Donahue, John

Donahue, John was paid $216K by Medicaid between Jan 2018 and Aug 2023, across 14 billing codes. Its largest line is 92014, Ophthalmological services: medical examination and evaluation, comprehensive, established patient — 35% of everything it billed.

33Billing provider infoDONAHUE, JOHN
PROVIDENCE, RI 02906

33aNPI1164409918assigned 12/22/2005

33bProvider typeOphthalmology Physician

28Total paid$216K

24GClaims6,677

24DCodes billed14

24AFirst – last monthJan 2018 – Aug 2023

Compared with peers

Next to other Ophthalmology Physician providers in Rhode Island

Rank by total paid#6 of 31

Median peer was paid$22K

This provider vs. median9.8×

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	1,593	$51K
2019	189	$7K
2020	976	$37K
2021	1,693	$52K
2022	1,456	$46K
2023	770	$24K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
92014	Ophthalmological services: medical examination and evaluation, comprehensive, established patient	35%	1,683	1,592	$76K
92004	Ophthalmological services: medical examination and evaluation, comprehensive, new patient	14%	499	480	$30K
92015	Determination of refractive state	14%	1,314	1,203	$29K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	8.2%	358	349	$18K
99214	Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	6.9%	236	201	$15K
S0580	Polycarbonate lens (list this code in addition to the basic code for the lens)	6.0%	700	663	$13K
V2020	Frames, purchases	6.0%	787	749	$13K
92340	Fitting of spectacles, except for aphakia; monofocal	5.5%	750	709	$12K
V2103	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	1.9%	123	108	$4K
99222	Initial hospital care, per day, moderate complexity	1.0%	26	24	$2K
92201		<1%	120	82	$1K
92060		<1%	54	51	$1K

2 more codes

92225		<1%	15	$505.43
S0508	Trifocal vision prescription lens (safety, athletic, or sunglass), per lens	<1%	12	$475.20

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.