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

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

James Miller (NPI 1710983721)

Field	Value
Entity Type	Individual
Organization	James Miller
Address	1342 Old Weisgarber Rd
City	Knoxville
State	TN
ZIP	37909
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 23, 2005

Payer Source	Total Paid
Medicare	$3.9M
Medicaid	$0

Key Findings

This provider is effectively a single‑payer Medicare practice: lifetime Medicare revenue is $3.9M and there is no Medicaid billing on file (none below). The absence of Medicaid activity indicates payer mix is overwhelmingly Medicare-driven, so analyses of utilization and revenue risk should focus on Medicare patterns rather than dual‑payer dynamics.

Revenue is highly concentrated in intravitreal drug administration: the precomputed top 3 Medicare codes account for 77.1% of this provider's total Medicare revenue, led by J2777 (43.5% of Medicare revenue, $1.7M) with J0178 (18.7%, $720.4K) and J2778 (15.0%, $577.8K) completing the top three. This concentration implies the business model is centered on high-frequency, high-revenue retinal injections rather than a broad mix of general ophthalmology services.

The provider shows exceptional national standing on several retina-focused service lines. J2777 ranks #71 of 2039 providers nationally (97th percentile; notably above typical national volume for this code) and J2778 ranks #98 of 1208 (92th percentile; typical, unremarkable volume), while 92134 (retinal imaging) is an extreme outlier at the 99th percentile (ranks #357 of 26868), indicating unusually high utilization of diagnostic retinal imaging compared with peers. These ranks suggest this clinician operates at higher than typical procedural volumes for retina diagnostics and biologic therapy.

Clinical mix emphasizes injections and imaging rather than office E/M or surgery. Office visit codes such as 92014 ($54.6K, 748 claims, 92th percentile) and 99213 ($44.2K, 691 claims, 97th percentile) together represent small shares of revenue relative to injection codes, and surgical retina codes (e.g., 67042, 67036, 67028) appear only in modest volumes and dollar totals. This pattern is consistent with a retina practice that delivers frequent intravitreal therapies and monitoring rather than predominantly surgical or general ophthalmology encounters.

There are notable per‑claim payment features to monitor: J2777 shows very large claim volume (57.9K claims at $29 avg paid/claim) producing $1.7M in revenue, while J0178 has far higher average per‑claim payment ($690 avg paid/claim, 1K claims, $720.4K) and J3490 shows a high avg payment per claim ($1761 avg paid/claim, 129 claims, $227.2K). These differences reflect a mix of low‑unit reimbursement/high frequency products and higher unit‑cost biologics that together drive total revenue.

Competitive posture is mixed by code: for some high‑revenue retinal therapeutics the provider ranks among the top national performers (e.g., J2777 at the 97th percentile), while for other biologics such as J0178 the provider’s rank is more middle‑of‑the‑pack (rank #1248 of 3204, 61th percentile; typical, unremarkable volume). This suggests market leadership in selected drug administrations and diagnostics but a more typical participation level for other commonly used agents.

Tenure supports experience in the specialty: the NPI was enumerated on 2005-06-23 (~21 years ago), indicating long-standing presence in the market which may underpin the high procedural throughput for retina injections and imaging seen in the Medicare data.

Medicare: Complete Services Breakdown

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

21 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	57,900	$30	$1.7M
J0178	Injection, aflibercept, 1 mg	1,040	$690	$720.4K
J2778	Injection, ranibizumab, 0.1 mg	3,230	$180	$577.8K
J3490	Unclassified drugs	130	$1,760	$227.2K
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.	2,180	$90	$196K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	1,190	$120	$142.2K
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.	3,110	$30	$83.9K
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…	750	$70	$54.6K
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…	690	$60	$44.2K
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…	30	$850	$26.2K

Showing 1–10 of 21

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Tennessee Distribution

James Miller — 4 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. state median

21 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	35	80	790	$680	$769.8K
J2777	2	50	15,060	$30	$592.1K
J2778	10	40	1,340	$180	$370.2K
67028	11	80	1,130	$90	$98.5K
J2781	2	20	560	$120	$82.5K
J3490	19	60	70	$400	$41.9K
67042	11	40	20	$1,020	$34.5K
67108	15	30	20	$970	$29.2K
67036	8	20	20	$940	$24.4K
92014	67	810	120	$80	$19.2K

Showing 1–10 of 21

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Devon Ghodasra	TN	Retina Specialist (Ophthalmology) Physician	$3.6M	$0
Nicholas Anderson	TN	Retina Specialist (Ophthalmology) Physician	$3M	$0
Rohan Shah	TN	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Scott Barb	TN	Ophthalmology Physician	$2.8M	$0
Robert Shuler	TN	Retina Specialist (Ophthalmology) Physician	$2.6M	$0
Tod Mcmillan	TN	Retina Specialist (Ophthalmology) Physician	$2.5M	$0
Ailee Laham	TN	Retina Specialist (Ophthalmology) Physician	$2.5M	$0
Stephen Perkins	TN	Retina Specialist (Ophthalmology) Physician	$2.3M	$0
Francis Decroos	TN	Retina Specialist (Ophthalmology) Physician	$2.3M	$0
Cristoforo Larzo	TN	Retina Specialist (Ophthalmology) Physician	$2.2M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Omni Community Health, Inc.	TN	Community/Behavioral Health Agency	$0	$77.7M
Summit Medical Group, PLLC	TN	Internal Medicine Physician	$0	$44.5M
Allergy Associates, P.A.	TN	Specialist	$0	$26.5M
Knoxville Pediatric Dentistry, PLLC	TN	General Practice Dentistry	$0	$11.2M
The Florence Crittenton Agency Inc	TN	Community/Behavioral Health Agency	$0	$10.7M
Bsp Enterprises, LLC	TN	In Home Supportive Care Agency	$0	$8M
Associated Pain Specialists, PC	TN	Pain Medicine Physician	$0	$6.8M
Jeremiah Bivins	TN	Allergy & Immunology Physician	$419.4K	$4.6M
Westbrook Medical Center, PLLC	TN	Family Medicine Physician	$0	$4M
Pcet Surgery Center LLC	TN	Ambulatory Surgical Clinic/Center	$1.7M	$60K

James Miller — 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