Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Guam for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Guam only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Guam (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Todu Guam Foundation Ltd (NPI 1063150530)

Key Findings

Field	Value
Entity Type	Organization
Organization	Todu Guam Foundation Ltd
Address	125 Tun Jesus Crisostomo St Ste 104
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Family Medicine Physician
NPI Enumerated	May 24, 2022

Payer Source	Total Paid
Medicaid	$49.1K
Medicare	$0

TODU GUAM FOUNDATION LTD’s Medicaid revenue is concentrated in new-patient office visits and vaccine administration: the three top Medicaid codes (99204, 99203, and 90472) together account for 53.7% of the provider’s total Medicaid revenue, with 99204 contributing $9.5K (19.3%), 99203 $9.4K (19.1%), and 90472 $7.5K (15.3%). This mix of moderate-complexity new-patient E/M codes and high-volume vaccine administration points to a primary-care practice that is actively onboarding new patients while also delivering routine immunizations.

The provider appears effectively single-payer in scope: there is no Medicare billing on file while Medicaid revenue totals $49.1K, so operations and revenue shown in the dataset are driven entirely by Medicaid activity rather than a split Medicare/Medicaid payer mix. Analysts should treat Medicaid as the sole documented public payer when evaluating this entity’s billing profile.

Competitive standing by code is modest statewide rather than dominant. For the leading codes, 99204 ranks #11 of 20 providers in-state (47th percentile) and 99203 ranks #15 of 24 (39th percentile), both described as "typical, unremarkable volume," while 90472 ranks #4 of 7 (50th percentile), all indicating routine participation rather than market leadership.

Preventive and immunization services are a clear operational focus: high claim counts appear for vaccine administration and screening codes (90471: 246 claims; 90472: 179 claims; 90688: 130 claims) and tuberculin testing (86580: 122 claims). The presence of these codes, together with new-patient E/M volume, suggests the practice delivers well-child/immunization and screening services at scale relative to its overall revenue base.

There are several codes with reported $0 avg paid/claim in the Medicaid file (90707, 90700, 96372), each showing claims but $0 recorded revenue; these entries indicate submitted services with no recorded Medicaid payments in this dataset and should be investigated or flagged when reconciling billing versus payment records. These zero-paid entries contrast with other vaccine codes that do show paid amounts (for example, 90688 has $6 avg paid/claim and $780 revenue).

Established-patient E/M codes generate meaningful but smaller shares of revenue compared with new-patient visits: 99213 accounts for $6.6K (13.5%) and ranks #41 of 48 providers in-state (15th percentile), while 99214 accounts for $4.9K (9.9%) and ranks #32 of 35 (9th percentile). This pattern suggests relatively lower volume of higher-complexity established visits versus peers, reinforcing the interpretation that this practice is weighted toward new-patient intake and preventive services.

Specific items that stand out relative to peers: 90688 (influenza vaccine) ranks #2 of 10 providers in-state (89th percentile), indicating comparatively high flu vaccine activity for this practice despite its overall modest Medicaid revenue. Conversely, several E/M codes fall in low percentiles (e.g., 99214 at the 9th percentile), underscoring the practice’s uneven competitiveness across service types.

The provider’s NPI was enumerated on 2022-05-24 (~4 years ago), making it a relatively recent entrant given the available billing data. With $49.1K in lifetime Medicaid revenue concentrated in a few codes, the practice’s current footprint appears established but small, and its concentration in a few service lines suggests both specialization in primary-care intake/immunization workflows and potential opportunity to diversify services or increase established-patient continuity over time.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	60	$170	$9.5K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	90	$110	$9.4K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	180	$40	$7.5K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	80	$90	$6.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	250	$20	$5.4K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	40	$130	$4.9K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	50	$80	$3.4K
86580	The lab analyst performs an intradermal skin test on a patient to test for tuberculosis.	120	$10	$1.3K
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	130	$10	$780
Q0091	Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	30	$10	$330

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Guam providers billing the same CPT/HCPCS codes.

Claims Volume vs. Guam Distribution

Todu Guam Foundation Ltd — 0 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Guam

Full comparison — all codes billed, vs. Guam median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	41	50	900	$80	$201.7K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	32	40	630	$90	$172.1K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	15	20	140	$110	$35.4K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	6	10	210	$70	$23.4K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	11	20	60	$140	$20.8K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	4	10	180	$30	$16.7K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	5	10	30	$80	$16.2K
86580	The lab analyst performs an intradermal skin test on a patient to test for tuberculosis.	11	20	450	$10	$11.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	7	20	180	$20	$10.1K
Q0091	Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	2	10	30	$40	$2.1K

Showing 1–10 of 13

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Lee	GU	Dentist	$0	$10.9M
Guam Memorial Hospital	GU	General Acute Care Hospital	$0	$3.5M
Rsa - Tumon, LLC	GU	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.9M
Robert Yang	GU	Dentist	$0	$2.4M
Antonio Garcia	GU	Pediatrics Physician	$0	$2.2M
Ma Gladys Linsangan	GU	Pediatrics Physician	$0	$2.2M
Ari Katerelos	GU	Radiation Oncology Physician	$2.1M	$0
Guam X-ray	GU	Vascular & Interventional Radiology Physician	$0	$2.1M
Sarah Clegg	GU	General Practice Dentistry	$0	$1.7M
Peter Kh Go	GU	Surgery Physician	$152.8K	$1.5M

Todu Guam Foundation Ltd — Billing Profile & Reimbursement Data

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Todu Guam Foundation Ltd — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References