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

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

Scott Gauthreaux (NPI 1710942065)

Field	Value
Entity Type	Individual
Organization	Scott Gauthreaux
Address	1101 S College Rd
City	Lafayette
State	LA
ZIP	70503
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	April 19, 2006

Payer Source	Total Paid
Medicare	$1.4M
Medicaid	$0

Key Findings

SCOTT GAUTHREAUX operates as a retina-focused ophthalmology practice with the bulk of clinical activity centered on intravitreal anti-VEGF therapy and high-volume retinal imaging. The top injectable drugs billed are J0178 (1.1K claims, $677 avg paid/claim, $710.9K revenue), J2777 (5.3K claims, $27 avg paid/claim, $142.6K revenue) and J2778 (791 claims, $177 avg paid/claim, $140K revenue), and the practice also reports substantial use of office-based injection code 67028 (1K claims, $87 avg paid/claim, $88.5K revenue) and retinal imaging 92134 (2.3K claims, $29 avg paid/claim, $68K revenue).

Revenue is highly concentrated in a handful of drug codes: the precomputed top 3 Medicare codes account for 71.6% of the provider’s total Medicare revenue, with J0178 alone representing 51.2% of Medicare revenue ($710.9K). This concentration indicates financial dependence on a small set of high-cost injectable therapies.

This provider is effectively single-payer on file: lifetime Medicare revenue totals $1.4M while there is no Medicaid billing on record. The absence of Medicaid revenue suggests limited exposure to Medicaid-managed populations and that payer strategy or reimbursement risk is concentrated in Medicare.

Injection volumes for the major retinal drugs are broadly in the typical national range rather than dominant: J0178 ranks #1238 of 3204 providers nationally (61th percentile; typical, unremarkable volume for this code), J2777 ranks #1494 of 2039 (27th percentile; typical, unremarkable volume for this code), and J2778 ranks #518 of 1208 (57th percentile; typical, unremarkable volume for this code). These ranks imply the provider is a modest national participant in anti-VEGF administration rather than a top-volume outlier for those specific drugs.

In contrast to injection ranks, clinical office workup and imaging are exceptional: 92134 appears as an extreme outlier with 2.3K claims ($29 avg paid/claim, $68K revenue) and ranks #753 of 26868 providers nationally (97th percentile; extreme outlier, far above typical national volume), while 92014 shows notably above-typical volume with 1.3K claims ($84 avg paid/claim, $111.6K revenue) and ranks #844 of 35415 (98th percentile; notably above typical national volume). High exam and OCT volumes point to a practice workflow that pairs frequent monitoring with treatment, consistent with retina specialty management of chronic macular disease.

The practice performs some in-office procedural work and occasional surgical retinal procedures: 67028 (injections into the vitreous) accounts for $88.5K (6.4% of Medicare revenue) and ranks #1364 of 4255 (68th percentile; typical, unremarkable volume for this code), while vitrectomy-related codes 67042, 67041, and 67036 appear at much lower claim counts and revenues. This pattern suggests predominantly clinic-based medical retina care with intermittent surgical referrals or limited surgical caseload.

Billing patterns show frequent small-value supply and drug claims alongside high-value injectables: J2403 is billed 20K times ($1 avg paid/claim, $20K revenue) and ranks #65 of 76 providers nationally (15th percentile; typical, unremarkable volume for this code), and there are entries for J7999 (257 claims, $67 avg paid/claim, $17.2K revenue) and J3301 (96 claims, $1 avg paid/claim, $96 revenue). The mix indicates routine billing for topical agents and compounded preparations in addition to the core anti-VEGF treatments.

The provider has long tenure in Medicare billing, with an NPI enumeration date of 2006-04-19 (~20 years ago), which combined with the concentrated anti-VEGF revenue stream and very high imaging/exam volumes, points to an established retina practice model focused on chronic disease management within the Medicare population. This operational profile suggests stable, outpatient-driven revenue generation with limited Medicaid participation.

Medicare: Complete Services Breakdown

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,050	$680	$710.9K
J2777	Injection, faricimab‑svoa, 0.1 mg	5,280	$30	$142.6K
J2778	Injection, ranibizumab, 0.1 mg	790	$180	$140K
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…	1,330	$80	$111.6K
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.	1,020	$90	$88.5K
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.	2,350	$30	$68K
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…	230	$110	$25K
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…	340	$60	$21K
J2403	Chloroprocaine hcl ophthalmic, 3% gel, 1 mg	20,000	$1	$20K
J7999	Compounded drug, not otherwise classified	260	$70	$17.2K

Showing 1–10 of 20

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Louisiana Distribution

Scott Gauthreaux — 3 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Louisiana

Full comparison — all codes billed, vs. state median

20 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	8	50	300	$680	$371.5K
J2777	16	30	6,660	$30	$309.4K
J2778	5	10	770	$180	$208.9K
J2403	6	10	50,400	$1	$45.5K
67028	11	70	410	$80	$44.3K
67042	12	20	20	$1,110	$26.6K
92014	18	470	170	$80	$23.9K
67036	9	10	20	$950	$23.7K
J7999	8	20	140	$40	$16.6K
99214	6,543	6,670	110	$80	$16.5K

Showing 1–10 of 20

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Health Shreveport LLC	LA	General Acute Care Hospital	$0	$98.1M
Ryan Olson	FL	Anatomic Pathology & Clinical Pathology Physician	$12.8M	$80
Charles Wykoff	TX	Ophthalmology Physician	$6.2M	$0
Matthew Benz	TX	Ophthalmology Physician	$5.7M	$0
David Brown	TX	Ophthalmology Physician	$5.7M	$0
Tien Wong	TX	Ophthalmology Physician	$4.5M	$0
Jay Wang	FL	Medical Oncology Physician	$4.5M	$0
Joseph Sedrak	TX	MOHS-Micrographic Surgery Physician	$4.4M	$0
Shanda Jackson	LA	Family Nurse Practitioner	$4M	$0
Ankoor Shah	TX	Ophthalmology Physician	$3.7M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Merakey Pennsylvania	LA	Community/Behavioral Health Agency	$0	$37.7M
Lafayette General Medical Center Inc	LA	General Acute Care Hospital	$0	$31.1M
New Day Personal Care Services	LA	In Home Supportive Care Agency	$0	$28.5M
Gulf Coast Teaching Family Services, Inc.	LA	Community/Behavioral Health Agency	$0	$13.1M
Coolidge Emergency Group LLC	LA	Emergency Medicine Physician	$0	$11.1M
Pediatrust Acadiana, LLC	LA	Medically Fragile Infants and Children Day Care	$0	$8.6M
Critical Care Newborn Services	LA	Neonatal-Perinatal Medicine Physician	$0	$7.6M
New Day Personal Care Services	LA	In Home Supportive Care Agency	$0	$6.9M
A Blessing Personal Home Care	LA	In Home Supportive Care Agency	$0	$6.4M
Priority Medical Care Inc.	LA	Home Health Agency	$0	$6.2M

Scott Gauthreaux — 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