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NPI 1811346414 · Springfield, MA · Retina Specialist (Ophthalmology) Physician
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Rebecca Soares is a retina specialist (ophthalmology) physician provider located in Springfield, Massachusetts. This profile covers 18 Medicare and 3 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 | Rebecca Soares |
| Address | 3640 Main St Ste 201 |
| City | Springfield |
| State | MA |
| ZIP | 01107 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | June 6, 2016 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3M |
| Medicaid | $9.1K |
This provider is effectively Medicare‑driven: lifetime Medicare revenue is $3M versus Medicaid revenue of $9.1K, indicating a negligible Medicaid footprint compared with Medicare and an operational focus on fee‑for‑service Medicare patients. The scale gap suggests payer mix risk concentrated in Medicare reimbursement trends and clinical demand from an older population.
Medicare revenue is highly concentrated in a small set of drugs/procedures: the precomputed top three Medicare codes account for 78.0% of Medicare revenue, led by J0178 at $1.7M (57.9%), followed by J2777 at $415.9K (13.9%) and 67028 at $187.4K (6.3%). This concentration shows the practice’s financial sensitivity to intravitreal drug usage and related injection services.
The code mix is consistent with a retina specialist running an injection‑centric ambulatory practice: high Medicare revenue from J0178 (aflibercept) and J2777 (faricimab) alongside significant volume of retinal imaging 92134 and comprehensive established exams 92014 points to an integrated imaging‑to‑injection workflow where diagnostic OCT and comprehensive visits support frequent intravitreal therapy.
Competitive standing is mixed across services: J0178 generates the majority of Medicare revenue but ranks #312 of 3204 nationally (90th percentile; typical, unremarkable volume for this code), meaning the provider’s market position for aflibercept use is not an outlier despite its revenue importance. In contrast, 92014 (rank #696 of 35415, 98th percentile; extreme outlier) and 92134 (rank #137 of 26868, 99th percentile; extreme outlier) are both labeled as extreme outliers, indicating substantially higher than typical national volumes for comprehensive established exams and retinal imaging.
Medicaid billing is fully concentrated in three codes (precomputed top‑3 = 100.0% of Medicaid revenue) with a modest in‑state presence: 67028 accounts for $4.2K (46.0%), 92134 for $2.9K (31.4%), and 99214 for $2.1K (22.6%). All three Medicaid ranks sit in lower/mid state percentiles (67028 #55/59, 7th percentile; 92134 #87/132, 34th; 99214 #3803/5039, 24th) which signals the provider is a modest Medicaid participant compared with Massachusetts peers.
Operational detail supports an imaging‑heavy clinic: 92134 appears with 4K Medicare claims and also 111 Medicaid claims, showing robust retinal imaging throughput that likely feeds treatment decisions for intravitreal injections. The coexistence of high 92134 volume with high injectable drug revenue (J0178, J2777) suggests same‑day or closely coordinated diagnostic and therapeutic services.
Surgical and higher‑acuity procedures are present but limited: 67042 (vitrectomy with internal limiting membrane work) appears with 21 Medicare claims generating $19.8K, ranking #506 of 1087 (51st percentile; typical, unremarkable volume for this code). This pattern indicates the provider performs occasional surgical interventions but that surgery is not a primary revenue driver compared with injections and imaging.
Provider tenure is established: NPI enumerated 2016‑06‑06 (~10 years ago), which, combined with concentrated Medicare revenue and outlier volumes for 92014 and 92134, suggests a matured referral base and stabilized ambulatory retina practice focused on diagnostic imaging and repeat intravitreal therapy delivery.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
18 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,530 | $690 | $1.7M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 14,340 | $30 | $415.9K |
| 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. | 1,800 | $100 | $187.4K |
| 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… | 1,430 | $100 | $144.6K |
| 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. | 3,950 | $30 | $130.4K |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 770 | $160 | $119.3K |
| J2778 | Injection, ranibizumab, 0.1 mg | 480 | $180 | $83.6K |
| 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… | 490 | $70 | $34.4K |
| 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… | 440 | $70 | $31.6K |
| J9035 | Injection, bevacizumab, 10 mg | 520 | $60 | $28.5K |
Showing 1–10 of 18
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
18 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 9 | 90 | 790 | $690 | $826.5K |
| J2777 | 18 | 50 | 7,080 | $30 | $343.1K |
| J2778 | 20 | 30 | 560 | $180 | $200.7K |
| Q5124 | 6 | 10 | 800 | $160 | $186K |
| 67028 | 14 | 120 | 570 | $100 | $80.7K |
| 92014 | 37 | 1,070 | 160 | $90 | $30.1K |
| 67042 | 10 | 30 | 20 | $1,170 | $25.7K |
| J9035 | 14 | 80 | 250 | $50 | $19.7K |
| 99214 | 8,543 | 15,410 | 110 | $80 | $15.6K |
| 92012 | 62 | 560 | 90 | $70 | $12.4K |
Showing 1–10 of 18
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 20 | $260 | $4.2K |
| 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. | 110 | $30 | $2.9K |
| 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… | 40 | $50 | $2.1K |
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 3,803 | 5,040 | 200 | $70 | $209.5K |
| 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. | 55 | 60 | 780 | $80 | $178.3K |
| 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. | 87 | 130 | 430 | $10 | $39.3K |
Other providers in the same ZIP code as Rebecca Soares, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Center For Human Development, Inc. | MA | Community/Behavioral Health Agency | $0 | $97.1M |
| Viecare Corp | MA | Foster Care Agency | $0 | $35.5M |
| Andventure, LLC | MA | Home Health Agency | $0 | $14.6M |
| Baystate Mri & Imaging Center, LLC | MA | Magnetic Resonance Imaging (MRI) Clinic/Center | $2.6M | $6.7M |
| Radiology & Imaging, Inc. | MA | Diagnostic Radiology Physician | $0 | $5.8M |
| David Lally | MA | Ophthalmology Physician | $3.2M | $670 |
| Shilpa Gulati | MA | Ophthalmology Physician | $2.4M | $0 |
| Andrew Lam | MA | Ophthalmology Physician | $1.4M | $0 |
| Hari Mylvaganam | MA | Ophthalmology Physician | $1.3M | $5.1K |
| Pioneer Valley Surgicenter LLC | MA | Ambulatory Surgical Clinic/Center | $429.2K | $614.8K |
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