Injection, ranibizumab, 0.1 mg2,640$180$474.3K
    J2777Injection, faricimab‑svoa, 0.1 mg15,360$30$445.4K
    67028The 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.1,310$90$117.6K
    92134The 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.1,740$30$48.8K
    92014An 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…410$90$34.8K
    67113The provider repairs a complicated detached retina. He removes vitreous humor, the gelatinous material that gives shape to the eye, and peels the retinal membrane. He reattaches the retina with…20$980$14.7K
    99214The provider sees an established 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…120$80$10.3K
    67041In this procedure, the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical…10$830$9.9K
    99213The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…160$60$9.9K

    Showing 1–10 of 15

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    15 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J01782680790$680$769.8K
    J2777235015,060$30$592.1K
    J277813401,340$180$370.2K
    6702836801,130$90$98.5K
    6711371020$1,280$32.1K
    6704171030$1,200$31.2K
    92014154810120$80$19.2K
    J90353570140$50$17.1K
    992145,62211,370120$80$16.6K
    921343960060$30$8.2K

    Showing 1–10 of 15

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    James MillerTNRetina Specialist (Ophthalmology) Physician$3.9M$0
    Devon GhodasraTNRetina Specialist (Ophthalmology) Physician$3.6M$0
    Nicholas AndersonTNRetina Specialist (Ophthalmology) Physician$3M$0
    Rohan ShahTNRetina Specialist (Ophthalmology) Physician$2.9M$0
    Scott BarbTNOphthalmology Physician$2.8M$0
    Robert ShulerTNRetina Specialist (Ophthalmology) Physician$2.6M$0
    Tod McmillanTNRetina Specialist (Ophthalmology) Physician$2.5M$0
    Ailee LahamTNRetina Specialist (Ophthalmology) Physician$2.5M$0
    Stephen PerkinsTNRetina Specialist (Ophthalmology) Physician$2.3M$0
    Francis DecroosTNRetina Specialist (Ophthalmology) Physician$2.3M$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Holston Medical Group PCTNFamily Medicine Physician$0$37M
    Wellmont Medical Associates IncTNPulmonary Disease Physician$0$27.8M
    Wellmont Health SystemTNGeneral Acute Care Hospital$0$17.6M
    Mountain States Health AllianceTNGeneral Acute Care Hospital$0$15.5M
    Watauga Dental Center, PLLCTNGeneral Practice Dentistry$0$8M
    LovinginhomecareincTNIn Home Supportive Care Agency$0$5.3M
    Harville Orthodontics PLLCTNOrthodontics and Dentofacial Orthopedics Dentistry$0$4.7M
    Sbh-kingsportTNPsychiatric Hospital$0$4M
    Thompson Delivery Services LLCTNNon-emergency Medical Transport (VAN)$0$3.2M
    Wellmont Cardiology ServicesTNCardiovascular Disease Physician$0$3.1M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Tennessee Distribution
    Howard Cummings — 0 of 15 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Tennessee