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NPI 1760441828 · Great Falls, MT · Optometrist
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Fred Abraham is a optometrist provider located in Great Falls, Montana. This profile covers 13 Medicare and 2 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 | Fred Abraham |
| Address | 2800 11th Ave S Ste 14 |
| City | Great Falls |
| State | MT |
| ZIP | 59405 |
| Taxonomy | Optometrist |
| NPI Enumerated | March 18, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $295K |
| Medicaid | $950 |
This provider’s billing is overwhelmingly Medicare-driven: Total Medicare revenue is $295K compared with Total Medicaid revenue of $950, so Medicaid is effectively a negligible payer for this NPI. The small Medicaid footprint means business and revenue risk is concentrated in the Medicare channel rather than spread across payers.
Medicare revenue is highly concentrated in a very small set of services: the precomputed top 3 Medicare codes account for 81.7% of this provider’s total Medicare revenue. Those top codes are 92014 (39.6%), 99213 (33.3%), and 92083 (8.9%), indicating that comprehensive eye exams and routine evaluation-and-management visits plus visual field testing drive the bulk of Medicare receipts.
The provider’s code-level activity shows a high-volume optometry practice focused on comprehensive exams and follow-up E/M work: 92014 appears with 1.5K claims, $79 avg paid/claim, $116.8K revenue (39.6% of Medicare revenue), and 99213 has 1.6K claims, $63 avg paid/claim, $98.3K revenue (33.3%). The presence of 92083 (596 claims, $44 avg paid/claim, $26.2K revenue) underscores routine use of visual field testing as part of clinical management.
National competitive standing on the Medicare side is exceptional for the top revenue drivers: 92014 ranks #642 of 35415 providers nationally (98th percentile; extreme outlier), 99213 ranks #1903 of 457151 providers nationally (100th percentile; extreme outlier), and 92083 ranks #419 of 25484 providers nationally (98th percentile; extreme outlier). These rank/percentile placements identify the provider as a high-volume outlier nationally on the core exam and E/M codes.
In contrast, the provider’s Medicaid presence is modest to minimal within-state: Medicaid billing is $950 total and 92014 (55 claims, $13 avg paid/claim, $715 revenue) ranks #113 of 133 providers in-state (14th percentile), while 99213 (43 claims, $5 avg paid/claim, $215 revenue) ranks #445 of 523 providers in-state (15th percentile). Those ranks indicate the provider is not a leading Medicaid participant in Montana for its main codes.
Diagnostic imaging and ancillary testing contribute meaningful but secondary Medicare revenue and support chronic disease management: 92134 ($17K, 5.7% of Medicare revenue), 92133 ($15K, 5.1%), and 92250 ($8.4K, 2.8%) are present in the top codes list. The mix of OCT/retinal imaging and fundus photography suggests ongoing monitoring of retinal and optic nerve pathology in addition to routine exams.
Tenure and continuity are notable: the NPI was enumerated on 2006-03-18 (~20 years ago), indicating a long-established billing presence. Combined with the concentrated Medicare volume and high national ranks for core codes, this suggests a sustained, Medicare-centered clinical practice over many years.
The concentration of Medicare revenue in a few high-volume codes (top 3 = 81.7%) creates operational sensitivity to reimbursement or policy shifts affecting comprehensive eye exams and low-level E/M visits. Given Medicaid accounts for only $950, any material change in Medicare reimbursement or utilization patterns for 92014 and 99213 would likely have outsized impact on the provider’s overall revenue stream.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 1,480 | $80 | $116.8K |
| 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… | 1,560 | $60 | $98.3K |
| 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… | 600 | $40 | $26.2K |
| 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. | 610 | $30 | $17K |
| 92133 | The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both… | 630 | $20 | $15K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 340 | $30 | $8.4K |
| 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… | 80 | $110 | $8.3K |
| 92020 | The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and… | 90 | $20 | $1.7K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 10 | $100 | $1.1K |
| 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… | 10 | $90 | $1K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 60 | $10 | $720 |
| 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… | 40 | $10 | $220 |
How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Montana median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 445 | 520 | 730 | $40 | $196.4K |
| 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… | 113 | 130 | 600 | $90 | $120.9K |
Other providers in the same ZIP code as Fred Abraham, ranked by combined Medicare and Medicaid revenue.
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