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NPI 1063603553 · Providence, RI · MOHS-Micrographic Surgery Physician
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Antonio Cruz is a mohs-micrographic surgery physician provider located in Providence, Rhode Island. This profile covers 24 Medicare and 9 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Antonio Cruz |
| Address | 1287 N Main St |
| City | Providence |
| State | RI |
| ZIP | 02904 |
| Taxonomy | MOHS-Micrographic Surgery Physician |
| NPI Enumerated | August 8, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $767.5K |
| Medicaid | $122.7K |
Provider is a Mohs-Micrographic Surgery Physician by taxonomy and Medicare billing confirms a surgical, skin-cancer–focused practice: total Medicare revenue is $767.5K with procedural Mohs codes and reconstruction codes dominating the Medicare portfolio. The presence of multiple 1731x Mohs codes and adjacent tissue transfer/graft codes in the top Medicare list indicates routine delivery of staged excision (Mohs) and subsequent defect repair in Medicare beneficiaries.
Revenue concentration on Medicare is high within the Mohs code family: the top three Medicare codes by revenue (17311, 17313, 17312) together account for 61.3% of the provider's Medicare revenue. Individually these codes generate $236.9K (17311, 542 claims), $119.7K (17313, 274 claims), and $113.6K (17312, 341 claims), showing the business is substantially driven by multimodality Mohs procedures.
Medicaid revenue is heavily concentrated in evaluation-and-management (E/M) visits rather than Mohs procedures: total Medicaid revenue is $122.7K and the top three Medicaid codes (99213, 99203, 99214) account for 95.6% of that total. The single largest Medicaid line is 99213 with 2.1K claims and $82.5K revenue (67.6% of Medicaid revenue), which signals a high-volume outpatient visit mix for Medicaid patients.
Payer mix is Medicare‑dominant by scale: Medicare revenue ($767.5K) substantially exceeds Medicaid revenue ($122.7K), so the provider’s overall financial footprint is driven primarily by Medicare procedural billing while Medicaid serves as a secondary, visit-focused payer. This split suggests the practice treats Medicare patients for surgical procedures and uses Medicaid largely for office-based care.
Competitive standing for signature Mohs codes is above-average nationally on select lines: 17313 ranks #67 of 2300 providers nationally (97th percentile) and is labeled “notably above typical national volume,” while 17311 (rank #471/2969, 84th percentile) and 17312 (rank #339/2770, 88th percentile) are described as typical but comfortably above median national volume. For in-state Medicaid activity, core E/M codes show above-typical volume as well—99213 ranks #289 of 2046 (86th percentile) and 99203 ranks #77 of 346 (78th percentile)—indicating the provider is a relatively active E/M contributor within Rhode Island.
Medicare top‑25 detail shows substantive reconstructive work accompanying Mohs: codes such as 14041 ($35.6K, 48 claims), 13132 ($30.7K, 158 claims), and 15260 ($17.8K, 22 claims) appear in the highest Medicare lines, all with percentiles indicating typical national volumes. This mix of Mohs plus adjacent tissue transfer and graft codes points to an end-to-end surgical workflow (excision plus repair) billed to Medicare, rather than isolated consults.
Reimbursement profile differs sharply across payers and service types: Medicare Mohs claims report average paid per claim values like $437 for 17311 and $333 for 17312, whereas the largest Medicaid E/M code 99213 shows an average paid per claim of $40. That contrast—higher per-claim payments for Mohs procedures vs lower per-claim payments but much higher claim counts for Medicaid E/M—highlights distinct margins and throughput dynamics by payer and service.
Provider tenure is long and stable: NPI enumerated on 2007-08-08 (~19 years ago), supporting the interpretation that observed high volumes in selected Mohs codes and sustained Medicaid E/M throughput reflect a well-established practice and referral network rather than a newly formed operation.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
24 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 17311 | Mohs surgery is a multi–staged procedure that is performed to excise a malignant lesion layer by layer, along with histo–pathological assessment. The assessment is performed to ensure that the… | 540 | $440 | $236.9K |
| 17313 | Mohs surgery is a multi–staged method of excising a malignant lesion layer by layer, along with histo–pathological assessment, to ensure negative malignancy of the margins. | 270 | $440 | $119.7K |
| 17312 | Mohs surgery is a multi–staged method of excising a malignant lesion layer by layer, along with histo–pathological assessment, to ensure negative malignancy of the margins. | 340 | $330 | $113.6K |
| 14041 | The provider replaces the lesions in the forehead, cheeks, chin, mouth, neck, axillae or armpits, genitalia, hands, or feet with the healthy tissues from an adjacent site. This code represents a… | 50 | $740 | $35.6K |
| 17314 | Mohs surgery is a multi–staged method of excising a malignant lesion layer by layer, along with histo–pathological assessment, to ensure negative malignancy of the margins. | 110 | $320 | $35.4K |
| 13132 | The provider repairs a wound measuring 2.6 cm to 7.5 cm in size of the cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet, which may require scar revision, debridement extensive… | 160 | $190 | $30.7K |
| 14021 | The provider repairs lesions in the patient’s scalp, arms, or legs by using the healthy tissues from an adjacent site. This code represents a defect of 10.1 cm2 to 30.0 cm2. | 40 | $690 | $29.8K |
| 14060 | The provider replaces the lesions in the eyelids, nose, ears, or lips, with the healthy tissues from an adjacent site. This code represents a defect of 10 cm2 or less. | 40 | $600 | $25.2K |
| 14040 | The provider repairs lesions in the patient’s forehead, cheeks, chin, mouth, neck, axillae or armpits, genitalia, hands, and/or feet by using healthy tissues from an adjacent site. This code… | 40 | $610 | $23.2K |
| 13121 | This is for a complex repair of a wound to the scalp, arms, and/or legs. This wound should be 2.6 to 7.5 cm in size. | 120 | $170 | $20.5K |
Showing 1–10 of 24
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 24 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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… | 2,060 | $40 | $82.5K |
| 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… | 370 | $60 | $20.8K |
| 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… | 290 | $50 | $13.4K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 40 | $30 | $1.1K |
| 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… | 10 | $90 | $1.1K |
| 17110 | The provider destroys benign lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of one to 14 lesions other than skin tags or… | 30 | $40 | $1K |
| 11102 | The provider biopsies a single skin lesion using a tangential (side–ways) approach; he shaves off the lesion or scoops it out with a knife or curette. | 30 | $40 | $1K |
| 17000 | The provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of the first or only lesion. | 30 | $20 | $630 |
| 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… | 10 | $40 | $480 |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 760 | 1,730 | 220 | $70 | $75.2K |
| 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… | 289 | 2,050 | 300 | $50 | $72.3K |
| 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… | 274 | 300 | 50 | $130 | $40.6K |
| 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… | 77 | 350 | 80 | $90 | $40.5K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 320 | 500 | 90 | $50 | $24.9K |
| 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… | 87 | 90 | 50 | $60 | $13.8K |
| 17110 | The provider destroys benign lesions using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of one to 14 lesions other than skin tags or… | 21 | 20 | 120 | $30 | $12.7K |
| 11102 | The provider biopsies a single skin lesion using a tangential (side–ways) approach; he shaves off the lesion or scoops it out with a knife or curette. | 7 | 10 | 90 | $50 | $4.7K |
| 17000 | The provider destroys a premalignant lesion using techniques such as chemosurgery, cryosurgery, electrosurgery, or others. This code reports the destruction of the first or only lesion. | 4 | 10 | 60 | $10 | $610 |
Other providers in the same ZIP code as Antonio Cruz, ranked by combined Medicare and Medicaid revenue.
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