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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

John Denny (NPI 1679684237)

Field	Value
Entity Type	Individual
Organization	John Denny
Address	4414 Lake Boone Trl
City	Raleigh
State	NC
ZIP	27607
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	August 31, 2006

Payer Source	Total Paid
Medicare	$2.3M
Medicaid	$0

Key Findings

Practice is heavily procedure- and drug-focused within retinal disease management: the top revenue generators are anti-VEGF injections and the intravitreal injection procedure itself, led by J0178 (2K claims, $689 avg paid/claim, $1.4M revenue) and J2778 (3.3K claims, $181 avg paid/claim, $591.9K revenue), together with the injection administration code 67028 (1.5K claims, $90 avg paid/claim, $132K revenue). This mix indicates a clinical operation centered on recurrent in-office injections and related retina procedures rather than broad multispecialty outpatient care.

Medicare revenue is concentrated: the precomputed top-3 Medicare codes account for 92.0% of this provider's Medicare revenue, with J0178 at 60.0%, J2778 at 26.2%, and 67028 at 5.8% of total Medicare revenue. Given a lifetime Medicare revenue of $2.3M, the business is financially dependent on repeat anti-VEGF therapy.

Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $2.3M while there is no Medicaid billing on file, so Medicaid contributes none to observed public-payer activity. This profile suggests the provider’s publicly billed caseload and revenue stream are concentrated entirely in Medicare beneficiaries.

Competitive standing varies by drug: the provider ranks #97 of 1208 for J2778 (92th percentile), indicating a relatively strong national position for ranibizumab administration, while J0178 ranks #554 of 3204 (83th percentile) and 67028 ranks #828 of 4255 (81th percentile), both described as typical or unremarkable national volumes for those codes. In sum, the provider is a notable national user of ranibizumab and a solid, but not dominant, user of aflibercept and the intravitreal injection code.

Imaging and documentation volumes are unusually high: code 92250 (fundus photography) shows 1.2K claims, $25 avg paid/claim, $30.1K revenue and ranks #140 of 25087 (99th percentile; extreme outlier, far above typical national volume for this code). This elevated imaging activity signals a practice workflow that emphasizes photodocumentation and monitoring in support of retinal disease management.

E/M visit volume for established patients is also an outlier: 99213 appears with 952 claims, $61 avg paid/claim, $58.1K revenue and ranks #7246 of 457151 (98th percentile; extreme outlier, far above typical national volume for this code). High established-patient visit volume is consistent with frequent follow-up visits required for ongoing injection therapy and chronic retinal care.

Use of lower-cost bevacizumab and unclassified-drug billing is limited but present: J9035 (bevacizumab) is 106 claims, $54 avg paid/claim, $5.7K revenue (0.3% of Medicare revenue) and ranks in the middle nationally (#1019 of 1852, 45th percentile), while J3490 (unclassified drugs) shows only 20 claims but a high $1853 avg paid/claim, $37.1K revenue and ranks #2609 of 2838 (7th percentile). These patterns suggest a preference for branded anti-VEGF agents (aflibercept and ranibizumab) in billed Medicare encounters, with occasional high-cost unclassified drug charges.

Provider tenure is long-standing: the NPI was enumerated on 2006-08-31 (~20 years ago), indicating roughly two decades of potential billing history and likely established referral relationships within the local retinal care market. That longevity, combined with concentrated anti-VEGF volumes, supports a mature, injection-centered retina practice profile.

Medicare: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,970	$690	$1.4M
J2778	Injection, ranibizumab, 0.1 mg	3,270	$180	$591.9K
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.	1,470	$90	$132K
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…	950	$60	$58.1K
J3490	Unclassified drugs	20	$1,850	$37.1K
92250	Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…	1,210	$30	$30.1K
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.	990	$30	$27.8K
99203	The provider sees a new 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 provider…	110	$70	$7.8K
J9035	Injection, bevacizumab, 10 mg	110	$50	$5.7K
92235	The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken…	40	$90	$3.8K

Showing 1–10 of 13

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. North Carolina Distribution

John Denny — 3 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. state median

13 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	22	100	950	$690	$881K
J2778	2	50	620	$180	$202.2K
67028	30	120	780	$90	$80K
J3490	66	80	50	$450	$24.1K
99214	14,014	18,060	110	$80	$15.1K
J9035	53	90	140	$50	$13.4K
92235	37	70	60	$100	$8.7K
92134	66	790	70	$30	$7.5K
99213	139	16,320	70	$50	$7.1K
99204	4,283	8,430	30	$110	$4.8K

Showing 1–10 of 13

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shil Patel	VA	Ophthalmology Physician	$6.1M	$0
James Pate	NC	Ophthalmology Physician	$5.2M	$0
Nitin Gupta	NC	Ophthalmology Physician	$4.7M	$0
John Thordsen	NC	Retina Specialist (Ophthalmology) Physician	$3.5M	$0
Rebecca Manning	NC	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
William Clark	SC	Ophthalmology Physician	$3.3M	$0
Sachin Mudvari	NC	Retina Specialist (Ophthalmology) Physician	$3.2M	$0
Daniel Bennett	NC	Retina Specialist (Ophthalmology) Physician	$3M	$0
Brian Lehpamer	NC	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Elizabeth Tegins	NJ	Ophthalmology Physician	$2.7M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Autism Society Of North Carolina, Inc.	NC	Community/Behavioral Health Agency	$0	$95.7M
Rex Hospital Inc.	NC	General Acute Care Hospital	$0	$25.3M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$24.8M
Nc Dept Of Health And Human Service	NC	Clinical Medical Laboratory	$0	$16.4M
Jeffers Mann & Artman Pediatric & Adolesent Medicine PA	NC	Pediatric Adolescent Medicine Physician	$0	$10.9M
Pediatric Therapy Associates	NC	Physical Therapist	$0	$10.2M
Blue Ridge Day Surgery Center, LP	NC	Ambulatory Surgical Clinic/Center	$1.6M	$2.2M
Eugene Milder	NC	Retina Specialist (Ophthalmology) Physician	$2.1M	$0
Raynor Casey	NC	Retina Specialist (Ophthalmology) Physician	$1.9M	$0
Lisa Mckenna	NC	Retina Specialist (Ophthalmology) Physician	$1.9M	$0

John Denny — 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