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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
Sister Sites: OpenMedicaid ยท OpenFeds ยท OpenSpending

ยฉ 2026 OpenMedicare. Independent data journalism. Built by TheDataProject.ai

Methodologyโ€ขDownload Data
  1. Home
  2. Providers
  3. Sumit Shah
๐Ÿ‘๏ธ
MDIndividual

Sumit Shah, M.D.

NPI: 1346439213
New Brunswick, NJ
10 years of data
Ophthalmology
$37.0M
Total Payments
181
Beneficiaries
200.0K
Services
3.53x
Markup Ratio

Peer Comparison

99th
percentile in specialty
This provider$37.0M
Specialty median$383.7K
Rank #141 of 189 in specialty

๐Ÿ“‹ Key Findings

1Billed $37.0M over 10 years
23.53x markup ratio (above median)
399th percentile in Ophthalmology by payments
480 services/day โ€” unusually high
517 procedures with >3x markup

This provider averages 80 services per working day

Based on 200.0K total services over 10 years (250 working days/year). Learn about impossible service volumes โ†’

๐Ÿ”Ž Data Analysis

This provider's $37.0M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.

Averaging 80 services per working day raises questions about billing patterns.

Medicare payments to this provider grew 56% from 2014 to 2023.

AI-generated analysis based on Medicare payment data.

Annual Medicare Payments

Annual Services Provided

Avg Payment per Service

Markup Ratio Over Time

Submitted Charges vs. Medicare Payments

Average per-service amounts submitted by the provider compared to what Medicare actually paid โ€” the gap represents the markup.

YearAvg SubmittedAvg PaidMarkup RatioGap per ServiceTotal PaymentsServicesBeneficiaries
2014$500.73$172.802.90x$327.93$2.6M15.3K18
2015$565.90$190.532.97x$375.37$3.8M19.9K22
2016$611.87$203.103.01x$408.77$4.6M22.5K22
2017$574.91$190.203.02x$384.71$4.1M21.4K20
2018$636.00$197.913.21x$438.09$3.8M19.0K19
2019$752.63$196.723.83x$555.91$3.2M16.2K17
2020$890.37$228.613.89x$661.76$3.7M16.2K17
2021$893.14$225.243.97x$667.90$3.5M15.7K13
2022$799.59$191.234.18x$608.36$3.6M18.8K15
2023$513.38$118.134.35x$395.25$4.1M35.0K18

Top Procedures (20)

