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NPI 1811204894 · Portland, OR · Retina Specialist (Ophthalmology) Physician
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Harpal Sandhu is a retina specialist (ophthalmology) physician provider located in Portland, Oregon. This profile covers 11 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 | Harpal Sandhu |
| Address | 5440 Sw Westgate Dr Ste 217 |
| City | Portland |
| State | OR |
| ZIP | 97221 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | September 11, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.4M |
| Medicaid | $4.5K |
This provider’s revenue is overwhelmingly Medicare-driven: total Medicare revenue is $1.4M versus total Medicaid revenue of $4.5K, indicating Medicare is the dominant payer by orders of magnitude and the practice is effectively a Medicare-centric operation. Medicaid activity is minimal in scale relative to Medicare and does not materially contribute to lifetime revenue.
Medicare revenue is highly concentrated in a small set of retina-related codes: the top 3 Medicare codes (J0178, J2777, 67028) account for 78.5% of this provider’s Medicare revenue. In particular J0178 alone represents $735.6K (53.3% of Medicare revenue), followed by J2777 at $224.5K (16.3%) and 67028 at $122.9K (8.9%), which signals a procedure- and drug-driven reimbursement mix rather than a diversified portfolio.
Clinical/service-line mix supports a procedure-oriented retina practice focused on intravitreal injections and retinal diagnostics: high-volume drug codes J0178, J2777, and J2778 together with intravitreal procedure 67028 indicate routine administration of anti-VEGF and newer biologic agents, while 92134 (1.6K claims, $49.1K) shows substantial use of retinal imaging to guide treatment. This pattern is consistent with ambulatory retina care managing wet AMD and similar conditions through repeated injections and imaging-guided follow-up.
Competitive standing across Medicare codes is mixed: J0178 ranks #1224 of 3204 (62th percentile; typical, unremarkable volume) and J2777 ranks #1202 of 2039 (41th percentile; typical, unremarkable volume), indicating modest national presence for major drug administrations. By contrast, the provider is notably above typical national volume for retinal imaging and E/M work—92134 ranks #1428 of 26868 (95th percentile; notably above typical national volume) and 99213 ranks #18144 of 457151 (96th percentile; notably above typical national volume)—suggesting strong local utilization of imaging and follow-up visits even if drug-injection volumes are middle-tier nationally.
Medicaid billing is extremely concentrated and low in absolute terms: the precomputed top-3 Medicaid codes account for 100.0% of Medicaid revenue, with 99213 comprising $3.8K (83.6%) and 92134 $756 (16.4%). Both the dollar volumes and in-state ranks show this provider is not a major Medicaid retinal provider—99213 ranks #1143 of 1591 in-state (28th percentile; typical, unremarkable volume) and 92134 ranks #37 of 41 in-state (10th percentile; typical, unremarkable volume).
Use of compounded drug billing (J7999) represents a visible ancillary revenue stream within Medicare: J7999 shows 731 claims for $52.6K (3.8% of Medicare revenue) and ranks #76 of 1333 (94th percentile; typical, unremarkable volume). While not a primary revenue driver, the above-typical rank suggests this provider uses compounded products more than many peers, which is relevant for pharmacy procurement and cost-management considerations.
Encounter-level activity indicates a clinic workflow centered on established-patient management and frequent follow-ups: 99213 has 622 Medicare claims and $41.7K (3.0% of Medicare revenue) and is notably above typical national volume (rank #18144 of 457151, 96th percentile). Paired with high imaging activity (92134), this suggests the practice operates recurring office-based care and monitoring alongside injection procedures rather than a pure surgical subspecialty model.
The provider’s NPI was enumerated on 2010-09-11 (~16 years ago), signaling an established tenure in practice. Combined with the billing mix—steady imaging and follow-up visits plus repeated intravitreal drug administrations—this tenure supports a mature, outpatient retina specialty practice with consistent Medicare engagement over many years.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
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 | 1,060 | $690 | $735.6K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 7,740 | $30 | $224.5K |
| 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. | 1,280 | $100 | $122.9K |
| J2778 | Injection, ranibizumab, 0.1 mg | 680 | $180 | $121K |
| J7999 | Compounded drug, not otherwise classified | 730 | $70 | $52.6K |
| 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. | 1,580 | $30 | $49.1K |
| 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… | 620 | $70 | $41.7K |
| 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… | 110 | $120 | $13.5K |
| 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… | 110 | $100 | $10.5K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 50 | $110 | $6K |
Showing 1–10 of 11
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
Full comparison — all codes billed, vs. state median
11 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 21 | 60 | 840 | $680 | $623.7K |
| J2777 | 25 | 30 | 10,050 | $30 | $527.6K |
| J2778 | 4 | 20 | 400 | $180 | $87.8K |
| 67028 | 14 | 70 | 580 | $90 | $72.3K |
| J7999 | 4 | 50 | 270 | $70 | $23.4K |
| 92235 | 18 | 30 | 60 | $100 | $11.1K |
| 99214 | 2,371 | 6,070 | 80 | $70 | $10.3K |
| 92134 | 22 | 390 | 80 | $30 | $8.1K |
| 99213 | 91 | 5,480 | 60 | $50 | $5.7K |
| 99204 | 164 | 2,750 | 30 | $110 | $4.4K |
Showing 1–10 of 11
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 |
|---|---|---|---|---|
| 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… | 130 | $30 | $3.8K |
| 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. | 30 | $30 | $760 |
How this provider's Medicaid billing volume and revenue compare to other Oregon providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oregon 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… | 1,143 | 1,590 | 590 | $50 | $236.5K |
| 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. | 37 | 40 | 1,240 | $20 | $82.9K |
Other providers in the same ZIP code as Harpal Sandhu, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Lifeworks Nw | OR | Mental Health Counselor | $0 | $57.6M |
| Lifeworks Northwest | OR | Addiction (Substance Use Disorder) Counselor | $0 | $14.4M |
| Janani Singaravelu | OR | Ophthalmology Physician | $35.1K | $0 |
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