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

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

Shil Patel (NPI 1750541553)

Field	Value
Entity Type	Individual
Organization	Shil Patel
Address	17 N Medical Park Dr
City	Fishersville
State	VA
ZIP	22939
Taxonomy	Ophthalmology Physician
NPI Enumerated	June 15, 2008

Payer Source	Total Paid
Medicare	$6.1M
Medicaid	$0

Key Findings

This provider’s billing is effectively single‑payer: total Medicare revenue is $6.1M and there is no Medicaid billing on file, so Medicare dominates the practice’s public‑payer volume and financial footprint. Analysts should treat Medicare policy and reimbursement as the primary external risk to this entity’s revenue stream.

Revenue is highly concentrated in a very small set of infusion and procedure codes: the top 3 Medicare codes by revenue account for 87.8% of the provider’s Medicare revenue, driven by J0178 ($4.3M, 70.5%), J2777 ($715.1K, 11.8%), and 67028 ($330.3K, 5.4%). This concentration means most Medicare dollars flow through intravitreal drug administration and isolated intravitreal injection procedures.

The code mix and volumes point to a retina‑focused, injection‑centric ophthalmology operation: J0178 (aflibercept), J2777 (faricimab), J2778 (ranibizumab), J9035 (bevacizumab), and J7312 (dexamethasone implant) comprise the bulk of therapeutic activity, while high volumes of 92134 indicate frequent retinal imaging supporting those treatment decisions. Together these codes are consistent with an ambulatory retina practice that emphasizes repeated intravitreal therapies and associated diagnostic imaging.

This provider is a national high‑volume outlier on several injection and imaging codes. J0178 ranks #11 of 3204 providers nationally (100th percentile; extreme outlier), and 67028 ranks #51 of 4255 (99th percentile; extreme outlier), indicating unusually large national volumes for intravitreal drug use and isolated intravitreal injections. Those ranks position the provider as a dominant, high‑throughput performer for specific retina services compared with most peers.

Several supporting codes also show above‑typical activity: 92134 ranks #121 of 26868 providers nationally (100th percentile; extreme outlier), and J7312 ranks #10 of 492 providers nationally (98th percentile; notably above typical national volume). At the same time, many E/M codes and some surgical codes (for example 99204 ranks #2264 of 227068 providers nationally, 99th percentile; extreme outlier) indicate the practice sees new and established patients but that these visits are a much smaller share of revenue versus drug administration.

The practice performs some higher‑acuity surgical retina work but at a modest scale relative to injections: 67042 (vitrectomy with internal limiting membrane removal) appears with 36 claims and $30.3K revenue and ranks #195 of 1087 providers nationally (81th percentile; typical, unremarkable volume). These surgical codes demonstrate procedural breadth beyond injections but do not drive the revenue profile.

From a business risk and strategy perspective, reliance on high‑cost, frequently administered biologic drugs (notably J0178 at $4.3M) concentrates exposure to Medicare reimbursement changes, drug pricing shifts, and utilization edits focused on intravitreal therapies. Because Medicaid billing is absent, any changes in Medicare policy or reimbursement for these specific HCPCS codes would disproportionately affect the provider’s topline.

The provider has an established billing history (NPI enumerated 2008-06-15, ~18 years ago), and the combination of longevity with extreme national ranks for key injection and imaging codes suggests a sustained, high‑volume referral and treatment program for retinal disease rather than a low‑volume general ophthalmology practice. This tenure plus concentration in retina services is important context for competitive analyses and contracting discussions.

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	6,230	$690	$4.3M
J2777	Injection, faricimab‑svoa, 0.1 mg	24,660	$30	$715.1K
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.	3,480	$100	$330.3K
J2778	Injection, ranibizumab, 0.1 mg	1,390	$180	$254.6K
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.	4,080	$30	$118.3K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	730	$160	$114.3K
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…	880	$90	$80.4K
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…	730	$60	$46.1K
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…	260	$120	$30.6K
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…	40	$840	$30.3K

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. Virginia Distribution

Shil Patel — 7 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. state median

20 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	1	80	1,400	$690	$1.1M
J2777	18	60	13,200	$30	$517.1K
J2778	11	40	560	$180	$171.5K
67028	1	90	1,000	$90	$107.1K
J7312	1	20	240	$160	$42.5K
67042	8	20	20	$1,130	$33.8K
92014	40	870	170	$80	$32.8K
99214	14,014	12,890	140	$80	$21K
J9035	11	60	170	$50	$19.9K
92012	7	430	80	$60	$11.9K

Showing 1–10 of 20

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
James Pate	NC	Ophthalmology Physician	$5.2M	$0
Homayoun Tabandeh	CA	Ophthalmology Physician	$5.1M	$6.8K
Nitin Gupta	NC	Ophthalmology Physician	$4.7M	$0
John Thordsen	NC	Retina Specialist (Ophthalmology) Physician	$3.5M	$0
Rebecca Manning	NC	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
Matthew Cole	TN	Ophthalmology Physician	$3.3M	$0
William Clark	SC	Ophthalmology Physician	$3.3M	$0
Sachin Mudvari	NC	Retina Specialist (Ophthalmology) Physician	$3.2M	$0
Daniel Bennett	NC	Retina Specialist (Ophthalmology) Physician	$3M	$0
Brian Lehpamer	NC	Retina Specialist (Ophthalmology) Physician	$2.9M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Augusta Health Care, Inc	VA	General Acute Care Hospital	$0	$63.6M
Augusta Medical Group	VA	General Practice Physician	$0	$12.6M
Shenandoah Emergency Medicine Specialists LLC	VA	Emergency Medicine Physician	$0	$7.5M
Ashley Blurton	VA	Nuclear Medicine Physician	$2.9M	$0
Yevgeniy Shildkrot	VA	Ophthalmology Physician	$1.5M	$0
Blue Ridge Pathologists PC	VA	Anatomic Pathology Physician	$224.6K	$1.2M
James Tiedeman	VA	Ophthalmology Physician	$782.7K	$0
William Jones	VA	Urology Physician	$468.4K	$0
David Barnes	VA	Specialist	$405.8K	$150
Rachna Patel	VA	Specialist	$377K	$0

Shil Patel — 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