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

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

Philip Nelsen (NPI 1982606109)

Field	Value
Entity Type	Individual
Organization	Philip Nelsen
Address	2865 N Reynolds Rd
City	Toledo
State	OH
ZIP	43615
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 1, 2005

Payer Source	Total Paid
Medicare	$2.6M
Medicaid	$0

Key Findings

Medicare dominates this provider's reported revenue profile: lifetime Medicare revenue is $2.6M while Medicaid billing is listed as none, making PHILIP NELSEN effectively a single-payer (Medicare) practice in the available data. This concentration means payer negotiation and Medicare reimbursement trends will drive most revenue risk and growth opportunities for the practice.

Revenue is highly concentrated in a small set of drug and injection codes: the precomputed top three Medicare codes account for 79.1% of total Medicare revenue, led by J0178 at $1.7M (67.2%) with J3490 at $160.9K (6.3%) and 67028 at $143.4K (5.6%). This concentration indicates that a few therapy modalities—chiefly the anti-VEGF biologic represented by J0178—are the primary commercial drivers of the practice.

The procedural and drug mix is consistent with a retina specialty that is injection-centric: J0178 (aflibercept) has 2.5K claims and $1.7M revenue, and 67028 (intravitreal injection) has 1.7K claims and $143.4K revenue, while E/M and routine ophthalmic visit codes such as 92014 ($62K, 765 claims) and 99214 ($42.1K, 478 claims) make up a much smaller share of revenue. This pattern suggests the business model is centered on high-volume intravitreal therapy delivery with office visits and evaluations supporting treatment rather than driving revenue.

Competitive standing is mixed across codes: for the practice's top drug, J0178, the provider ranks #324 of 3204 (90th percentile) which is above typical national volume but described as "typical, unremarkable" in character; J3490 ranks #872 of 2838 (69th percentile) and 67028 ranks #622 of 4255 (85th percentile). Overall these ranks indicate the provider is an above-typical national participant for its revenue-driving injection services, but not a dominant outlier at the national level for those specific codes.

Imaging utilization is a clear statistical outlier: 92134 generated $72.3K (2.8% of Medicare revenue) and ranks #671 of 26868 providers nationally (98th percentile; extreme outlier, far above typical national volume). That elevated OCT imaging volume relative to peers implies substantial in‑office diagnostic capacity and frequent follow-up imaging tied to active therapeutic management.

Adoption of newer intravitreal agents appears selective: J2781 (pegcetacoplan) accounts for $133.9K (5.2%) and ranks #94 of 490 (80th percentile), indicating relatively strong adoption among a smaller set of providers, while J2777 (faricimab) accounts for $104.4K (4.1%) but ranks #1745 of 2039 (14th percentile). This split suggests the provider uses multiple advanced biologics but with differing intensity, which may reflect local treatment preferences, patient mix, or formulary access.

Procedural retina surgery volumes are present but modest: codes for vitrectomy and complex retinal repair such as 67042 ($17.4K, 20 claims), 67113 ($16.6K, 17 claims), and 67036 ($10.3K, 15 claims) are reported at typical national volumes and represent a small portion of total revenue. These items imply the practice performs some surgical retina cases in addition to high-volume injection treatments, but surgery is not the primary revenue engine.

The provider has long-tenure in the NPI registry, enumerated 2005-06-01 (~21 years ago), which supports an interpretation of operational stability and established referral patterns in the Toledo, OH market. That longevity combined with concentrated Medicare drug/injection revenue and high imaging use frames the practice as a stable, injection-focused retina specialist with strong diagnostic throughput and selective adoption of newer biologics.

Medicare: Complete Services Breakdown

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

21 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,490	$690	$1.7M
J3490	Unclassified drugs	90	$1,770	$160.9K
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.	1,670	$90	$143.4K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	1,130	$120	$133.9K
J2777	Injection, faricimab‑svoa, 0.1 mg	3,600	$30	$104.4K
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.	2,490	$30	$72.3K
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…	770	$80	$62K
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…	480	$90	$42.1K
J3590	Unclassified biologics	400	$100	$38.7K
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	$870	$17.4K

Showing 1–10 of 21

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Ohio Distribution

Philip Nelsen — 2 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. state median

21 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	9	100	840	$680	$729K
J2777	57	70	9,480	$30	$353.3K
J2781	8	20	1,040	$120	$152.4K
J3490	30	50	100	$560	$73.1K
67028	14	150	470	$90	$64K
J3590	30	100	200	$100	$30K
67042	28	50	20	$960	$29.7K
67113	5	20	20	$1,090	$22.8K
67036	27	50	20	$870	$21K
92014	35	1,390	100	$70	$12.9K

Showing 1–10 of 21

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cei Physicians Psc LLC	OH	Ophthalmology Physician	$0	$8.5M
Cei Physicians Psc LLC	OH	Ophthalmologic Surgery Clinic/Center	$4.1M	$1M
James Osher	OH	Ophthalmology Physician	$3.7M	$0
Bruce Buerk	OH	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
Juan Lebron	OH	Retina Specialist (Ophthalmology) Physician	$2.7M	$0
Kendall Wannamaker	NC	Ophthalmology Physician	$2.7M	$0
Hang Pham	OH	Ophthalmology Physician	$2.6M	$0
Ahmed Alkaliby	FL	Ophthalmology Physician	$2.6M	$0
Cei Physicians Psc LLC	OH	Ambulatory Surgical Clinic/Center	$1.9M	$680.3K
Robert Sisk	OH	Ophthalmology Physician	$2.5M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Richard Health Systems	OH	Home Health Agency	$0	$13.3M
Philio, Inc.	OH	Community/Behavioral Health Agency	$0	$8.4M
Pinnacle Treatment Centers Oh-ix, LLC	OH	Methadone Clinic	$66.9K	$7.6M
Niraj Shah	OH	Ophthalmology Physician	$1.3M	$0
Charles Dabbs	OH	Retina Specialist (Ophthalmology) Physician	$780K	$0
Jeffery Stephens	OH	Ophthalmology Physician	$540.8K	$0
Reynolds Road Surgical Center Ltd	OH	Ambulatory Surgical Clinic/Center	$324.2K	$0
Fadhil Hussein	OH	Cardiovascular Disease Physician	$307.2K	$0
Ashok Biyani	OH	Orthopaedic Surgery of the Spine Physician	$297.9K	$0
Tyler Vovos	OH	Orthopaedic Surgery Physician	$293.7K	$0

Philip Nelsen — Billing Profile & Reimbursement Data

Sign up for Philip Nelsen — Billing Profile & Reimbursement Data policy alerts

Philip Nelsen — Billing Profile & Reimbursement Data

Sign up for Philip Nelsen — Billing Profile & Reimbursement Data policy alerts

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