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NPI 1871509323 · Springfield, IL · Ophthalmology Physician
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Robert Lowenthal is a ophthalmology physician provider located in Springfield, Illinois. This profile covers 14 Medicare and 5 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 | Robert Lowenthal |
| Address | 1025 S 6th St |
| City | Springfield |
| State | IL |
| ZIP | 62703 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 1, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.2M |
| Medicaid | $62.6K |
This provider is effectively Medicare‑focused: lifetime Medicare revenue is $3.2M compared with $62.6K in Medicaid, indicating that Medicare accounts for the vast majority of billed volume and dollars while Medicaid is a minor revenue source. The scale difference suggests the practice’s referral and payer mix are centered on Medicare beneficiaries rather than Medicaid populations.
Medicare revenue is highly concentrated in intravitreal drug administration and related retina services: the top 3 Medicare codes account for 89.9% of Medicare revenue, driven by J2777 (43.7%) and J0178 (41.3%) with 67028 contributing 4.9%. That concentration signals the business is largely built around high-volume, high-cost retinal injections rather than a broad mix of general ophthalmology procedures.
Code-level service mix supports a medical retina/retinal injection specialty model: J2777 and J0178 are intravitreal biologic injections and 67028 is the isolated intravitreal injection procedure, while 92134 (retinal imaging) also appears on the top list. Together these codes indicate a workflow focused on recurrent office-based injections plus frequent retinal imaging to monitor therapy response.
The provider is a strong national performer on faricimab (J2777): J2777 ranks #115 of 2039 nationally (94th percentile) and is described as notably above typical national volume, indicating above-average adoption or referral for this newer retinal agent compared with peers. Aflibercept (J0178) is a solid but less dominant national placement (rank #574 of 3204, 82th percentile; typical, unremarkable volume), so the practice combines heavy use of both agents with particularly elevated faricimab activity.
Several utilization measures are statistical outliers suggesting very high throughput for imaging and basic E/M encounters: 92134 ranks #656 of 26868 (98th percentile; extreme outlier) and 99213 ranks #1587 of 457151 (100th percentile; extreme outlier). These extreme outlier designations imply an unusually large volume of retinal imaging and low‑level established-patient visits relative to national peers, consistent with a high-frequency injection clinic model.
On Medicaid the revenue profile is similarly concentrated—top 3 Medicaid codes account for 93.2% of Medicaid revenue—with J0178 (49.6%), 67028 (25.5%), and 92134 (18.1%) together dominating Medicaid receipts. However, the provider’s Medicaid competitive standing is modest in-state: J0178 ranks #39 of 45 providers in-state (14th percentile) and 67028 ranks #91 of 120 (24th percentile), indicating relatively low Medicaid market share compared with state peers despite similar service mix.
There is a notable difference in per‑claim payments for the same drug between payers: Medicare shows J0178 at $688 avg paid/claim while Medicaid lists J0178 at $997 avg paid/claim for this provider. This payer-level payment divergence combined with concentration in expensive injectable therapies means reimbursement policy changes or payer mix shifts could materially affect revenue.
The provider has long tenure in the NPI registry (enumerated 2006-08-01, ~20 years), supporting an established practice footprint; that longevity aligns with the observed high cumulative volumes in Medicare and with sustained use of retina-focused therapeutics and diagnostic imaging.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 47,940 | $30 | $1.4M |
| J0178 | Injection, aflibercept, 1 mg | 1,910 | $690 | $1.3M |
| 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. | 1,780 | $90 | $154.5K |
| 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… | 1,660 | $60 | $104.5K |
| J2778 | Injection, ranibizumab, 0.1 mg | 420 | $180 | $75.9K |
| 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. | 2,520 | $30 | $73K |
| 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… | 300 | $90 | $27.5K |
| 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… | 210 | $90 | $17.9K |
| 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… | 150 | $50 | $7.8K |
| 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… | 70 | $110 | $7.7K |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
14 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 22 | 140 | 700 | $690 | $688.4K |
| J2777 | 4 | 90 | 9,180 | $30 | $451K |
| J2778 | 15 | 20 | 540 | $180 | $214.9K |
| 67028 | 22 | 190 | 400 | $90 | $64.4K |
| 92014 | 530 | 1,420 | 130 | $80 | $24.7K |
| J9035 | 103 | 130 | 140 | $60 | $24.6K |
| 99214 | 3,930 | 18,540 | 110 | $80 | $17.1K |
| 92012 | 268 | 670 | 100 | $60 | $12.4K |
| 92134 | 33 | 1,080 | 80 | $30 | $9K |
| 99213 | 45 | 17,390 | 70 | $60 | $8.8K |
Showing 1–10 of 14
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.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 30 | $1,000 | $30.9K |
| 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. | 170 | $90 | $15.9K |
| 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. | 1,250 | $10 | $11.3K |
| 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… | 220 | $10 | $2.2K |
| 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… | 120 | $20 | $2.1K |
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 39 | 50 | 200 | $1,100 | $391.2K |
| 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. | 91 | 120 | 540 | $160 | $166.3K |
| 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… | 795 | 1,230 | 450 | $40 | $54.1K |
| 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… | 9,382 | 14,190 | 280 | $20 | $38.9K |
| 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. | 77 | 250 | 510 | $20 | $20.1K |
Other providers in the same ZIP code as Robert Lowenthal, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Central Counties Health Centers, Inc. | IL | Federally Qualified Health Center (FQHC) | $0 | $32.5M |
| America Ambulance Service, Inc. | IL | Ambulance | $1M | $7.5M |
| Gateway Foundation, Inc. | IL | Substance Use Disorder Rehabilitation Clinic/Center | $0 | $8.4M |
| Sangamon Area Special Education Dist | IL | Local Education Agency (LEA) | $0 | $2.9M |
| Joseph Baima | IL | Diagnostic Radiology Physician | $217.4K | $708.3K |
| Edward Harter | IL | Diagnostic Radiology Physician | $242.8K | $666.8K |
| Robert Knudson | IL | Diagnostic Radiology Physician | $701.8K | $80.8K |
| Justin Brooks | IL | Diagnostic Radiology Physician | $99.1K | $666.3K |
| Bridget Kistner | IL | Nuclear Radiology Physician | $652.9K | $24.9K |
| Marc Stees | IL | MOHS-Micrographic Surgery Physician | $316K | $58.6K |
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