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

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

Retina Consultants, Ltd (NPI 1972589182)

Field	Value
Entity Type	Organization
Organization	Retina Consultants, Ltd
Address	4450 31st Ave S Ste 200
City	Fargo
State	ND
ZIP	58104
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	December 20, 2005

Payer Source	Total Paid
Medicaid	$625.8K
Medicare	$0

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	260	$1,370	$357.8K
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.	2,240	$80	$185.9K
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.	2,840	$30	$71K
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…	70	$80	$5.6K
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…	40	$60	$2.5K
J9035	Injection, bevacizumab, 10 mg	20	$70	$1.7K
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…	10	$80	$1.2K
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…	10	$0	$0

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other North Dakota providers billing the same CPT/HCPCS codes.

Claims Volume vs. North Dakota Distribution

Retina Consultants, Ltd — 2 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

Full comparison — all codes billed, vs. North Dakota median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	167	210	360	$100	$498.2K
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…	162	170	300	$100	$415.8K
J0178	Injection, aflibercept, 1 mg	1	10	130	$1,100	$172.1K
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…	20	20	150	$100	$100.3K
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…	32	50	160	$80	$66.4K
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.	1	10	350	$90	$61.2K
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	10	1,110	$10	$21.9K
J9035	Injection, bevacizumab, 10 mg	1	10	20	$70	$1.7K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Marina Gilca	ND	Retina Specialist (Ophthalmology) Physician	$4.3M	$0
Max Johnson	ND	Retina Specialist (Ophthalmology) Physician	$2.8M	$0
Ravi Pandit	OK	Retina Specialist (Ophthalmology) Physician	$2.5M	$0
Deepak Mangla	MI	Ophthalmology Physician	$1M	$0
Matthew Hockert	ND	Physician Assistant	$10.3K	$0

Nearby Providers

Other providers in the same ZIP code as Retina Consultants, Ltd, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pediatric Therapy Partners, Inc.	ND	Early Intervention Provider Agency	$0	$7M
Fargo Maple View LLC	ND	Alzheimer Center (Dementia Center)	$0	$4M
Beyond Boundaries Occupational Therapy, Inc.	ND	Multi-Specialty Clinic/Center	$0	$3.9M
St. Sophie's, LLC	ND	Adolescent and Children Mental Health Clinic/Center	$0	$2.7M
Shangri-la Home Care	ND	Home Health Agency	$0	$2M
Beyond Boundaries Speech Language Therapy, Inc.	ND	Speech-Language Pathologist	$0	$2M
About Smiles Dental, LLC	ND	Dental Clinic/Center	$0	$1.7M
Center For Pain Medicine Surgery Center LLC	ND	Ambulatory Surgical Clinic/Center	$1.2M	$0
Davita Dakota Dialysis Center LLC	ND	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.2M
Michelle Atchison	ND	Ophthalmology Physician	$872.5K	$0

Retina Consultants, Ltd — Billing Profile & Reimbursement Data

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Retina Consultants, Ltd — Billing Profile & Reimbursement Data

Sign up for Retina Consultants, Ltd — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References