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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Nitin Gupta (NPI 1962454835)

Field	Value
Entity Type	Individual
Organization	Nitin Gupta
Address	1101 Dresser Ct
City	Raleigh
State	NC
ZIP	27609
Taxonomy	Ophthalmology Physician
NPI Enumerated	May 17, 2006

Payer Source	Total Paid
Medicare	$4.7M
Medicaid	$0

Key Findings

This profile is effectively single‑payer: Total Medicare revenue: $4.7M and there is no Medicaid billing on file (none below). The absence of any Medicaid revenue means the provider’s outpatient operation and payer mix are driven almost entirely by Medicare patients and fee schedules. Analysts should treat conclusions about in‑state payer behavior as limited by lack of Medicaid data.

Revenue is highly concentrated in a very small set of codes: the precomputed top 3 Medicare codes by revenue account for 90.7% of this provider's total Medicare revenue. Those top contributors are J0178 ($3.8M revenue, 80.9% of Medicare revenue), 67028 ($254.7K revenue, 5.4% of Medicare revenue), and J2778 ($208.8K revenue, 4.4% of Medicare revenue), indicating a narrow revenue base driven by a few high‑impact services.

The service mix and code descriptions point to a retina‑focused ophthalmology practice that primarily delivers intravitreal biologic injections and high volumes of retinal imaging. J0178 (J0178 – Injection, aflibercept) accounts for 5.6K claims and $3.8M in revenue, and 92134 (computerized retinal imaging) appears as a complementary service with 3.2K claims and $93.8K revenue, consistent with a clinic organized around recurring injection visits and diagnostic imaging.

On competitive standing, the provider is an outlier nationally for aflibercept and retinal imaging volumes: J0178 ranks #20 of 3204 providers nationally (99th percentile; extreme outlier, far above typical national volume for this code) and 92134 ranks #317 of 26868 providers nationally (99th percentile; extreme outlier). 67028 also ranks notably above typical national volume at #137 of 4255 providers (97th percentile). Those rankings indicate market leadership in Medicare for specific retina procedures rather than broad, diversified ophthalmology volume.

Billing patterns show strong reliance on a single high‑cost drug code. The high average paid per claim for J0178 ($686 avg paid/claim) combined with its 5.6K claim volume produced $3.8M in revenue, far exceeding other anti‑VEGF codes (for example, J2778 shows $180 avg paid/claim and $208.8K revenue). This concentration implies operational emphasis on drug procurement, infusion/injection workflow, and recurring patient visits tied to biologic therapy.

Other injection and imaging codes are generally typical or modest in national context: J2778 (ranibizumab) ranks #379 of 1208 providers (69th percentile; typical, unremarkable volume) and J2777 (faricimab) ranks #1272 of 2039 providers (37th percentile; typical, unremarkable volume). The presence of multiple anti‑VEGF codes at lower percentiles suggests the provider bills a mix of agents but that aflibercept (J0178) dominates monetarily and by claims.

Tenure data show the provider was enumerated on 2006-05-17 (~20 years ago), indicating a long‑standing NPI registration. That longevity is consistent with an established practice infrastructure capable of supporting the high recurring injection and imaging volumes observed in the Medicare data.

From a business risk and operational planning perspective, the combination of single‑payer dependence (Medicare only) and extreme reliance on J0178 for the majority of revenue creates vulnerability to changes in reimbursement, utilization patterns, or clinical guidelines affecting aflibercept. Analysts and contracting teams should treat the provider as high‑volume but concentrated, and prioritize review of drug acquisition, utilization protocols, and outpatient injection capacity when evaluating network value and contracting terms.

Medicare: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	5,560	$690	$3.8M
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.	2,680	$100	$254.7K
J2778	Injection, ranibizumab, 0.1 mg	1,160	$180	$208.8K
J2777	Injection, faricimab‑svoa, 0.1 mg	7,080	$30	$205.3K
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.	3,240	$30	$93.8K
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…	1,060	$70	$68.6K
J9035	Injection, bevacizumab, 10 mg	190	$60	$10.2K
67210	The provider destroys a lesion of the retina using a laser beam that heats up the tissue.	20	$430	$9.1K
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…	90	$90	$8.7K
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…	30	$270	$7.9K

Showing 1–10 of 19

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. North Carolina Distribution

Nitin Gupta — 4 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. state median

19 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	3	100	950	$690	$881K
J2777	46	70	12,990	$30	$503.7K
J2778	15	50	620	$180	$202.2K
67028	3	120	780	$90	$80K
92014	484	880	110	$80	$17.7K
99214	17,416	18,060	110	$80	$15.1K
J9035	34	90	140	$50	$13.4K
92242	6	10	40	$190	$12.1K
92012	2	300	80	$60	$8.9K
92235	26	70	60	$100	$8.7K

Showing 1–10 of 19

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shil Patel	VA	Ophthalmology Physician	$6.1M	$0
James Pate	NC	Ophthalmology Physician	$5.2M	$0
John Thordsen	NC	Retina Specialist (Ophthalmology) Physician	$3.5M	$0
Rebecca Manning	NC	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
Matthew Cole	TN	Ophthalmology Physician	$3.3M	$0
William Clark	SC	Ophthalmology Physician	$3.3M	$0
Sachin Mudvari	NC	Retina Specialist (Ophthalmology) Physician	$3.2M	$0
Daniel Bennett	NC	Retina Specialist (Ophthalmology) Physician	$3M	$0
Brian Lehpamer	NC	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
David Fingerhut	TN	Retina Specialist (Ophthalmology) Physician	$2.8M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Arc Of North Carolina	NC	Community/Behavioral Health Agency	$0	$77.5M
Voca Corp Of North Carolina	NC	Community/Behavioral Health Agency	$0	$62.8M
Easter Seals Ucp North Carolina & Virginia, Inc.	NC	Community/Behavioral Health Agency	$0	$58.3M
Fastmed Urgent Care PC	NC	Urgent Care Clinic/Center	$0	$40.4M
Easter Seals Ucp North Carolina & Virginia, Inc.	NC	Community/Behavioral Health Agency	$0	$29.3M
Carter Clinic, P A	NC	Psychiatry Physician	$0	$19.4M
Professional Healthcare, LLC	NC	Nursing Care Agency	$0	$17.6M
Healing Interventions, Inc	NC	Community/Behavioral Health Agency	$0	$15.3M
Kids First Pediatrics Of Raleigh, PLLC	NC	Pediatrics Physician	$0	$12M
Raleigh Best Medical Supply And Home Health Care Services, LLC	NC	Home Health Agency	$0	$11.9M

Nitin Gupta — 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