Else, James
Else, James was paid $238K by Medicaid between Jan 2018 and Dec 2024, across 8 billing codes. Its largest line is 92004, Ophthalmological services: medical examination and evaluation, comprehensive, new patient — 53% of everything it billed.
33Billing provider infoELSE, JAMES
OSKALOOSA, IA 52577
OSKALOOSA, IA 52577
33aNPI1083692214assigned 01/06/2006
33bProvider typeOptometrist
28Total paid$238K
24GClaims6,625
24DCodes billed8
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Optometrist providers in Iowa
Rank by total paid#46 of 521
Median peer was paid$28K
This provider vs. median8.4×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 1,542 | $73K | |
| 2019 | 936 | $44K | |
| 2020 | 388 | $21K | |
| 2021 | 1,022 | $29K | |
| 2022 | 1,238 | $36K | |
| 2023 | 805 | $18K | |
| 2024incomplete | 694 | $16K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | 53% | 1,382 | 1,353 | $125K |
| 92012 | Ophthalmological services: medical examination and evaluation, intermediate, established patient | 23% | 1,208 | 1,196 | $56K |
| 92002 | 11% | 493 | 493 | $27K | |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 9.3% | 362 | 346 | $22K |
| V2020 | Frames, purchases | 3.1% | 323 | 300 | $7K |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | <1% | 42 | 32 | $732.27 |
| V2756 | Eye glass case | <1% | 228 | 212 | $223.63 |
| 92015 | Determination of refractive state | <1% | 2,587 | 2,569 | $60.20 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.