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NPI 1942232913 · Silverdale, WA · Ophthalmology Physician
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David Spinak is a ophthalmology physician provider located in Silverdale, Washington. This profile covers 23 Medicare and 1 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 | David Spinak |
| Address | 9800 Levin Rd Nw |
| City | Silverdale |
| State | WA |
| ZIP | 98383 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | July 7, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.1M |
| Medicaid | $0 |
DAVID SPINAK is an ophthalmology physician with an NPI enumerated ~20 years ago (2006-07-07), indicating long-standing Medicare enrollment and multi-year clinical presence in SILVERDALE, WA. Tenure at this level of registration supports established referral and service patterns consistent with a mature ophthalmology practice.
Medicare is effectively the sole reported public payer for this profile: lifetime Medicare revenue is $4.1M while recorded Medicaid revenue is $0, so the provider operates as a single-payer (Medicare-focused) billing entity in the available public data. This payer mix implies commercial and Medicare beneficiaries are the primary sources of revenue rather than state Medicaid.
Revenue concentration is high: the top three Medicare codes by revenue (J0178, J2777, Q5128) account for 69.1% of the provider's total Medicare revenue. Those codes are all intravitreal injections of high-cost ophthalmic drugs (aflibercept, faricimab, and a ranibizumab biosimilar), indicating that anti-VEGF and related intravitreal biologic administration drives the majority of this practice's income.
Operationally, the code mix (dominance of J0178, J2777, Q5128 and significant shares from 67028, 92134) indicates a practice organized around medical retina care and frequent in-office intravitreal injections and retinal imaging. High-volume imaging code 92134 and injection codes together suggest routine follow-up visits with retinal OCT-guided treatment, consistent with chronic retinal disease management (e.g., AMD, diabetic macular edema).
Competitive standing on leading drug codes is mixed: J0178 ($1.5M, 36.4% of Medicare revenue) ranks #421 of 3204 providers nationally (87th percentile) and J2777 ($944.8K, 22.9%) ranks #258 of 2039 providers (87th percentile), both characterized as typical, unremarkable volume relative to national peers — this indicates the provider is a solid, above-median contributor for these injectables but not a national high-volume outlier. Q5128 ($405.3K, 9.8%) ranks #72 of 373 providers (81th percentile) and likewise sits in a high-but-typical range among a smaller national cohort for that biosimilar.
There are notable statistical outliers among commonly billed codes: 99213 (2.6K claims, $172.4K, 4.2% of Medicare revenue) and 92134 (3.8K claims, $117.2K, 2.8%) are each described as extreme outliers and rank at or near the top percentiles nationally (99213 at the 100th percentile; 92134 at the 99th percentile). These extreme volumes for routine E/M visits and retinal imaging suggest very high visit throughput or intensive follow-up scheduling compared with most U.S. ophthalmologists.
Several procedure codes are also notably above typical national volume: 67028 (2.3K claims, $224.1K, 5.4% of Medicare revenue) ranks in the 94th percentile and 99204 ranks in the 98th percentile; both are labeled notably above typical national volume. The elevated frequency of 67028 (intravitreal injection as an isolated procedure) reinforces the business model centered on injection-driven services and high procedural throughput.
Although there are high-cost and high-frequency biologic/drug codes reported (e.g., J3490 unclassified drugs at $349.5K and J2781 pegcetacoplan at $165.6K), the rank descriptions for these suggest typical national volumes for specialty biologic use; none of the drug codes put the provider in an unusual national leadership position. The practice appears to be a high-volume, regionally important retinal injection center rather than a small general ophthalmology clinic.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,240 | $670 | $1.5M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 32,580 | $30 | $944.8K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 1,860 | $220 | $405.3K |
| J3490 | Unclassified drugs | 200 | $1,770 | $349.5K |
| 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. | 2,330 | $100 | $224.1K |
| 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… | 2,610 | $70 | $172.4K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1,380 | $120 | $165.6K |
| 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. | 3,780 | $30 | $117.2K |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 540 | $170 | $92.6K |
| J3590 | Unclassified biologics | 40 | $1,020 | $36.7K |
Showing 1–10 of 23
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
23 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2777 | 13 | 50 | 12,780 | $30 | $599.7K |
| J0178 | 8 | 90 | 470 | $680 | $597.2K |
| Q5128 | 1 | 10 | 520 | $220 | $136.6K |
| J2778 | 27 | 30 | 510 | $180 | $117.1K |
| J2781 | 2 | 10 | 650 | $120 | $88.6K |
| 67028 | 4 | 110 | 550 | $90 | $72.9K |
| J3490 | 10 | 70 | 70 | $50 | $51.2K |
| Q5124 | 1 | 10 | 220 | $170 | $48.7K |
| 67042 | 36 | 40 | 30 | $1,190 | $39.2K |
| 67108 | 5 | 20 | 20 | $1,180 | $29.6K |
Showing 1–10 of 23
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 20 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 82 | 100 | 240 | $10 | $22.2K |
Other providers in the same ZIP code as David Spinak, ranked by combined Medicare and Medicaid revenue.
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