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

Why is the Medicaid comparison limited to Pennsylvania 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. Pennsylvania (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 Vander (NPI 1780632570)

Field	Value
Entity Type	Individual
Organization	James Vander
Address	4060 Butler Pike
City	Plymouth Meeting
State	PA
ZIP	19462
Taxonomy	Ophthalmology Physician
NPI Enumerated	May 4, 2006

Payer Source	Total Paid
Medicare	$6.3M
Medicaid	$0

Key Findings

This provider is effectively single‑payer: reported Medicare revenue totals $6.3M while there is no Medicaid billing on file, and the NPI was enumerated 2006-05-04 (~20 years ago), indicating long tenure. The combination of a long enrollment history and a sole Medicare revenue stream suggests a mature, Medicare‑focused ophthalmology practice rather than a mixed Medicaid/Medicare population model.

Revenue is highly concentrated in intravitreal pharmacotherapy: the top 3 Medicare codes account for 78.6% of this provider's total Medicare revenue, led by J0178 ($2.4M, 37.5%), Q5128 ($1.3M, 20.6%), and J2778 ($1.3M, 20.4%). This concentration means most Medicare dollars come from a small set of high‑impact drug codes rather than distributed office or surgical procedures.

The provider’s operational profile is retina‑focused with very high volumes of injections and related procedures: J0178 shows 3.5K claims, Q5128 6K claims, J2778 6.8K claims, and 67028 has 3.8K claims. Combined with substantial diagnostic imaging (92134 with 5.5K claims), the code mix indicates a workflow centered on frequent follow‑up visits, intravitreal injections, and retina imaging rather than primary care ophthalmology or broad general ophthalmic services.

Competitive standing for the top agents is notably elevated at the national level: Q5128 ranks #10 of 373 providers nationally (98th percentile; extreme outlier), J2778 ranks #20 of 1208 providers (98th percentile; notably above typical national volume), and J0178 ranks #114 of 3204 providers (96th percentile; notably above typical national volume). These ranks mark the provider as a high‑volume national outlier for multiple anti‑VEGF agents and a major participant in Medicare billing for these drugs.

High ancillary and diagnostic throughput supports the injection volume: 92012 has 2.6K claims and $182.8K revenue (2.9% of total Medicare revenue) and 92134 has $169.3K revenue (2.7% of total Medicare revenue) with ranks in the 100th percentile and described as extreme outliers. This pattern—large counts of intermediate/comprehensive exams and retinal imaging—aligns with a practice model that manages chronic retinal disease requiring recurrent visits and monitoring.

Payer revenue composition and per‑claim economics show drug dollars dominate: average paid/claim for J0178 is $685, for Q5128 is $217, and for J2778 is $189, so high per‑claim payments for certain agents drive a disproportionate share of overall Medicare revenue. The combination of high per‑claim payment for some drugs and very large claim counts for others indicates revenue is driven by both price and volume across different agents.

The practice demonstrates adoption of a range of intravitreal agents, including biosimilars and newer therapies: besides the top three agents, J2777 (faricimab) appears with 10.6K claims and $308K revenue (4.9%) but is characterized as typical/unremarkable volume, while J2781 (pegcetacoplan) has 585 claims and $70.2K revenue (1.1%) and is typical as well. This mix suggests clinical use of multiple therapeutic classes and some uptake of newer compounds, with variability in how much each contributes to revenue.

Because the top three codes produce 78.6% of Medicare revenue, the provider’s revenue profile is highly sensitive to utilization and reimbursement shifts for those specific intravitreal drugs. Any changes in coverage, pricing, or care patterns for J0178, Q5128, or J2778 would disproportionately affect the provider’s Medicare revenue given the current concentration.

Medicare: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	3,470	$690	$2.4M
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	6,010	$220	$1.3M
J2778	Injection, ranibizumab, 0.1 mg	6,830	$190	$1.3M
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.	3,820	$100	$385.4K
J2777	Injection, faricimab‑svoa, 0.1 mg	10,620	$30	$308K
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…	2,610	$70	$182.8K
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.	5,460	$30	$169.3K
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…	1,000	$90	$90.9K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	590	$120	$70.2K
J3490	Unclassified drugs	40	$1,770	$63.6K

Showing 1–10 of 19

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Pennsylvania Distribution

James Vander — 5 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. state median

19 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	11	140	830	$690	$865.1K
Q5128	6	20	3,830	$220	$838.7K
J2778	6	70	1,030	$190	$417.1K
J2777	40	100	7,950	$30	$360.2K
J2781	12	20	690	$120	$109.1K
67028	5	180	600	$90	$87.5K
J7999	34	110	100	$120	$33.3K
67042	17	50	20	$1,100	$31.9K
J3490	82	110	60	$70	$27.9K
92014	66	1,570	130	$80	$21K

Showing 1–10 of 19

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Nemours Foundation	DE	Multi-Specialty Clinic/Center	$0	$172M
The Nemours Foundation	FL	Children's Hospital	$0	$104.9M
The Nemours Foundation	DE	Children's Hospital	$0	$104M
The Nemours Foundation	FL	Multi-Specialty Clinic/Center	$0	$46.2M
Nemours Children's Health, Downtown Orlando, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$44.4M
Nemours Children's Health, Jacksonville, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$23.6M
Sedigheh Ebadi	FL	Pediatrics Physician	$0	$10.1M
Children's Health Alliance, LLC	FL	Pediatrics Physician	$0	$9.6M
Alok Bansal	CA	Ophthalmology Physician	$3M	$4.7M
David Reed	MA	Retina Specialist (Ophthalmology) Physician	$7.7M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gemma Services	PA	Psychiatric Residential Treatment Facility	$0	$23.8M
Access Services Inc	PA	Community/Behavioral Health Agency	$0	$8.3M
Omesh Gupta	PA	Ophthalmology Physician	$7.1M	$80
Mitchell Fineman	PA	Ophthalmology Physician	$7M	$0
Michael Klufas	PA	Ophthalmology Physician	$7M	$0
Richard Kaiser	PA	Ophthalmology Physician	$6.6M	$0
Allen Chiang	PA	Ophthalmology Physician	$6.6M	$0
Carl Regillo	PA	Ophthalmology Physician	$6.5M	$0
Allen Ho	PA	Ophthalmology Physician	$6.4M	$0
Yoshihiro Yonekawa	PA	Ophthalmology Physician	$6.4M	$0

James Vander — Billing Profile & Reimbursement Data

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

James Vander — Billing Profile & Reimbursement Data

Sign up for James Vander — 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