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 Alabama for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Alabama 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. Alabama (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.

Mark Douglas (NPI 1679576516)

Field	Value
Entity Type	Individual
Organization	Mark Douglas
Address	2880 Dauphin St
City	Mobile
State	AL
ZIP	36606
Taxonomy	Ophthalmology Physician
NPI Enumerated	May 24, 2005

Payer Source	Total Paid
Medicare	$2.1M
Medicaid	$0

Key Findings

This provider reports $2.1M in lifetime Medicare revenue and has no Medicaid billing on file, making its publicly visible payer mix effectively single-payer (Medicare) on the claims record. The NPI was enumerated 2005-05-24 (~21 years ago), indicating an established practice presence in Mobile, AL.

Revenue is highly concentrated in a very small set of services: the precomputed top three Medicare codes account for 86.1% of this provider's total Medicare revenue. Those top three are J0178 ($1.6M; 76.1%), 67028 ($124.4K; 6.0%), and 92134 ($83.1K; 4.0%), so most dollars come from intravitreal drug administration and retinal diagnostic imaging.

The code mix points to a medical-retina operating model: J0178 (aflibercept injections) dominates revenue and 92134 (computerized retinal imaging) is high-volume, which together are consistent with frequent intravitreal anti-VEGF treatment plus routine retinal monitoring. 67028 (isolated intravitreal injection) further supports an injection-centered outpatient workflow rather than surgery-heavy practice.

Despite J0178 producing $1.6M (76.1% of Medicare revenue), the provider ranks #397 of 3204 nationally for J0178 in the 88th percentile and is labeled a "typical, unremarkable volume for this code," implying that the high revenue share is driven primarily by the drug's per-claim value rather than an extreme claim count relative to peers.

Imaging and E/M activity are unusually large in absolute volume: 92134 has 3.1K claims and $83.1K in revenue and ranks #367 of 26868 nationally (99th percentile; described as an "extreme outlier, far above typical national volume for this code"), while office E/M codes 99214 (820 claims, $64K; 96th percentile) and 99213 (771 claims, $44.7K; 97th percentile) are both "notably above typical national volume," indicating sustained clinic visit throughput to support the injection and imaging workload.

The provider uses a range of injectable biologic codes beyond J0178: J2777 (faricimab) has 2.8K claims for $81.8K (3.9%) but ranks in the 8th percentile (#1863 of 2039; "typical, unremarkable volume"), and J9035 (bevacizumab) has 473 claims and $24.6K (1.2%) at the 85th percentile. This mix shows multiple anti-VEGF and biologic agents in use, though relative rank varies by drug code.

Concentration risk and operational sensitivity are material: with 76.1% of Medicare revenue tied to J0178 and the top three codes making up 86.1% of total Medicare revenue, the practice’s financial performance on the Medicare side is highly dependent on reimbursement and utilization patterns for a small set of injection and imaging services. Any shifts in drug reimbursement, utilization guidelines, or coding practice for these specific codes could meaningfully affect revenue.

Medicare: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,300	$690	$1.6M
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.	1,520	$80	$124.4K
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.	3,080	$30	$83.1K
J2777	Injection, faricimab‑svoa, 0.1 mg	2,820	$30	$81.8K
99214	The 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…	820	$80	$64K
J3590	Unclassified biologics	30	$2,120	$59.4K
99213	The 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…	770	$60	$44.7K
J9035	Injection, bevacizumab, 10 mg	470	$50	$24.6K
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…	80	$100	$8.1K
92083	The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended…	40	$40	$1.6K

Showing 1–10 of 14

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Alabama Distribution

Mark Douglas — 3 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. state median

14 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	6	40	920	$690	$706.2K
J2777	22	20	7,140	$30	$267.9K
67028	6	40	990	$90	$82.5K
J3590	1	10	30	$2,120	$59.4K
J9035	18	40	410	$50	$24.5K
99214	292	7,330	120	$80	$16.8K
99215	1,658	1,710	40	$110	$8.1K
99213	122	6,470	80	$50	$7.9K
92134	2	410	50	$30	$6.4K
99204	574	3,750	30	$100	$4.8K

Showing 1–10 of 14

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Premier Health Management, Inc.	AL	Ophthalmology Physician	$0	$3M
Henry Semple	AL	Ophthalmology Physician	$2M	$0
Stuart Ball	AL	Ophthalmology Physician	$1.3M	$0
Mark Gacek	AL	Otolaryngology Physician	$244.7K	$0
Curtis Graf	AL	Ophthalmology Physician	$242.9K	$0
Ryan Burton	AL	Ophthalmology Physician	$240.4K	$0
Joseph Turner	AL	Ophthalmology Physician	$239.7K	$0
Jay Brown	AL	Ophthalmology Physician	$211.9K	$0
Charles Salisbury	AL	Ophthalmology Physician	$199.6K	$0
Charles Mosteller	AL	Ophthalmology Physician	$197.9K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mobile Bay Dental, LLC	AL	General Practice Dentistry	$0	$3.6M
Scott Freeman	AL	MOHS-Micrographic Surgery Physician	$2.9M	$0
Lifeguard Ambulance Service LLC	AL	Land Ambulance	$414.6K	$2.2M
Rehab Medical, LLC	AL	Durable Medical Equipment & Medical Supplies	$0	$1.9M
Mobile Bay Vision, LLC	AL	Optometrist	$0	$1.8M
Surgicare Of Mobile Ltd	AL	Ambulatory Surgical Clinic/Center	$1.5M	$101.9K
Sleep Management, L.L.C.	AL	Oxygen Equipment & Supplies (DME)	$0	$1.5M
Odyssey Healthcare Operating B, LP	AL	Community Based Hospice Care Agency	$0	$1.4M
Lincare Inc.	AL	Oxygen Equipment & Supplies (DME)	$0	$1.4M
Vital Smiles Alabama PC	AL	Health Maintenance Organization	$0	$1.3M

Mark Douglas — Billing Profile & Reimbursement Data

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Mark Douglas — 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