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NPI 1720009525 · Hicksville, NY · Ophthalmology Physician
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James Maisel is a ophthalmology physician provider located in Hicksville, New York. This profile covers 24 Medicare and 3 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | James Maisel |
| Address | 400 So Oyster Bay Rd |
| City | Hicksville |
| State | NY |
| ZIP | 11801 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | July 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.4M |
| Medicaid | $8.9K |
This provider is an ophthalmology physician in Hicksville, NY with a long Medicare enrollment: NPI enumerated 2006-07-21 (about 20 years ago), indicating longstanding participation in Medicare and an established practice history. The tenure supports interpretation of stable procedural volumes rather than a new entrant effect.
Medicare revenue dominates this profile: total Medicare revenue is $4.4M versus total Medicaid revenue of $8.9K, so the provider operates effectively as a Medicare-focused practice with minimal Medicaid activity. Any analysis or contracting should treat this entity as essentially single-payer driven by Medicare.
Revenue concentration on Medicare is heavy and driven by a few drug-injection codes: the precomputed top 3 Medicare codes by revenue account for 74.9% of total Medicare revenue, showing material dependence on a small set of high-revenue services. The largest single Medicare revenue contributor is J2777 (faricimab) with $1.9M (43.1% of Medicare revenue), followed by J0178 (aflibercept) at $911.9K (20.5%) and J3490 (unclassified drugs) at $500.5K (11.3%).
Service-line implication: the code mix is dominated by intravitreal injections and retina-focused diagnostics (J2777, J0178, 67028, 92134), indicating a retina/interventional ophthalmology practice that delivers high-volume anti-VEGF and novel biologic therapies plus associated imaging and diagnostic testing. High volumes for injection codes paired with extensive imaging codes suggest a workflow centered on medically managed retinal disease (e.g., AMD, diabetic retinal disease).
Competitive standing on key Medicare codes is strong in several areas: J2777 ranks #60 of 2039 providers nationally (97th percentile) and 92012 ranks #32 of 17177 providers nationally (100th percentile), both described as notably or extremely above typical national volume, indicating this provider is a major national participant for faricimab administration and very high-volume for intermediate established-patient ophthalmic visits. Other Medicare services such as 92134 and 92083 are also extreme outliers (98th–100th percentiles), underscoring a concentrated high-volume practice in retinal imaging and visual field testing.
Some Medicare codes show typical or unremarkable volumes despite high revenue contribution: J0178 (aflibercept) is at the 69th percentile and J3490 is at the 92th percentile, described as typical or unremarkable for national volume even though they are among the top revenue contributors; this suggests the practice achieves high Medicare revenue partly through high utilization of a few very high-cost medicines rather than uniformly dominating across all retinal drug codes.
Medicaid activity is minimal and concentrated: total Medicaid revenue is $8.9K with the top 3 Medicaid codes accounting for 100.0% of Medicaid revenue. The Medicaid billing is mainly for retina imaging and established-patient visits (92134 $3.7K, 92012 $2.8K) and injections (67028 $2.4K), but ranks for these codes are middling to low in-state (42nd, 30th, and 11th percentiles respectively), indicating the provider is not a significant Medicaid player in New York.
Diagnostic and testing volumes are a distinguishing feature: several imaging and testing codes (92134, 92012, 92083, 92235, 92273) are at or near extreme percentiles nationally for Medicare, indicating high throughput of retinal imaging, visual field testing, and angiographic studies. This pattern aligns with a high-turnover, device- and procedure-heavy retina practice that pairs frequent diagnostics with drug administration.
Payer and operational implications for payers: given the very large Medicare base ($4.4M) concentrated in high-cost injectable drug codes (top 3 Medicare codes = 74.9% of Medicare revenue) and very low Medicaid exposure, payer strategy should focus on Medicare utilization management, drug reimbursement arrangements, and provider-level benchmarking against national high-volume retina practices rather than Medicaid network adequacy or volume controls.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
24 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 66,060 | $30 | $1.9M |
| J0178 | Injection, aflibercept, 1 mg | 1,310 | $690 | $911.9K |
| J3490 | Unclassified drugs | 290 | $1,740 | $500.5K |
| 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. | 2,210 | $110 | $236.9K |
| 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… | 2,660 | $80 | $204.8K |
| J2778 | Injection, ranibizumab, 0.1 mg | 810 | $180 | $145.4K |
| 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. | 2,980 | $30 | $98.5K |
| 92242 | The provider injects two different special dyes into one or both eyes that cause the blood vessels to stand out in photographic images timed so that multiple frames are taken in rapid succession. He… | 350 | $240 | $84.2K |
| 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… | 490 | $130 | $61.4K |
| 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… | 1,040 | $50 | $55.1K |
Showing 1–10 of 24
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 24 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
24 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 63 | 230 | 560 | $690 | $693K |
| J2777 | 3 | 120 | 7,740 | $30 | $364.9K |
| J2778 | 22 | 70 | 510 | $180 | $131.6K |
| J3590 | 14 | 20 | 30 | $1,430 | $72.7K |
| 67028 | 10 | 300 | 400 | $100 | $65.9K |
| J3490 | 8 | 120 | 60 | $470 | $50.8K |
| J7312 | 11 | 20 | 270 | $160 | $48K |
| 92242 | 2 | 20 | 110 | $240 | $33K |
| 92014 | 572 | 2,220 | 160 | $100 | $29.3K |
| 92273 | 4 | 80 | 80 | $110 | $17.7K |
Showing 1–10 of 24
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 250 | $20 | $3.7K |
| 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… | 90 | $30 | $2.8K |
| 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. | 30 | $80 | $2.4K |
How this provider's Medicaid billing volume and revenue compare to other New York providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New York median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 1,018 | 1,460 | 310 | $60 | $88.1K |
| 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. | 232 | 260 | 420 | $70 | $65.6K |
| 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. | 426 | 730 | 370 | $20 | $30K |
Other providers in the same ZIP code as James Maisel, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Sunrise Medical Laboratories, Inc. | NY | Clinical Medical Laboratory | $30.3M | $101.5M |
| Cottage Homecare, Services, Inc | NY | Home Health Agency | $0 | $121.8M |
| Acutis Diagnostics Inc | NY | Clinical Medical Laboratory | $5.2M | $60.6M |
| Aides At Home Inc | NY | Home Health Agency | $0 | $56.4M |
| Central Nassau Guidance & Counseling Services, Inc. | NY | Community/Behavioral Health Agency | $0 | $46M |
| Leena Doshi | NY | Diagnostic Radiology Physician | $914.5K | $500 |
| Stephanie Becker | NY | Ophthalmology Physician | $757.2K | $41.4K |
| Michael Sable | NY | Ophthalmology Physician | $671K | $470 |
| Florante Melchor | NY | Internal Medicine Physician | $211.5K | $102.2K |
| Richard Obedian | NY | Orthopaedic Surgery Physician | $268.3K | $0 |
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