Rouse, James

Rouse, James was paid $28K by Medicaid between Feb 2018 and Nov 2020, across 7 billing codes. Its largest line is 92012, Ophthalmological services: medical examination and evaluation, intermediate, established patient — 50% of everything it billed.

33Billing provider infoROUSE, JAMES
KNOXVILLE, TN 37920

33aNPI1083877369assigned 07/07/2008

33bProvider typeOphthalmology Physician

28Total paid$28K

24GClaims988

24DCodes billed7

24AFirst – last monthFeb 2018 – Nov 2020

Compared with peers

Next to other Ophthalmology Physician providers in Tennessee

Rank by total paid#46 of 114

Median peer was paid$15K

This provider vs. median1.9×

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	271	$8K
2019	413	$11K
2020	304	$8K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
92012	Ophthalmological services: medical examination and evaluation, intermediate, established patient	50%	490	464	$14K
92014	Ophthalmological services: medical examination and evaluation, comprehensive, established patient	30%	230	208	$8K
92133		8.3%	139	124	$2K
92004	Ophthalmological services: medical examination and evaluation, comprehensive, new patient	4.3%	16	13	$1K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	4.1%	52	47	$1K
92083		2.2%	27	24	$598.02
92015	Determination of refractive state	<1%	34	28	$214.22

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.