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

Why is the Medicaid comparison limited to Idaho 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. Idaho (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 Earl (NPI 1720248305)

Field	Value
Entity Type	Individual
Organization	James Earl
Address	13923 W. Wainwright Dr Ste 301
City	Boise
State	ID
ZIP	83713
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 17, 2008

Payer Source	Total Paid
Medicare	$3.1M
Medicaid	$0

Key Findings

This provider is a retina-focused ophthalmology practice whose Medicare revenue is highly concentrated in intravitreal drug administration and related retinal procedures: J0178 accounts for $1.9M (60.5% of Medicare revenue), J3490 accounts for $409.5K (13.4%), and J2781 accounts for $257.4K (8.4%), with the top 3 codes together representing 82.3% of this provider's total Medicare revenue on a $3.1M Medicare footprint. The dominance of high-cost drug codes indicates the practice’s primary business line is medication-delivery for retinal disease rather than primary care E/M or nonprocedural ophthalmology services.

Operational patterns reinforce a procedure-heavy retina practice: J0178 shows 2.7K claims with a $689 avg paid/claim and ranks #248 of 3204 providers (92th percentile), and the intravitreal injection procedure 67028 shows 1.9K claims and $165.9K revenue (5.4% of Medicare revenue). These volumes and code mix (large counts for drug and injection codes) are consistent with an outpatient retina clinic performing frequent intravitreal injections and follow-up imaging-based management.

Revenue concentration around a few specialty drug codes creates payer-negotiation and supply exposure: the top 3 Medicare codes produce 82.3% of Medicare revenue, so shifts in reimbursement, utilization, or drug mix (e.g., changes between J0178, J2781, J2777) could materially move practice revenue. For payers and network analysts, this profile flags a concentrated spend relationship where formulary decisions or utilization management for specific ophthalmologic injectables will disproportionately affect payments to this provider.

The provider’s competitive standing is mixed by code: for J0178 the provider ranks #248 of 3204 nationally (92th percentile), described as notably above typical national volume, indicating a high-volume national-level presence for aflibercept administration. For pegcetacoplan J2781 the provider ranks #26 of 490 (95th percentile), placing them among the top national reporters for that drug; by contrast, J2777 (faricimab) is ranked #1501 of 2039 (26th percentile), indicating markedly lower relative activity for that agent despite 5.2K claims.

Some non-drug clinical services also show above-typical activity that supports a full-service retina practice: 92014 (established patient comprehensive exam) has 926 claims and $79.6K revenue and ranks #1950 of 35415 providers (94th percentile, notably above typical), and 92134 retinal imaging has 1.8K claims and $47.1K revenue and ranks #1213 of 26868 providers (95th percentile, notably above typical). These patterns suggest the practice maintains substantial diagnostic imaging and follow-up visit throughput, consistent with ongoing management of chronic retinal disease.

There is heterogeneity in revenue per claim across drugs that affects overall revenue composition: J0178 has a $689 avg paid/claim while J2777 has a $29 avg paid/claim (5.2K claims), and J3490 shows a $1765 avg paid/claim over 232 claims. This mix means that high claim counts do not necessarily translate into high revenue and that a small number of high–avg-paid drug administrations drive most dollars.

Payer mix is effectively single-payer Medicare: total Medicare revenue is $3.1M and there is no Medicaid billing on file, so this provider’s public-payer exposure is concentrated entirely in Medicare. Analysts should treat the provider as a Medicare-centric vendor when modeling public program spend and network impact, and note that Medicaid-based utilization patterns or state-level Medicaid rate negotiations are not applicable here.

The provider has long tenure based on the NPI enumeration date of 2008-06-17 (~18 years ago), which suggests an established referral base and operational continuity over time. Combined with the concentrated drug-revenue profile and high national ranks on key retinal therapeutics, this tenure supports the view of an established specialty practice with sustained Medicare billing patterns.

Medicare: Complete Services Breakdown

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

11 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,690	$690	$1.9M
J3490	Unclassified drugs	230	$1,770	$409.5K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	2,150	$120	$257.4K
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.	1,890	$90	$165.9K
J2777	Injection, faricimab‑svoa, 0.1 mg	5,220	$30	$151.4K
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…	930	$90	$79.6K
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.	1,810	$30	$47.1K
J7999	Compounded drug, not otherwise classified	610	$70	$43.4K
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…	340	$90	$30.6K
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…	190	$110	$20.4K

Showing 1–10 of 11

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 11 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Idaho Distribution

James Earl — 4 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. state median

11 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	1	20	670	$690	$541.7K
J2777	10	10	8,640	$30	$454.7K
J3490	5	10	230	$880	$174.8K
J2781	2	10	990	$120	$153.8K
67028	4	30	470	$90	$66.6K
J7999	2	20	200	$70	$18.9K
92014	7	230	120	$70	$15.5K
99214	305	2,690	90	$70	$10.4K
J9035	10	10	100	$50	$6.4K
92134	6	190	60	$30	$5.9K

Showing 1–10 of 11

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Alphonsus Regional Medical Center Inc	ID	Family Medicine Physician	$0	$32.6M
Saint Alphonsus Regional Medical Center Inc	ID	General Acute Care Hospital	$0	$5.1M
Saint Alphonsus Regional Medical Center Inc	ID	General Acute Care Hospital	$0	$4.2M
Saint Alphonsus Regional Medical Center Inc	ID	General Acute Care Hospital	$0	$1.9M
Denton Roberts	ID	Ophthalmology Physician	$1.6M	$0
Jasmit Minhas	WA	Internal Medicine Physician	$965.4K	$0
Daniel Gealy	TX	Ophthalmology Physician	$923.7K	$0
Retina Specialists Of Idaho Partners, PLLC	ID	Retina Specialist (Ophthalmology) Physician	$0	$363.2K
Xiuqing Ru	NE	Hematology & Oncology Physician	$275K	$0
Adam Grimaldi	ID	Clinical Cardiac Electrophysiology Physician	$247.1K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rise, Inc	ID	Voluntary or Charitable Agency	$0	$263.8M
Trivium Life Services Mountain West, LLC	ID	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$3M
Trinity Mountain Health	ID	Home Health Agency	$0	$2.2M
Boise Toothtown Dentistry For Kids PLLC	ID	Pediatric Dentistry	$0	$2.1M
Mountain View Behavioral Health, LLC	ID	Community/Behavioral Health Agency	$0	$1.7M
Edgewood Spring Creek Boise, LLC	ID	Assisted Living Facility	$0	$1.6M
Edgewood Spring Creek Eagle Island LLC	ID	Assisted Living Facility	$0	$1.3M
Zrj Inc	ID	Physical Therapist	$0	$1.2M
Community Partnerships Of Idaho, Inc.	ID	Community/Behavioral Health Agency	$0	$1.2M
Blair Pediatric Dentistry PC	ID	Pediatric Dentistry	$0	$669.4K

James Earl — Billing Profile & Reimbursement Data

Sign up for James Earl — Billing Profile & Reimbursement Data policy alerts

James Earl — Billing Profile & Reimbursement Data

Sign up for James Earl — 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