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NPI 1841417441 · Camp Hill, PA · Ophthalmology Physician
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Paul Baker is a ophthalmology physician provider located in Camp Hill, Pennsylvania. This profile covers 17 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 | Paul Baker |
| Address | 220 Grandview Ave |
| City | Camp Hill |
| State | PA |
| ZIP | 17011 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | April 18, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $3.3K |
Practice profile and service mix: Billing is dominated by intravitreal pharmacologic therapy, with the top Medicare revenue drivers being J0178 (aflibercept), J2778 (ranibizumab), and J2777 (faricimab), which together account for 83.4% of Medicare revenue. This code mix and the presence of procedure code 67028 indicate an office-based medical retina operation that focuses on repeated intravitreal injections for chronic retinal disease rather than surgical retina or broad comprehensive ophthalmology alone.
Medicare revenue concentration risk: Total Medicare revenue is $2.4M and the top 3 Medicare codes account for 83.4% of that amount, showing heavy dependence on a small set of high-revenue drug/injection codes. Operationally, the practice’s revenue stream appears tightly tied to reimbursement for these injectable therapies and associated visit/procedure workflows.
Medicaid footprint and concentration: Medicaid revenue is negligible by comparison at $3.3K, and the precomputed top-3 share for Medicaid is 100.0%, reflecting that Medicaid billing is essentially limited to a very small set of services. The Medicaid activity that does exist is split between 92134 (52.7% of Medicaid revenue) and 67028 (47.3% of Medicaid revenue), indicating the same injection and retinal imaging focus at very low scale in the state program.
Payer mix and scale: The provider is effectively Medicare-dominant in scale (Medicare $2.4M vs. Medicaid $3.3K), demonstrating a near-single-payer commercial footprint in public programs with minimal Medicaid volume. This large disparity implies that any policy or reimbursement changes to Medicare-covered retinal injections would have an outsized impact on overall revenue.
Competitive standing on core injection codes: For major Medicare drug codes the provider shows typical-to-above-typical national volumes — J0178 ranks #676 of 3204 (79th percentile; typical, unremarkable volume), J2778 ranks #126 of 1208 (90th percentile; typical, unremarkable volume), and J2777 ranks #859 of 2039 (58th percentile; typical, unremarkable volume). These placements indicate the provider is a solid regional participant for anti-VEGF/faricimab therapies but not a dominant national outlier for those drugs.
Imaging and E/M intensity: The provider reports high relative volume of retinal imaging and office visits compared with peers: 92134 is 97th percentile nationally (described as notably above typical national volume) and 99213 is at the 98th percentile (an extreme outlier, far above typical national volume). This combination suggests a high-throughput clinic model that pairs frequent image-based monitoring with frequent lower-level E/M visits to support ongoing injection management.
State-level Medicaid competitiveness: Within Pennsylvania, Medicaid ranks for the two listed codes are modest — 92134 is #120 of 183 (35th percentile) and 67028 is #82 of 99 (17th percentile) in-state — indicating the provider is not a leading Medicaid retinal services provider in Pennsylvania despite strong Medicare activity. The practice’s Medicaid presence is small and concentrated, so competitive positioning in the state Medicaid market is limited.
Tenure and operational longevity: The NPI was enumerated on 2007-04-18 (~19 years ago), indicating long-standing enrollment and continuity in outpatient ophthalmology services. That tenure, paired with the concentrated anti-VEGF billing pattern, supports the interpretation of an established, injection-focused ophthalmology practice serving primarily Medicare beneficiaries.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,720 | $680 | $1.2M |
| J2778 | Injection, ranibizumab, 0.1 mg | 2,860 | $180 | $515.5K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 12,300 | $30 | $356.7K |
| 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. | 1,850 | $80 | $151.6K |
| 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. | 2,210 | $30 | $61.8K |
| 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… | 960 | $60 | $59.2K |
| 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… | 460 | $90 | $38.7K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 190 | $160 | $29.5K |
| 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… | 210 | $90 | $18.8K |
| J7999 | Compounded drug, not otherwise classified | 170 | $70 | $11.1K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 39 | 140 | 830 | $690 | $865.1K |
| J2778 | 19 | 70 | 1,030 | $190 | $417.1K |
| J2777 | 34 | 100 | 7,950 | $30 | $360.2K |
| 67028 | 32 | 180 | 600 | $90 | $87.5K |
| J7312 | 13 | 10 | 280 | $160 | $50.7K |
| J7999 | 32 | 110 | 100 | $120 | $33.3K |
| 92014 | 268 | 1,570 | 130 | $80 | $21K |
| 99214 | 6,374 | 23,230 | 100 | $80 | $14.5K |
| 92235 | 16 | 70 | 40 | $100 | $10K |
| J9035 | 52 | 60 | 80 | $50 | $8.7K |
Showing 1–10 of 17
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 |
|---|---|---|---|---|
| 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. | 140 | $10 | $1.7K |
| 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. | 50 | $30 | $1.6K |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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. | 82 | 100 | 330 | $70 | $85.4K |
| 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. | 120 | 180 | 290 | $20 | $24.8K |
Other providers in the same ZIP code as Paul Baker, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Medstaffers, LLC | PA | Home Health Agency | $0 | $15.1M |
| Penn State Health Holy Spirit Medical Center | PA | General Acute Care Hospital | $0 | $10.2M |
| Penn State Health Life Lion, LLC | PA | Ambulance | $2.4M | $6.9M |
| Shadai Healthcare Services LLC | PA | Home Health Agency | $0 | $9.2M |
| Lawrence Ho | PA | Ophthalmology Physician | $3M | $4.1K |
| Maxwell Stem | PA | Ophthalmology Physician | $2.9M | $31.9K |
| Steven Truong | PA | Ophthalmology Physician | $2.7M | $11.5K |
| Michael Banach | PA | Ophthalmology Physician | $2.1M | $5.1K |
| Tahsin Khundkar | PA | Ophthalmology Physician | $1.5M | $0 |
| Marissa Wedel | PA | Ophthalmology Physician | $1.4M | $26.3K |
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