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NPI 1821484981 · South Burlington, VT · Ophthalmology Physician
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John Hinkle is a ophthalmology physician provider located in South Burlington, Vermont. This profile covers 18 Medicare and 1 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 | John Hinkle |
| Address | 99 Swift St Ste 200 |
| City | South Burlington |
| State | VT |
| ZIP | 05403 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | April 15, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $807.4K |
| Medicaid | $940 |
This provider’s Medicare practice is heavily driven by intravitreal anti‑VEGF therapy: J0178 (aflibercept) alone accounts for $506.4K and 62.7% of the provider’s Medicare revenue, and the precomputed top‑3 Medicare codes collectively account for 77.8% of Medicare revenue. That concentration indicates a procedure‑focused retina practice where drug injections are the principal revenue source rather than broad general ophthalmology services.
Despite the injection concentration, the provider also reports high office evaluation volumes: 99214 generated $64.8K (8.0% of Medicare revenue) and ranks in the 95th percentile nationally, described as notably above typical national volume, while 99204 is labeled an extreme outlier (99th percentile) with $35.6K. These E/M volumes suggest substantial cognitive/visit-based activity alongside procedural work, possibly reflecting complex follow‑up or new patient consultation throughput.
Other retinal procedure codes appear at modest volumes and typical national standing: 67028 contributed $56.9K (7.0% of Medicare revenue) and is described as typical/unremarkable (54th percentile), and 92134 retinal imaging produced $41.4K (5.1% of Medicare revenue) and is described as notably above typical (94th percentile). Together with the injection codes, this mix is consistent with a retina sub‑specialty workflow combining imaging, injections, and occasional surgical procedures.
The provider’s overall payer mix is effectively Medicare‑dominant: total Medicare revenue is $807.4K versus total Medicaid revenue of $940, representing a very large scale difference and functionally a single‑payer practice on these datasets. Medicaid activity is negligible in scale compared with Medicare, so operational and revenue risk is concentrated in the Medicare business line.
Medicaid billing is essentially single‑code: 92134 is listed as 40 claims, $24 avg paid/claim, $960 revenue and as 100.0% of the provider’s Medicaid revenue, with a statewide rank of #5 of 7 (33th percentile) described as typical/unremarkable. Note there is a small data inconsistency between the Medicaid total reported as $940 and the code line shown as $960; both figures are reported here exactly as provided in the data.
Competitive standing is mixed by service: for the principal drug code J0178 the provider’s rank (#1582 of 3204, 51th percentile) is typical and not dominant nationally, whereas for office visits the provider is a clear high‑volume outlier (99214 at the 95th percentile and 99204 an extreme outlier at the 99th percentile). This pattern implies the provider is not a national leader in injection volume per se but does generate unusually large E/M activity relative to peers.
The provider’s portfolio includes lower‑volume surgical retinal codes (e.g., 67042 and 67108, each contributing around 1.3–1.4% of Medicare revenue) and a mix of diagnostic imaging and specialized ophthalmoscopy codes at modest revenue levels; these entries are characterized in the data as typical and unremarkable. This distribution supports a clinical model where occasional surgical interventions and diagnostics supplement a primary intravitreal injection business.
NPI tenure is established: the provider enumerated on 2015-04-15 (~11 years ago). That duration of registration suggests several years of billing history under this NPI, which can support stability in the observed Medicare‑centric revenue profile.
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 | 740 | $690 | $506.4K |
| 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… | 750 | $90 | $64.8K |
| 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. | 620 | $90 | $56.9K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 1,680 | $30 | $48.8K |
| 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. | 1,380 | $30 | $41.4K |
| 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… | 310 | $120 | $35.6K |
| J9035 | Injection, bevacizumab, 10 mg | 230 | $60 | $13K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 10 | $860 | $11.2K |
| 67108 | The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or… | 10 | $900 | $10.8K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 250 | $20 | $4.3K |
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.
View: State1 / 2
Full comparison — all codes billed, vs. state median
18 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 3 | 10 | 740 | $690 | $730.2K |
| 67028 | 5 | 10 | 1,220 | $80 | $90.1K |
| J2777 | 2 | 10 | 3,090 | $30 | $89.8K |
| 67042 | 2 | 10 | 20 | $1,210 | $20.6K |
| 67108 | 2 | 10 | 20 | $1,230 | $19.7K |
| 92014 | 90 | 100 | 200 | $80 | $19.6K |
| J9035 | 4 | 10 | 250 | $50 | $17.5K |
| 92235 | 6 | 10 | 30 | $90 | $13.1K |
| 99214 | 13 | 960 | 90 | $70 | $10.6K |
| 92012 | 25 | 50 | 50 | $60 | $5.8K |
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 40 | $20 | $960 |
How this provider's Medicaid billing volume and revenue compare to other Vermont providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Vermont median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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 | 10 | 60 | $10 | $12.2K |
Other providers in the same ZIP code as John Hinkle, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Nfi Vermont, Inc | VT | Clinic/Center | $0 | $33.6M |
| Bla Partners, LLC | VT | Clinical Medical Laboratory | $0 | $15.2M |
| Timberlane Dental Group | VT | Orthodontics and Dentofacial Orthopedics Dentistry | $0 | $7.5M |
| Tms Vt, LLC | VT | Durable Medical Equipment & Medical Supplies | $0 | $2.9M |
| Michelle Young | VT | Ophthalmology Physician | $2.1M | $0 |
| Howard Center Inc | VT | Psychiatry Physician | $0 | $2M |
| Vermont Eye Surgery & Laser Center | VT | Ambulatory Surgical Clinic/Center | $1.8M | $2.7K |
| David Weissgold | VT | Ophthalmology Physician | $1.7M | $0 |
| Surgi-care Inc | VT | Prosthetic/Orthotic Supplier | $0 | $1.7M |
| City Of So Burlington | VT | Ambulance | $400.9K | $1M |
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