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.

Mark Nelson (NPI 1689647109)

Field	Value
Entity Type	Individual
Organization	Mark Nelson
Address	2245 S 19th St
City	Tacoma
State	WA
ZIP	98405
Taxonomy	Ophthalmology Physician
NPI Enumerated	February 8, 2006

Payer Source	Total Paid
Medicare	$4.3M
Medicaid	$0

Key Findings

This provider’s billing is effectively single‑payer: lifetime Medicare revenue is $4.3M and there is no Medicaid billing on file, so payer exposure is concentrated to Medicare payment policies and utilization review. Analysts should treat this profile as Medicare‑driven rather than dual‑payer, with Medicaid representing no measurable revenue stream to date.

Revenue concentration is extreme: the precomputed top 3 Medicare codes account for 82.5% of the provider’s Medicare revenue, led by J2777 ($2.2M, 49.4% of Medicare revenue), J0178 ($1.2M, 28.4%), and 67028 ($208.3K, 4.8%). This implies the practice’s financial performance is highly sensitive to reimbursement and utilization patterns for those specific retina/injection services.

Clinical/service mix is retina‑and‑injection centric: the highest‑revenue items are intravitreal drug codes J2777 and J0178 and the isolated intravitreal injection code 67028, while high volumes of retinal imaging codes such as 92134 (2K claims, $64.6K) and fundus photography 92250 (802 claims, $22.5K) support a workflow centered on medical retina management. Together these codes indicate an operation focused on frequent anti‑VEGF and related biologic injections plus diagnostic imaging rather than a surgery‑heavy practice.

On competitive standing, the provider is a clear national outlier for certain retina services: J2777 (74.2K claims, $2.2M) ranks #42 of 2039 providers nationally (98th percentile; notably above typical national volume), and 92250 ranks #447 of 25087 providers nationally (98th percentile; extreme outlier). Several imaging and diagnostic codes also rank highly—92134 ranks #1020 of 26868 providers nationally (96th percentile; notably above typical national volume)—indicating unusually high imaging and documentation throughput relative to peers.

Other biologic and drug usage shows a mixed national profile: J0178 (1.8K claims, $1.2M) ranks #621 of 3204 providers nationally (81th percentile; typical, unremarkable volume), and J0179 (606 claims, $140.6K) ranks #18 of 64 providers nationally (73th percentile; typical, unremarkable volume). By contrast, use of J2778 (ranibizumab) and J9035 (bevacizumab) is low relative to peers—J2778 ranks #1167 of 1208 (3th percentile) and J9035 ranks #1732 of 1852 (6th percentile)—suggesting the practice favors certain proprietary or newer agents over these alternatives.

The provider’s utilization mix includes a few high average‑paid unclassified/compounded drug entries that amplify revenue concentration risk: J3490 shows 70 claims with $1768 avg paid/claim totaling $123.8K, and J7999 (compounded drug) appears as well. Payers should note the combination of high per‑claim drug payments (for example J0178 at $680 avg paid/claim and J3490 at $1768 avg) with concentrated volume when assessing financial impact and prior‑authorization needs.

Surgical vitreoretinal procedures are present but represent a small fraction of overall revenue and volume compared with injections and imaging: 67042 (39 claims, $35.5K) and 67036 (24 claims, $15K) are much smaller contributors. This split further supports characterization of the practice as predominantly outpatient medical retina/injection focused rather than surgical retina‑centric.

Provider tenure is long enough to support established referral patterns: the NPI was enumerated 2006-02-08 (~20 years ago), indicating the physician has been active on Medicare for approximately two decades. Combined with the heavy concentration in a few high‑volume retina codes, this tenure suggests these utilization patterns are sustained rather than transient.

Medicare: Complete Services Breakdown

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

25 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	74,220	$30	$2.2M
J0178	Injection, aflibercept, 1 mg	1,820	$680	$1.2M
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.	2,060	$100	$208.3K
J0179	Injection, brolucizumab-dbll, 1 mg	610	$230	$140.6K
J3490	Unclassified drugs	70	$1,770	$123.8K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	740	$120	$88.4K
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…	910	$90	$85.2K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	470	$150	$71.9K
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.	2,020	$30	$64.6K
67042	In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…	40	$910	$35.5K

Showing 1–10 of 25

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 25 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Washington Distribution

Mark Nelson — 5 of 25 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

25 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2777	2	50	12,780	$30	$599.7K
J0178	18	90	470	$680	$597.2K
J0179	3	10	660	$240	$165.8K
J2778	26	30	510	$180	$117.1K
J2781	6	10	650	$120	$88.6K
67028	5	110	550	$90	$72.9K
J3490	32	70	70	$50	$51.2K
J7312	2	20	270	$160	$46K
67042	8	40	30	$1,190	$39.2K
67036	7	20	20	$1,140	$28.6K

Showing 1–10 of 25

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sound Retina Ps	WA	Specialist	$0	$7.4M
Himanshu Banda	WA	Retina Specialist (Ophthalmology) Physician	$5.1M	$0
Anthony Truxal	WA	Ophthalmology Physician	$3.7M	$0
Matthew Asano	CO	Ophthalmology Physician	$2M	$0
Kenneth Fung	WA	Ophthalmology Physician	$1.6M	$0
Barton Blackorby	MO	Retina Specialist (Ophthalmology) Physician	$1.1M	$0
Jay Haynie	WA	Optometrist	$394.5K	$0
Jacob Light	WA	Ophthalmology Physician	$166.8K	$230

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Multicare Health System	WA	General Acute Care Hospital	$0	$162.2M
Multicare Health System	WA	Children's Hospital	$0	$108.4M
Franciscan Medical Group	WA	Family Medicine Physician	$0	$92.6M
Multicare Health System	WA	Family Medicine Physician	$0	$75M
Franciscan Health System	WA	General Acute Care Hospital	$0	$44.6M
Multicare Health System	WA	Pediatrics Physician	$0	$29.4M
Western Psychological And Counseling Services LLC	WA	Clinical Psychologist	$0	$20.8M
Sound Health Medical Supply	WA	Customized Equipment (DME)	$0	$20.7M
Tra-minw P S	WA	Radiology Clinic/Center	$0	$14.5M
Advanced Lifeline Services	WA	SNF/Subacute Care Certified Respiratory Therapist	$0	$12.5M

Mark Nelson — Billing Profile & Reimbursement Data

Sign up for Mark Nelson — Billing Profile & Reimbursement Data policy alerts

Mark Nelson — Billing Profile & Reimbursement Data

Sign up for Mark Nelson — Billing Profile & Reimbursement Data policy alerts

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