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

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

Mathew Sapp (NPI 1720023153)

Field	Value
Entity Type	Individual
Organization	Mathew Sapp
Address	2208 University Blvd Ste 101
City	Birmingham
State	AL
ZIP	35233
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 19, 2006

Payer Source	Total Paid
Medicare	$1.6M
Medicaid	$0

Key Findings

This provider is operating squarely in medical retina: intravitreal drug administration and retinal imaging dominate the Medicare book of business. J0178 (Injection, aflibercept) alone accounts for $1.1M in revenue (69.2% of Medicare revenue) and two other retina-focused codes (67028 and 92134) are among the top three, with all three codes together accounting for 82.8% of the provider's Medicare revenue, indicating a procedure-heavy, treatment-focused retina practice.

Revenue concentration is high: the precomputed top-three share (82.8%) shows the practice depends heavily on a very small set of drug and retina-imaging codes for the bulk of its Medicare receipts. That level of concentration suggests the provider’s financial performance is closely tied to injection volume and associated diagnostic imaging rather than broad outpatient or surgical case mix.

The payer mix is effectively single-payer Medicare: Total Medicare revenue: $1.6M while Total Medicaid revenue: none (no Medicaid billing on file). There is no Medicaid activity reported, so analyses of state Medicaid competitiveness or Medicaid-managed-care exposure are not applicable for this NPI.

Competitive standing by code is mixed: although J0178 ($1.1M, 69.2%) is the dominant revenue driver, the provider’s J0178 volume ranks #722 of 3204 nationally (77th percentile) and is characterized as typical/unremarkable volume for that code. In contrast, the provider shows unusually high national standing on retinal imaging and some E&M codes—suggesting pockets of above-average intensity despite J0178 being typical versus peers.

Several individual codes are statistical outliers versus national peers and indicate service-line strengths. 92134 (retinal imaging) is an extreme outlier, far above typical national volume (2.8K claims, $74.5K revenue), and 99213 (office E&M) ranks in the 98th percentile and is described as notably above typical national volume (815 claims, $48.9K). J9035 (bevacizumab) also ranks highly at the 97th percentile (1.2K claims, $66.6K revenue, notably above typical national volume).

Operative retina/surgical procedures are present but account for a small share of revenue, consistent with a primarily medical-retina practice rather than a surgical-retina focus. For example, 67042 has 21 claims and $17.3K revenue, 67036 has 26 claims and $14.6K revenue, and 67108 has 15 claims and $12.4K revenue—each is listed as typical or unremarkable volume for those surgical codes.

The mix of ophthalmology-specific visits and general E&M shows the provider maintains both procedure-driven and clinic visit activity. 92014 (established comprehensive ophthalmological exam) appears with 728 claims and $59.7K revenue (3.6%) and ranks in the 91st percentile (typical), while 99213 and 99214 together also contribute meaningful Medicare revenue ($48.9K and $37.6K respectively), reflecting routine follow-up and management visits tied to ongoing injection therapy.

This NPI has long tenure in Medicare billing, which supports stability in observed patterns: NPI enumerated (registered) 2006-06-19 (~20 years ago). The sustained presence alongside concentrated injection/imaging revenue indicates an established retina practice with consistent service lines over time rather than a newly emergent billing profile.

Medicare: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,650	$690	$1.1M
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.	1,720	$90	$149.3K
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.	2,760	$30	$74.5K
J9035	Injection, bevacizumab, 10 mg	1,210	$60	$66.5K
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…	730	$80	$59.7K
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…	820	$60	$48.9K
99214	The provider sees an established 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…	440	$90	$37.6K
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…	20	$830	$17.3K
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…	130	$110	$14.7K
67036	The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana.	30	$560	$14.6K

Showing 1–10 of 16

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Alabama Distribution

Mathew Sapp — 5 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. state median

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	8	40	920	$690	$706.2K
67028	5	40	990	$90	$82.5K
67042	10	20	20	$940	$24.6K
J9035	2	40	410	$50	$24.5K
99214	1,004	7,330	120	$80	$16.8K
67108	4	10	20	$970	$15.5K
92014	21	430	100	$80	$13.3K
67036	3	20	20	$690	$12.4K
92235	10	10	50	$90	$10.7K
99213	105	6,470	80	$50	$7.9K

Showing 1–10 of 16

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Uahsf Neonatology	AL	Neonatal-Perinatal Medicine Physician	$0	$94M
University Of Alabama Health Services Foundation, PC	AL	Pediatrics Physician	$0	$79.6M
University Of Alabama Health Services Foundation, PC.	AL	Multi-Specialty Clinic/Center	$0	$77.1M
University Of Alabama Health Services Foundation PC	AL	Clinic/Center	$0	$18.6M
University Of Alabama Ophthalmology Services Foundation	AL	Ophthalmology Physician	$0	$6.9M
University Of Alabama At Birmingham	AL	Clinical Medical Laboratory	$2.9K	$3.2M
Vikram Saini	AL	Retina Specialist (Ophthalmology) Physician	$3.1M	$0
Andrew Mcfarland	VA	Retina Specialist (Ophthalmology) Physician	$3.1M	$0
Daniel Bennett	NC	Retina Specialist (Ophthalmology) Physician	$3M	$0
Chelsea Cockrell	MS	Family Nurse Practitioner	$3M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratory Corporation Of America Holdings	AL	Clinical Medical Laboratory	$60.5M	$289.1M
The Children's Hospital Of Alabama	AL	Children's Hospital	$0	$59M
M&o Enterprises LLC	AL	Home Infusion Therapy Pharmacy	$0	$31.2M
Medical Resources, Inc	AL	Oxygen Equipment & Supplies (DME)	$0	$23.6M
Southern Lab Partners, LLC	AL	Clinical Medical Laboratory	$5.4M	$14.4M
Jefferson County Board Of Health	AL	Public Health or Welfare Agency	$0	$12.2M
The Children's Hospital Of Alabama	AL	Psychologist	$0	$12M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$7.5M
Pediatric Anesthesia Associates PC	AL	Anesthesiology Physician	$0	$7.2M
Pediatric Radiology Associates PC	AL	Pediatric Radiology Physician	$0	$6.8M

Mathew Sapp — 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