J2778Injection, ranibizumab, 0.1 mgโš  3.0x markup
$15.7M
56.8K services$276.13/svc3.01x markup
J0178Injection, aflibercept, 1 mgโš  3.4x markup
$13.2M
18.1K services$729.25/svc3.43x markup
67028Injection of drug into eyeโš  5.8x markup
$2.1M
22.8K services$90.58/svc5.77x markup
92014Established patient complete exam of visual systemโš  3.0x markup
$1.9M
18.7K services$101.66/svc3.01x markup
92134Imaging of retinaโš  9.0x markup
$925.4K
25.2K services$36.74/svc8.98x markup
J2777Injection, faricimab-svoa, 0.1 mgโš  4.3x markup
$642.6K
22.0K services$29.26/svc4.27x markup
92012Established patient problem focused exam of visual system
$422.6K
5.7K services$74.32/svc2.83x markup
J3590Unclassified biologicsโš  3.3x markup
$373.5K
181 services$2.1K/svc3.25x markup
99204New patient office or other outpatient visit, 45-59 minutesโš  3.1x markup
$325.7K
2.5K services$129.03/svc3.14x markup
Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mgโš  4.7x markup
$289.8K
1.4K services$214.64/svc4.66x markup
92226Examination of eye by ophthalmoscope with retinal drawingโš  3.9x markup
$217.8K
10.2K services$21.35/svc3.93x markup
92235Exam of retinal blood vessels using a special camera after injection of a dyeโš  3.9x markup
$190.7K
2.1K services$90.13/svc3.85x markup
J7312Injection, dexamethasone, intravitreal implant, 0.1 mg
$160.6K
1.0K services$157.14/svc2.73x markup
92250Photography of the retinaโš  3.8x markup
$80.7K
1.6K services$51.10/svc3.79x markup
92225Examination of eye by ophthalmoscope with retinal drawingโš  3.6x markup
$68.1K
2.9K services$23.47/svc3.62x markup
J3490Unclassified drugsโš  3.1x markup
$58.4K
33 services$1.8K/svc3.14x markup
67145Preventive retinal detachment treatment by heat or laser, 1 or more sessions
$55.9K
126 services$443.28/svc2.78x markup
67042Removal of membrane from the retina, pars plana approachโš  3.6x markup
$55.1K
55 services$1.0K/svc3.56x markup
J9035Injection, bevacizumab, 10 mgโš  7.5x markup
$52.9K
925 services$57.21/svc7.49x markup
67228Destruction of leaking blood vessels of retina using laserโš  7.3x markup
$49.0K
125 services$391.77/svc7.26x markup
Show detailed table โ–พ
CodeDescriptionServicesPaymentsAvg/ServiceMarkup
J2778Injection, ranibizumab, 0.1 mg56.8K$15.7M$276.133.01x
J0178Injection, aflibercept, 1 mg18.1K$13.2M$729.253.43x
67028Injection of drug into eye22.8K$2.1M$90.585.77x
92014Established patient complete exam of visual system18.7K$1.9M$101.663.01x
92134Imaging of retina25.2K$925.4K$36.748.98x
J2777Injection, faricimab-svoa, 0.1 mg22.0K$642.6K$29.264.27x
92012Established patient problem focused exam of visual system5.7K$422.6K$74.322.83x
J3590Unclassified biologics181$373.5K$2.1K3.25x
99204New patient office or other outpatient visit, 45-59 minutes2.5K$325.7K$129.033.14x
Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg1.4K$289.8K$214.644.66x
92226Examination of eye by ophthalmoscope with retinal drawing10.2K$217.8K$21.353.93x
92235Exam of retinal blood vessels using a special camera after injection of a dye2.1K$190.7K$90.133.85x
J7312Injection, dexamethasone, intravitreal implant, 0.1 mg1.0K$160.6K$157.142.73x
92250Photography of the retina1.6K$80.7K$51.103.79x
92225Examination of eye by ophthalmoscope with retinal drawing2.9K$68.1K$23.473.62x
J3490Unclassified drugs33$58.4K$1.8K3.14x
67145Preventive retinal detachment treatment by heat or laser, 1 or more sessions126$55.9K$443.282.78x
67042Removal of membrane from the retina, pars plana approach55$55.1K$1.0K3.56x
J9035Injection, bevacizumab, 10 mg925$52.9K$57.217.49x
67228Destruction of leaking blood vessels of retina using laser125$49.0K$391.777.26x

Markup Analysis

Charge-to-Payment Ratio

3.53x

This provider submits charges 3.53 times higher than what Medicare actually pays.

What This Means

A markup ratio of 3.53x means for every $100 Medicare pays, this provider initially charges $353. This is higher than the national average.

Location

New Brunswick, NJ

Provider Verification

Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.

Similar Providers

Other Ophthalmology providers in NJ for peer comparison.

Sumit Shah (you)
$37.0M
Howard Fine, MD MHSC
$44.5M
Robert Barone, MD
$43.3M
Jonathan Prenner, MD
$43.1M
David Kim, M.D.
$36.1M
Leonard Feiner, M.D
$36.0M
Show detailed table โ–พ
ProviderLocationTotal PaymentsStatus
Howard Fine, MD MHSCNew Brunswick, NJ$44.5Mโœ“ Clear
Robert Barone, MDNewton, NJ$43.3Mโœ“ Clear
Jonathan Prenner, MDNew Brunswick, NJ$43.1Mโœ“ Clear
David Kim, M.D.Union, NJ$36.1Mโœ“ Clear
Leonard Feiner, M.DUnion, NJ$36.0Mโœ“ Clear

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Data Sources

  • โ€ข Centers for Medicare & Medicaid Services (CMS)
  • โ€ข Medicare Provider Utilization and Payment Data (2014-2023)
  • โ€ข National Plan and Provider Enumeration System (NPPES)

Last Updated: February 2026 (data through 2023, the latest CMS release)

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.

Believe this data is inaccurate? Dispute this data