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 Delaware for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Delaware 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. Delaware (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.

Paula Ko (NPI 1942216320)

Field	Value
Entity Type	Individual
Organization	Paula Ko
Address	1207 N Scott St
City	Wilmington
State	DE
ZIP	19806
Taxonomy	Ophthalmology Physician
NPI Enumerated	July 31, 2006

Payer Source	Total Paid
Medicare	$1.7M
Medicaid	$0

Key Findings

This provider is effectively single‑payer in the available data: Total Medicare revenue is $1.7M while Medicaid revenue is none (no Medicaid billing on file), indicating Medicare patients drive the practice’s billed volume and revenue. Analysts should treat Medicaid as absent for payer-mix modeling or consider non-billing arrangements with state programs.

Revenue is highly concentrated in a small set of retinal therapy codes: the precomputed top 3 Medicare codes by revenue account for 86.3% of this provider's total Medicare revenue, led by J2777 (40.4%) and J0178 (40.3%) with 67028 contributing 5.6%. This concentration signals that a few high-revenue services dominate the financial profile and that changes in reimbursement or utilization for these drugs/procedures would materially impact overall revenue.

The code mix and top revenue drivers indicate a retina/interventional ophthalmology service line: J2777 (faricimab) with 24.1K claims and $697.7K revenue and J0178 (aflibercept) with 1K claims and $695.6K revenue are both intravitreal biologic injections, and 67028 (1.1K claims, $97.2K revenue) is isolated intravitreal injection—together these imply routine, high-volume intravitreal therapy and retina disease management. Complementary imaging and follow-up codes in the top list reinforce a practice workflow centered on injection visits plus diagnostic monitoring.

Competitive standing on the national stage is mixed by code: J2777 ranks #414 of 2039 providers (80th percentile) which is described as typical/unremarkable volume for the code, while J0178 ranks #1266 of 3204 providers (60th percentile) and 67028 ranks #1316 of 4255 providers (69th percentile), both likewise characterized as typical volumes. In short, the provider is not a national outlier dominating these drug codes but does participate at a solid, mid-to-upper percentile level for J2777 in particular.

Diagnostic and follow-up services show unusually high national volume: 92014 (946 claims, $87K revenue) ranks in the 95th percentile and is labeled notably above typical national volume, and 92134 (1.9K claims, $54.2K revenue) ranks in the 96th percentile and is also described as notably above typical national volume. These high percentiles for comprehensive established exams and retinal imaging suggest sustained longitudinal care and frequent monitoring consistent with a retina clinic that pairs injections with regular imaging and evaluation.

Procedural emphasis over E/M revenue is evident: E/M code 99214 accounts for 109 claims and $8.7K revenue and ranks at the 50th percentile (typical), while many of the highest-revenue items are drug/procedure codes. This pattern points to a business model driven by procedure- and drug-reimbursement rather than high-volume office evaluation codes.

A few low-volume/high-dollar items merit attention for anomaly screening and contracting: J3490 (24 claims, $42.4K revenue, $1768 avg paid/claim) ranks #2482 of 2838 providers (12th percentile) and is labeled typical/unremarkable volume, but its high average paid per claim compared with other items on the list means these unclassified drug entries could affect per-claim cost metrics and should be reviewed during utilization or network pricing discussions.

The provider’s tenure is long-standing: NPI enumerated (registered) on 2006-07-31 (~20 years ago), indicating an established practice footprint and experience with Medicare billing. Combined with the concentrated retina-focused revenue mix and high imaging/exam percentiles, this tenure supports an interpretation of an experienced ophthalmology practice operating a sustained intravitreal therapy and retinal monitoring program.

Medicare: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J2777	Injection, faricimab‑svoa, 0.1 mg	24,060	$30	$697.7K
J0178	Injection, aflibercept, 1 mg	1,030	$680	$695.6K
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.	1,060	$90	$97.2K
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…	950	$90	$87K
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.	1,870	$30	$54.2K
J3490	Unclassified drugs	20	$1,770	$42.4K
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…	20	$890	$15.2K
J9035	Injection, bevacizumab, 10 mg	230	$50	$12.4K
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…	110	$80	$8.7K
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…	100	$70	$7.1K

Showing 1–10 of 15

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Delaware Distribution

Paula Ko — 2 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. state median

15 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	3	10	510	$680	$495.6K
J2777	1	10	20,040	$30	$474.7K
67028	3	10	970	$90	$85.6K
J3490	7	10	50	$990	$65.2K
92014	8	120	250	$80	$29.9K
99214	1,072	1,830	150	$80	$25.5K
92012	30	40	230	$60	$21.4K
J9035	4	10	290	$50	$15K
99213	1,679	1,810	120	$60	$13.6K
67042	1	10	20	$860	$13K

Showing 1–10 of 15

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Christiana Care Health Services, Inc.	DE	General Acute Care Hospital	$0	$99.4M
Christiana Care Health Services Inc	DE	Hospitalist Physician	$0	$13.6M
Mercy Health System Corporation	WI	Multi-Specialty Clinic/Center	$0	$13.2M
Christiana Care Health Services Inc	DE	Obstetrics & Gynecology Physician	$0	$9.9M
Christiana Care Health Services Inc	DE	Neonatal-Perinatal Medicine Physician	$0	$8.9M
Christiana Care Health Services Inc	DE	Family Medicine Physician	$0	$5.6M
Christiana Care Health Services Inc	DE	Neurology Physician	$0	$5.1M
Christiana Care Health Services, Inc	DE	Family Medicine Physician	$0	$5.1M
Christiana Care Health Services Inc	DE	Student Health Clinic/Center	$0	$3.9M
Christiana Care Health Services, Inc	DE	Psychiatry Physician	$0	$2.9M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nancy Pancko	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$10M
Ingleside Homes, Inc	DE	Assisted Living Facility	$0	$2.5M
Liberty Dialysis - Wilmington LLC	DE	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.6M
Eye Physicians & Surgeons, PA	DE	Ophthalmology Physician	$0	$1.6M
Brandywine Medical Associates, Inc.	DE	Family Medicine Physician	$0	$1.3M
Brian Toussaint	DE	Ophthalmology Physician	$1.2M	$0
Ingleside Homes, Inc	DE	Homemaker	$0	$1.2M
Rmb Group, LLC	DE	In Home Supportive Care Agency	$0	$1.1M
Philip Schwartz	DE	Rheumatology Physician	$937.1K	$0
Anthony Vattilana	DE	General Practice Dentistry	$0	$668.6K

Paula Ko — Billing Profile & Reimbursement Data

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Paula Ko — 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