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NPI 1851373484 · Little Rock, AR · Retina Specialist (Ophthalmology) Physician
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Gerald Ware is a retina specialist (ophthalmology) physician provider located in Little Rock, Arkansas. This profile covers 18 Medicare and 7 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 | Gerald Ware |
| Address | 9800 Baptist Health Dr Ste 200 |
| City | Little Rock |
| State | AR |
| ZIP | 72205 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | November 18, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2M |
| Medicaid | $45.4K |
GERALD WARE’s Medicare billing profile is heavily retina/medical retina–focused: the single highest‑revenue Medicare code is J0178 (aflibercept injection), which alone accounts for $1.2M and 57.6% of the provider’s Medicare revenue, and the top three Medicare codes together drive 80.4% of Medicare revenue. This concentration on high‑cost intravitreal injections (J0178, J2777, and procedure 67028) indicates a practice model centered on ongoing in‑office pharmacologic management of retinal disease rather than primarily refractive or routine eye care.
Medicare revenue dwarfs Medicaid revenue for this clinician: lifetime Medicare revenue is $2M compared with $45.4K in Medicaid, indicating Medicare is the dominant payer by scale. The provider’s commercial/Medicare beneficiary mix likely represents the core patient population for retina specialty services, with Medicaid accounting for a very small share of lifetime public‑payer receipts.
Revenue concentration within Medicaid mirrors the procedural focus seen in Medicare: the top three Medicaid codes (92012, 67028, and 92134) account for 77.2% of the provider’s Medicaid revenue, showing the practice bills a mix of intermediate established exams and retina procedures/imaging for the small Medicaid caseload. This pattern suggests that even the provider’s limited Medicaid volume is driven by retina follow‑up care and imaging rather than broad primary ophthalmology services.
On selected service volumes the provider is an outlier nationally for some diagnostic eye exams and retinal imaging: Medicare claims for 92012 rank #105 of 17177 providers (99th percentile) and for 92134 rank #674 of 26868 providers (97th percentile), both labeled as extreme outliers—these high percentiles indicate substantially greater-than‑typical national volume for intermediate eye exams and retinal OCT imaging and suggest a large established patient panel receiving frequent follow‑up and imaging.
Competitive standing for intravitreal pharmacotherapy is mixed: J0178 volume is typical nationally (78th percentile) given its $1.2M revenue rank (#699 of 3204), while J2777 (faricimab) shows typical volume at the 54th percentile despite $320.2K in revenue. Conversely, the provider ranks highly for use of some lower‑cost biologics—J9035 (bevacizumab) is at the 95th percentile (rank #96 of 1852) indicating comparatively strong utilization of that agent versus national peers. Together these ranks imply solid local competitiveness for injection‑based retina care but not dominance across all drug codes.
The practice performs some surgical retina procedures but at moderate volume: 67028 (intravitreal injection as an isolated procedure) generates $140.2K (6.9% of Medicare revenue) and ranks at the 87th percentile nationally, while vitrectomy codes (67041 and 67042) appear infrequently (28 and 12 Medicare claims respectively) producing smaller revenue contributions. This mix points to a primarily injection‑and‑clinic oriented retina practice with occasional surgical interventions rather than a high‑volume surgical retina center.
Tenure and stability: the provider’s NPI was enumerated on 2005-11-18 (~21 years ago), indicating long‑standing Medicare participation and likely an established referral pipeline and patient base in Little Rock. That duration, combined with high percentile rankings on several diagnostic and injection codes, supports an interpretation of an experienced retina specialist with sustained procedural and clinic throughput.
Medicaid competitive standing is modest statewide: for the Medicaid top codes the provider typically sits in middle percentiles (e.g., 92012 at the 83rd percentile in‑state, 67028 at the 38th percentile, 92134 at the 62nd percentile), indicating respectable but not dominant share of Medicaid retina visits and imaging in Arkansas. Given the small absolute Medicaid revenue ($45.4K lifetime), the provider is a modest participant in the state Medicaid market rather than a leading Medicaid retina provider.
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 | 1,680 | $690 | $1.2M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 11,040 | $30 | $320.2K |
| 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. | 1,730 | $80 | $140.2K |
| 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… | 1,800 | $60 | $102.8K |
| 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. | 2,490 | $30 | $64.7K |
| 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… | 790 | $70 | $58.4K |
| J2778 | Injection, ranibizumab, 0.1 mg | 290 | $180 | $51.3K |
| J9035 | Injection, bevacizumab, 10 mg | 890 | $60 | $49.8K |
| 67041 | In this procedure, the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical… | 30 | $800 | $22.4K |
| 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… | 170 | $100 | $16.8K |
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
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.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 580 | $20 | $13.4K |
| 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. | 110 | $100 | $11.4K |
| 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. | 480 | $20 | $10.5K |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 150 | $40 | $5.8K |
| 99222 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 70 | $60 | $4.5K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 20 | $10 | $140 |
| J7999 | Compounded drug, not otherwise classified | 20 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Arkansas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arkansas median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 173 | 260 | 430 | $30 | $93.3K |
| 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. | 11 | 20 | 260 | $110 | $91.6K |
| 99222 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 54 | 110 | 70 | $60 | $35.1K |
| 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. | 17 | 40 | 260 | $20 | $26.2K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 104 | 110 | 150 | $30 | $19.1K |
| 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… | 17 | 100 | 120 | $30 | $14.3K |
| J7999 | Compounded drug, not otherwise classified | 6 | 10 | 150 | $1 | $420 |
Other providers in the same ZIP code as Gerald Ware, ranked by combined Medicare and Medicaid revenue.
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