Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Wisconsin for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Wisconsin only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Wisconsin (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Nicholas Tosi (NPI 1891924650)

Field	Value
Entity Type	Individual
Organization	Nicholas Tosi
Address	2600 N Mayfair Rd Ste 901
City	Milwaukee
State	WI
ZIP	53226
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	July 14, 2009

Payer Source	Total Paid
Medicare	$4.9M
Medicaid	$0

Key Findings

This provider's Medicare business is overwhelmingly driven by intravitreal anti-VEGF therapy: J0178 generated $3.1M in revenue (64.6% of the provider's Medicare revenue) and J2777 contributed $687.5K (14.1%). Those two J‑codes plus the injection procedure code 67028 together account for 86.0% of Medicare revenue, indicating a practice model focused on high-volume injection therapy rather than broad primary ophthalmology services.

Revenue concentration is acute: the precomputed top-3 share is 86.0% of total Medicare revenue, with J0178 alone at $3.1M (64.6%) and 67028 at $353.9K (7.3%). This level of concentration signals dependence on reimbursed drug and injection-procedure flows for the majority of dollars collected from Medicare.

The provider is effectively single‑payer in scope: lifetime Medicare revenue is $4.9M and there is no Medicaid billing on file. Absence of Medicaid activity means payor diversification is limited and the practice is highly exposed to Medicare policy and payment changes affecting injectable medications and associated procedures.

Competitive standing on national benchmarks is top-tier for several retina-specific services: J0178 ranks #37 of 3204 providers nationally (99th percentile; extreme outlier) and 67028 ranks #34 of 4255 providers nationally (99th percentile; extreme outlier). By contrast, J2777 ranks #421 of 2039 (79th percentile; typical), so the practice is a national outlier for aflibercept volume while maintaining more routine positioning for faricimab.

Diagnostic and ancillary procedure volumes further reinforce a retina-specialty profile: 92134 has 3.9K claims and $110K revenue (2.3%) and ranks #140 of 26868 providers nationally (99th percentile; extreme outlier), indicating a high throughput of retinal imaging to support injection-based care. Additional imaging codes such as 92235 and 92250 appear in the top CPT list, consistent with frequent monitoring and documentation of retinal disease.

Other medication and procedure codes show concentrated, atypical volumes in select areas: J9035 (bevacizumab) appears with 1.8K claims and $97.4K revenue, ranking #22 of 1852 providers nationally (99th percentile; notably above typical national volume), suggesting substantial use of multiple anti-VEGF agents alongside J0178. Office E&M activity is present but relatively small by revenue, with 99213 contributing $56.9K (1.2%) and ranking #7636 of 457151 providers nationally (98th percentile; extreme outlier), which reflects many brief follow-up visits tied to injection protocols.

Tenure and credentialing support long-term operational presence: the NPI was enumerated 2009-07-14 (~17 years ago), indicating an established practice history that aligns with high cumulative Medicare billing over time. That tenure likely underpins the provider's ability to generate sustained, specialized injection volumes.

From a payer strategy perspective, the combination of extremely high aflibercept volume (J0178) and procedural throughput (67028, 92134) positions this provider as a dominant, procedure- and drug-driven retina specialist within the Medicare population. The lack of Medicaid billing suggests minimal engagement with that payer segment, which may limit access to Medicaid patient flows but simplifies the revenue mix to primarily Medicare-funded anti-VEGF and related retinal care.

Medicare: Complete Services Breakdown

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

21 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	4,620	$680	$3.1M
J2777	Injection, faricimab‑svoa, 0.1 mg	23,710	$30	$687.5K
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.	3,890	$90	$353.9K
J2778	Injection, ranibizumab, 0.1 mg	1,370	$180	$247.3K
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.	3,930	$30	$110K
J9035	Injection, bevacizumab, 10 mg	1,800	$50	$97.4K
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…	930	$60	$56.9K
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…	330	$100	$32K
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…	30	$860	$24K
67228	In retinopathy, tiny new vessels grow profusely and fibrous tissue proliferates in between the layers of the retina, which may extend into the optic nerve and vitreous, clear gel that fills the space…	70	$260	$17.7K

Showing 1–10 of 21

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Wisconsin Distribution

Nicholas Tosi — 9 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. state median

21 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	1	60	440	$690	$488.1K
J2777	2	30	7,290	$30	$332K
J2778	2	10	520	$180	$131.2K
67028	1	110	310	$80	$43.7K
67042	5	20	20	$870	$20.8K
67108	5	10	20	$960	$17.3K
67036	5	10	20	$850	$15.2K
J9035	1	70	110	$50	$14.5K
67113	4	10	20	$930	$13.9K
99214	714	9,800	80	$70	$9.2K

Showing 1–10 of 21

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Retina & Vitreous Consultants Of Wi, Ltd.	WI	Retina Specialist (Ophthalmology) Physician	$0	$3.8M
Sharath Raja	WI	Retina Specialist (Ophthalmology) Physician	$3.3M	$0
Lincoln Shaw	WI	Retina Specialist (Ophthalmology) Physician	$832.5K	$0
Razek Georges Coussa	WI	Retina Specialist (Ophthalmology) Physician	$556.7K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Of Wisconsin, Inc.	WI	Children's Hospital	$0	$262.3M
Froedtert Memorial Lutheran Hospital, Inc.	WI	General Acute Care Hospital	$0	$157.8M
The Medical College Of Wisconsin, Inc.	WI	Internal Medicine Physician	$17.8K	$74.8M
Emergency Medicine Specialists, S.c.	WI	Emergency Medicine Physician	$0	$35.3M
Wisconsin Diagnostic Laboratories LLC	WI	Clinical Medical Laboratory	$2.3M	$22.7M
Childrens Hospital Of Wisconsin, Inc.	WI	Pediatrics Physician	$0	$19M
Children's Hospital And Health System, Inc.	WI	Urgent Care Clinic/Center	$0	$17.7M
Option Care Home Care Inc	WI	Pharmacy	$0	$12.5M
Curative Care Network, Inc.	WI	Rehabilitation Clinic/Center	$0	$12.2M
Children's Specialty Group, Inc.	WI	Pediatrics Physician	$0	$10.4M

Nicholas Tosi — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References