Cummins, James
Cummins, James was paid $209K by Medicaid between Jan 2018 and Aug 2022, across 11 billing codes. Its largest line is 92004, Ophthalmological services: medical examination and evaluation, comprehensive, new patient — 21% of everything it billed.
33Billing provider infoCUMMINS, JAMES
SPRING VALLEY, CA 91977
SPRING VALLEY, CA 91977
33aNPI1568595791assigned 03/14/2007
33bProvider typeOptometrist
28Total paid$209K
24GClaims6,829
24DCodes billed11
24AFirst – last monthJan 2018 – Aug 2022
Compared with peers
Next to other Optometrist providers in California
Rank by total paid#294 of 1,899
Median peer was paid$23K
This provider vs. median9.3×
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 | 2,271 | $91K | |
| 2019 | 2,092 | $70K | |
| 2020 | 672 | $14K | |
| 2021 | 1,637 | $31K | |
| 2022 | 157 | $3K |
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 | 21% | 1,140 | 1,118 | $45K |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 19% | 761 | 740 | $41K |
| V2020 | Frames, purchases | 19% | 1,711 | 1,607 | $41K |
| V2200 | Sphere, bifocal, plano to plus or minus 4.00d, per lens | 19% | 360 | 353 | $40K |
| 92225 | 11% | 1,204 | 1,074 | $23K | |
| 92341 | 3.2% | 422 | 417 | $7K | |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 2.4% | 96 | 95 | $5K |
| 92015 | Determination of refractive state | 2.4% | 865 | 856 | $5K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | <1% | 17 | 12 | $1K |
| 92340 | Fitting of spectacles, except for aphakia; monofocal | <1% | 92 | 92 | $1K |
| 92202 | <1% | 161 | 148 | $1K |
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.