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    OpenPayerNPI Medicare & MedicaidJames Lai
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    James Lai — Billing Profile & Reimbursement Data

    NPI 1871606186 · Aiea, HI · Ophthalmology Physician

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    James Lai is a ophthalmology physician provider located in Aiea, Hawaii. This profile covers 13 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationJames Lai
    Address98-1079 Moanalua Rd
    CityAiea
    StateHI
    ZIP96701
    TaxonomyOphthalmology Physician
    NPI EnumeratedAugust 17, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$1.4M
    Medicaid$0

    Key Findings

    This provider is an ophthalmology physician based in AIEA, HI with an NPI enumerated 2006-08-17 (~20 years ago), indicating long tenure in Medicare billing and a specialty focus consistent with retinal and intravitreal services. The top revenue codes are dominated by injectable biologics and ophthalmic evaluation codes, which together shape the clinical footprint seen in the Medicare data.

    Medicare is effectively the only payer on file: reported lifetime Medicare revenue is $1.4M and there is no Medicaid billing on file. This makes the provider functionally a single-payer (Medicare) operation in the datasets available rather than a mixed Medicaid/Medicare practice.

    Revenue concentration is high: the precomputed top three Medicare codes account for 81.8% of this provider's total Medicare revenue, led by J0178 (43.4%), J2777 (30.8%), and 92014 (7.6%). This indicates that a small set of service types — anti-VEGF/intravitreal drug administration and comprehensive established-patient visits — drive the bulk of billed Medicare dollars.

    The injection codes show substantial absolute revenue but sit at typical national volumes for their categories: J0178 (J0178 – Injection, aflibercept) generated $609K from 934 claims with an avg paid/claim $652 and ranks #1353 of 3204 providers nationally (58th percentile; typical, unremarkable volume), while J2777 (faricimab) produced $432.6K from 14.9K claims with an avg paid/claim $29 and ranks #718 of 2039 providers (65th percentile; typical, unremarkable volume). These rankings suggest the practice is a normal-volume participant nationally for high-cost injectable therapies rather than an outlier provider of those drugs.

    Certain ambulatory exam and imaging codes are materially above typical national volumes, implying higher diagnostic and follow-up throughput: 92014 posted 1.2K claims and $106.8K revenue and ranks #1190 of 35415 providers (97th percentile; notably above typical national volume), 92134 had 1.9K claims and $59.2K revenue and ranks in the 96th percentile, and 92012 is at the 95th percentile. The combination of above-typical exam and imaging volume with typical injectable volumes indicates a practice model that pairs frequent diagnostic follow-up with routine intravitreal therapy.

    Procedural retinal work is also present but represents a smaller share of revenue: 67028 generated $80.3K from 902 claims (5.7% of Medicare revenue) and ranks #1512 of 4255 providers (64th percentile; typical, unremarkable volume), while 67042 contributed $24.2K from 26 claims (1.7% of Medicare revenue) and ranks #365 of 1087 providers (65th percentile; typical, unremarkable volume). This mix indicates the provider performs both injection-focused care and some vitreoretinal procedures without appearing to be a high-volume surgical center.

    Across lower-revenue services, the provider reports a mix of diagnostic imaging and ancillary tests consistent with retinal specialty care: 92250 (fundus photography) and 92235 (fluorescein angiography) appear in the top codes with typical volume ranks, supporting the conclusion that diagnostic imaging is a routine element of the care pathway billed to Medicare. These ancillary services collectively reinforce the clinical narrative of a retina-oriented ophthalmology practice rather than a general ophthalmology office.

    Taken together, the profile shows a Medicare-centric ophthalmology practice concentrated in high-revenue injectable drugs and high-volume diagnostic/exam activity. The nationally notable percentiles on exam and imaging codes alongside typical percentiles for the injectable drugs suggest a practice that provides intensive monitoring and management of retinal disease while participating at typical levels in distribution of high-cost biologic injections.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

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

    13 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg930$650$609K
    J2777Injection, faricimab‑svoa, 0.1 mg14,920$30$432.6K
    92014An 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…1,160$90$106.8K
    67028The 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.900$90$80.3K
    92134The 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.1,910$30$59.2K
    92012For 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…740$70$51.3K
    67042In 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…30$930$24.2K
    99204The 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$13.8K
    J7999Compounded drug, not otherwise classified110$70$7.9K
    92250Code 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,…260$30$7.7K

    Showing 1–10 of 13

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    13 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J0178420330$680$350.4K
    J27771104,140$30$173.8K
    67028320390$90$44.1K
    6704221030$1,190$38.2K
    920148220120$90$22.5K
    920128150110$60$13.1K
    J7999610100$70$12.8K
    9223561030$110$11K
    92134315060$30$7.2K
    992044263030$110$5.3K

    Showing 1–10 of 13

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Jonathan JonischNYOphthalmology Physician$6.4M$940.9K
    Kenneth GrahamNYOphthalmology Physician$5.6M$64.5K
    Brett RosenblattNYOphthalmology Physician$5.5M$9.3K
    David PoonNYOphthalmology Physician$4.1M$796.1K
    Jeffrey ShakinNYOphthalmology Physician$4.4M$82.4K
    David FastenbergNYOphthalmology Physician$4.4M$31.2K
    David RheeNYOphthalmology Physician$4M$73.4K
    Vincent DeramoNYOphthalmology Physician$4M$15.1K
    Eric ShakinNYOphthalmology Physician$3.3M$291.7K
    Juan RomeroNYOphthalmology Physician$3.1M$441.8K

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Diagnostic Laboratory Services, IncHIClinical Medical Laboratory$10.5M$46M
    Pali Momi Medical CenterHIGeneral Acute Care Hospital$0$49.3M
    Dlmc, Inc.HIHome Health Agency$0$39.5M
    Usrc Pearlridge, LLCHIEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center$0$11.7M
    International Life Support IncHIAmbulance$1.2M$8.6M
    Dialysis Newco LLCHIEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center$0$5.8M
    Pharmacare International, Inc.HICommunity/Retail Pharmacy$125.1K$4.7M
    Emergency Medicine Physicians Of Honolulu Pali Momi, LLCHIEmergency Medicine Physician$0$4.2M
    Absolute Care Management ServicesHIPoint of Service$0$3.2M
    Derek B Tom Dds LLCHIPediatric Dentistry$0$2.6M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Hawaii Distribution
    James Lai — 4 of 13 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Hawaii