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

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

John Davies (NPI 1811904212)

Field	Value
Entity Type	Individual
Organization	John Davies
Address	3601 W 76th St Ste 325
City	Edina
State	MN
ZIP	55435
Taxonomy	Ophthalmology Physician
NPI Enumerated	August 1, 2006

Payer Source	Total Paid
Medicare	$3.9M
Medicaid	$0

Key Findings

The provider’s CPT/HCPCS mix is strongly weighted toward intravitreal drug therapy and retinal diagnostic imaging, consistent with a retina-focused ophthalmology practice. High-revenue J-codes (J0178, J2777, Q5128) plus procedure codes such as 67028 and imaging code 92134 indicate routine in-office injections and frequent posterior-segment imaging rather than a general ophthalmology panel of minor procedures and refractions.

Revenue is highly concentrated in a small number of drug administrations: the precomputed top 3 Medicare codes account for 79.1% of this provider's total Medicare revenue. Those top codes are J0178 ($1.8M, 45.5%), J2777 ($880.4K, 22.5%), and Q5128 ($431.8K, 11.0%), so most Medicare dollars flow from a tight set of anti-VEGF and related injectable therapies.

This profile is effectively single-payer from an encounter perspective: Total Medicare revenue is $3.9M while there is no Medicaid billing on file. The absence of Medicaid activity means the practice’s revenue and utilization patterns are concentrated in Medicare reimbursement and beneficiary demand.

On national competitive standing for the highest-revenue drugs, this provider shows typical to unremarkable national placement despite high absolute dollar volume: J0178 ranks #291 of 3204 providers (91th percentile) and J2777 ranks #293 of 2039 providers (86th percentile). Q5128 is relatively stronger within its smaller peer set (rank #68 of 373, 82th percentile), but none of these ranks indicate clear national dominance for anti-VEGF administrations.

Several procedure and imaging codes are statistical outliers in a way that signals unusually high service volumes relative to peers. Code 92134 is an extreme outlier (3.3K claims, $98.6K revenue, 2.5% of Medicare revenue; rank #294 of 26868, 99th percentile) and 67028 is notably above typical national volume (2.5K claims, $237.7K revenue, 6.1% of Medicare revenue; rank #178 of 4255, 96th percentile), together showing concentrated throughput for retinal imaging and in-office injections.

The practice also reports notably above-typical visit-level activity consistent with ongoing follow-up care: 92012 has 969 claims and $62K revenue (1.6% of Medicare revenue; rank #507 of 17177, 97th percentile). Surgical retina procedures are present but limited in volume (for example, 67041 with 15 claims and $13.4K revenue), suggesting the clinical mix prioritizes medical retina and office procedures over frequent major surgeries.

The provider has long tenure in the NPI registry (NPI enumerated: 2006-08-01 (~20 years ago)), which, combined with $3.9M in lifetime Medicare revenue and a concentrated injection/imaging mix, is consistent with an established, referral-dependent retina practice in EDINA, MN. Longevity supports stable referral and episodic-treatment volumes that produced the observed Medicare revenue profile.

From a risk and operational perspective, reliance on a narrow set of high-revenue injection codes creates sensitivity to shifts in drug pricing, coverage, or clinical utilization patterns. Given that the top 3 codes drive 79.1% of Medicare revenue and there is no Medicaid offset, changes to reimbursement or utilization of those specific agents could materially affect practice revenue; conversely, the concentrated volume could support negotiating favorable drug procurement or care-pathway efficiencies.

Medicare: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,570	$690	$1.8M
J2777	Injection, faricimab‑svoa, 0.1 mg	30,360	$30	$880.4K
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	1,990	$220	$431.8K
J2778	Injection, ranibizumab, 0.1 mg	1,640	$190	$304.5K
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.	2,500	$100	$237.7K
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.	3,290	$30	$98.6K
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…	970	$60	$62K
J9035	Injection, bevacizumab, 10 mg	670	$60	$36.7K
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…	360	$100	$34.2K
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…	120	$120	$14.3K

Showing 1–10 of 15

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Minnesota Distribution

John Davies — 4 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Minnesota

Full comparison — all codes billed, vs. state median

15 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	6	40	580	$690	$743.4K
J2777	3	20	6,120	$30	$411.1K
Q5128	7	20	1,410	$220	$393.8K
J2778	2	20	500	$180	$121K
67028	5	80	420	$90	$64.8K
67041	7	10	20	$1,090	$25.1K
J9035	3	40	220	$50	$16.9K
92014	79	830	100	$80	$11.9K
92012	5	200	60	$60	$8.8K
92235	8	40	40	$110	$6.9K

Showing 1–10 of 15

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hennepin Healthcare System, Inc	MN	General Acute Care Hospital	$420.8K	$708.9M
Hennepin County	MN	Case Manager/Care Coordinator	$0	$34.9M
Vitreoretinal Surgery PLLC	MN	Ophthalmology Physician	$0	$27.8M
Hennepin Healthcare System, Inc	MN	Home Health Agency	$0	$23.2M
Hennepin Healthcare System, Inc	MN	Clinic/Center	$0	$12.3M
David Williams	MN	Retina Specialist (Ophthalmology) Physician	$5.5M	$0
David Parke	MN	Ophthalmology Physician	$4.8M	$0
Sundeep Dev	MN	Ophthalmology Physician	$4.5M	$0
Polly Quiram	MN	Ophthalmology Physician	$3.7M	$0
Geoffrey Emerson	MN	Retina Specialist (Ophthalmology) Physician	$3.3M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Emergency Physicians Professional Association	MN	Emergency Medicine Physician	$0	$72.7M
Fairview Health Services	MN	General Acute Care Hospital	$0	$17.2M
Professional Resource Network - Prn - Corporation	MN	Home Health Agency	$0	$12.4M
Virtual Radiologic Professionals, LLC	MN	Diagnostic Radiology Physician	$0	$11.3M
Mental Health Systems PC	MN	Psychologist	$0	$11M
Premier Obgyn Of Minnesota PLLC	MN	Obstetrics & Gynecology Physician	$0	$7M
Noran Neurological Clinic P.A.	MN	Specialist	$0	$6M
Nura Surgical Center LLC	MN	Ambulatory Surgical Clinic/Center	$5.3M	$581.7K
Southdale Pediatric Associates, Ltd	MN	Multi-Specialty Clinic/Center	$0	$5.3M
Robert Mittra	MN	Ophthalmology Physician	$3.1M	$0

John Davies — 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