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NPI 1942308473 · La Grande, OR · Ophthalmology Physician
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William Pettit is a ophthalmology physician provider located in La Grande, Oregon. This profile covers 20 Medicare and 7 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 | William Pettit |
| Address | 1404 Gekeler Lane |
| City | La Grande |
| State | OR |
| ZIP | 97850 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | September 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.1M |
| Medicaid | $94K |
WILLIAM PETTIT is a long-tenured ophthalmology practitioner, with an NPI enumerated on 2006-09-20 (~20 years ago), indicating stable billing history and multi-decade presence in the La Grande, OR market. This tenure supports a mature outpatient eye-care practice profile and suggests sustained referral streams for ophthalmic procedures and retinal services.
Medicare dominates this provider’s public-payer revenue: total Medicare revenue is $1.1M versus total Medicaid revenue of $94K, indicating Medicare is the primary payer by an order of magnitude and the practice is effectively Medicare-focused in scale. Analysts should treat Medicaid-related volumes as a smaller, complementary part of overall activity rather than a primary business driver.
Revenue concentration is high on both payers by a small set of procedures. Precomputed metrics show the top 3 Medicare codes account for 65.0% of Medicare revenue, and the top 3 Medicaid codes account for 85.2% of Medicaid revenue; this implies that a handful of services—primarily intravitreal injection and retinal imaging/exam codes—drive most public-payer receipts. Such concentration signals dependency on routine, repeatable procedural lines rather than broad, equally distributed service mix.
The provider’s Medicare billing mix is injection- and retina-heavy: J0178 (aflibercept) alone accounts for $577.7K and 51.5% of Medicare revenue, and 92134 (retinal imaging) and 67028 (intravitreal injection procedure) are also among the top contributors. This pattern is consistent with an ophthalmology practice focused on medical retina care and high-volume intravitreal therapy delivery rather than primarily surgical cataract volume.
Competitive standing varies by code. For J0178 the provider ranks #1466 of 3204 nationally (54th percentile), indicating a typical, unremarkable national volume for aflibercept injections rather than a market-leading position. In contrast, the provider is an extreme outlier on 92134 (retinal imaging) for Medicare—rank #654 of 26868 (98th percentile)—and also posts notably above-typical volumes for several evaluation and diagnostic codes (92014 at the 94th percentile, 92004 at the 96th percentile), signaling local or regional strength in diagnostic/retinal imaging services even if injection volumes are average nationally.
Medicaid activity mirrors Medicare service lines but at lower reimbursement levels: 92014, 92134, and 99213 together make up the top Medicaid revenues (31.6%, 27.1%, and 26.4% respectively) and together account for the precomputed top-3 share of 85.2% of Medicaid revenue. This indicates the provider delivers many established-patient comprehensive exams, retinal imaging, and routine E/M visits to Medicaid enrollees, reinforcing a diagnostics- and visit-driven Medicaid footprint rather than high-reimbursement procedure billing.
Relative in-state competitiveness on Medicaid is modest to typical across the top codes: for example 92014 ranks #85 of 251 (66th percentile) and 92134 ranks #18 of 41 (57th percentile) in-state, so the provider is not a dominant Medicaid retinal services hub statewide but does maintain meaningful volume compared with peers. Conversely, a low in-state rank on 67028 (9th percentile) suggests intravitreal injection activity is limited in the Medicaid population relative to peers.
Operational implications: the combination of very high retinal imaging volumes (Medicare 92134 at the 98th percentile) with substantial aflibercept administration (J0178 representing 51.5% of Medicare revenue) points to a practice workflow optimized for repeated imaging-plus-injection visits. Payers and network planners should expect frequent short visits tied to anti-VEGF treatment protocols and substantial demand for diagnostic retinal services rather than a high share of complex surgical cataract procedures.
Cost and reimbursement profile: Medicare paid amounts per claim show a large spread between high-revenue drug billing (J0178 avg $691/claim) and many low-unit-value diagnostic services (e.g., 92134 avg $27/claim). For Medicaid, lower per-claim payments (92014 avg $35, 92134 avg $10, 99213 avg $24) mean similar visit types generate far less revenue, which contributes to the disproportionally small Medicaid revenue total ($94K) despite similar service mix. This differential is important for payer rate negotiations, network adequacy and assessing the financial viability of Medicaid-facing services within the practice.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
20 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 840 | $690 | $577.7K |
| 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. | 860 | $90 | $77.1K |
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 180 | $410 | $73.8K |
| 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… | 860 | $80 | $70.1K |
| 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 | $68K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 140 | $240 | $34.1K |
| 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… | 390 | $80 | $32.8K |
| J9035 | Injection, bevacizumab, 10 mg | 610 | $50 | $32.7K |
| 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… | 520 | $60 | $31.4K |
| 66982 | The provider inserts an intraocular lens prosthesis after extracapsular cataract extraction using complex techniques and devices. He may perform this by means of an iris expansion device, providing… | 50 | $560 | $25.9K |
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How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
20 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 31 | 60 | 840 | $680 | $623.7K |
| 66984 | 55 | 260 | 70 | $540 | $82.7K |
| 67028 | 30 | 70 | 580 | $90 | $72.3K |
| 66982 | 13 | 60 | 20 | $720 | $20.8K |
| 92014 | 11 | 440 | 110 | $80 | $16K |
| 66821 | 20 | 160 | 40 | $230 | $15.4K |
| J9035 | 1 | 10 | 250 | $50 | $14.9K |
| 99214 | 427 | 6,070 | 80 | $70 | $10.3K |
| 67210 | 1 | 10 | 20 | $400 | $9.9K |
| 92134 | 5 | 390 | 80 | $30 | $8.1K |
Showing 1–10 of 20
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 850 | $40 | $29.6K |
| 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. | 2,540 | $10 | $25.4K |
| 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… | 1,030 | $20 | $24.6K |
| 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. | 160 | $40 | $5.9K |
| 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… | 180 | $30 | $5K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 50 | $50 | $2.9K |
| 92020 | The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and… | 10 | $10 | $100 |
How this provider's Medicaid billing volume and revenue compare to other Oregon providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oregon median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 1,044 | 1,500 | 650 | $70 | $312.4K |
| 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. | 21 | 20 | 4,080 | $60 | $290K |
| 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… | 637 | 1,590 | 590 | $50 | $236.5K |
| 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… | 85 | 250 | 460 | $80 | $121.3K |
| 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. | 18 | 40 | 1,240 | $20 | $82.9K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 187 | 260 | 200 | $100 | $72.7K |
| 92020 | The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and… | 7 | 10 | 30 | $20 | $710 |
Other providers in the same ZIP code as William Pettit, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Union County | OR | Case Management Agency | $0 | $4.8M |
| Grande Ronde Recovery | OR | Addiction Psychiatry Physician | $0 | $3.5M |
| Norco, Inc | OR | Durable Medical Equipment & Medical Supplies | $0 | $1.5M |
| Assure Drug Detection LLC | OR | Clinical Medical Laboratory | $0 | $1.3M |
| City Of La Grande | OR | Land Ambulance | $415.8K | $693.3K |
| Mountain Valley Therapy, Inc | OR | Physical Therapist | $0 | $1.1M |
| Lincare Inc | OR | Durable Medical Equipment & Medical Supplies | $0 | $1M |
| Center For Human Development, Inc | OR | Public Health or Welfare Agency | $65.3K | $559K |
| Daniel Kirkham | OR | Diagnostic Radiology Physician | $217.9K | $0 |
| Travis Hampton | OR | Foot & Ankle Surgery Podiatrist | $198.5K | $0 |
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