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NPI 1104800630 · San Juan, PR · Ophthalmology Physician
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Maria Berrocal-fernandez is a ophthalmology physician provider located in San Juan, Puerto Rico. This profile covers 11 Medicare and 3 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 | Maria Berrocal-fernandez |
| Address | 150 Ave De Diego |
| City | San Juan |
| State | PR |
| ZIP | 00907 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | November 29, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $132.2K |
| Medicaid | $15.1K |
This provider’s payer mix is Medicare-dominant: total Medicare revenue is $132.2K versus total Medicaid revenue of $15.1K, so Medicare accounts for the large majority of billings on file. Medicaid activity is present but comparatively limited in scale, indicating the provider operates primarily in the Medicare outpatient eye-care market rather than as a Medicaid-focused practice.
Medicare revenue is concentrated in a small set of services: the precomputed top 3 Medicare codes by revenue account for 63.2% of this provider's total Medicare revenue, driven by 92014 (31.5% of Medicare revenue, $41.6K), 66984 (18.6%, $24.5K), and 67028 (13.2%, $17.4K). This concentration points to a practice model where comprehensive established exams, cataract surgery with IOL insertion, and intravitreal injections are the primary revenue drivers.
The procedure mix suggests a mixed ophthalmology practice that incorporates both surgical and medical retina care: 66984 (cataract extraction with intraocular lens) and 66821 (YAG capsulotomy) indicate cataract surgical volume, while 67028 (intravitreal injection) plus J7999 (compounded drug) and imaging codes like 92134 indicate in-office injection services and diagnostic retinal imaging supporting medical retina management. The presence of both high-volume established-patient exams (92014) and procedural codes implies the provider manages longitudinal outpatient care and same-practice procedural treatment.
On national competitive standing for Medicare-coded services, exam-level activity is solid while surgical and injection volumes are modest. 92014 ranks #5889 of 35415 nationally (83th percentile) and is described as typical, unremarkable volume; 66984 ranks #10069 of 15965 (36th percentile) and 67028 ranks #3166 of 4255 (25th percentile), both characterized as typical, unremarkable volume but lower in national rank for procedural intensity relative to large surgical or retina centers.
Medicaid billing is highly concentrated and clinically routine: the top 3 Medicaid codes account for 100.0% of Medicaid revenue, led by 92012 at 81.2% ($12.4K) with 538 claims, followed by 92134 at 16.9% ($2.6K) and 92201 at 1.9% ($289). This pattern indicates Medicaid services are primarily office-based intermediate exams and retinal imaging rather than high-revenue surgical procedures.
Within the state Medicaid competitive landscape, the provider is middle-to-low tier on key codes: 92012 ranks #177 of 353 in-state (50th percentile) and is labeled typical, unremarkable volume; 92134 ranks #64 of 83 (23th percentile) and 92201 ranks #69 of 75 (8th percentile), both described as typical, unremarkable volume but at lower percentiles in-state, consistent with a local outpatient clinic rather than a regional referral center.
Specific code-level signals show some diagnostic imaging strength on Medicare but otherwise routine utilization: Medicare 92134 (OCT) generates $11.8K and ranks #3822 of 26868 nationally (86th percentile) yet is described as typical, unremarkable volume—indicating respectable OCT use for monitoring retinal disease without being an outlier. Compounded drug billing (J7999) appears in the top Medicare codes ($10.5K, 156 claims) and ranks #562 of 1333 (58th percentile), which is characterized as typical and aligns with in-office injection workflows.
The provider shows long tenure in the NPI registry, enumerated 2005-11-29 (~21 years ago), which supports an established outpatient practice profile and consistent Medicare/Medicaid billing patterns over time rather than a newly started operation. This longevity, combined with the code mix, suggests stable delivery of routine ophthalmic care with supplemental surgical and injection services at modest volumes.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 92014 | An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group… | 470 | $90 | $41.6K |
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 60 | $420 | $24.5K |
| 67028 | The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye. | 180 | $100 | $17.4K |
| 92134 | The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes. | 440 | $30 | $11.8K |
| J7999 | Compounded drug, not otherwise classified | 160 | $70 | $10.5K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 30 | $270 | $8.3K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 70 | $110 | $7.3K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 260 | $20 | $4.2K |
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 40 | $70 | $2.7K |
| 92136 | The provider uses a noninvasive method to measure the patient’s eye or eyes to get information that the provider then uses to calculate the appropriate power for an intraocular lens (IOL). Selecting… | 60 | $30 | $2.1K |
Showing 1–10 of 11
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 11 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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 540 | $20 | $12.4K |
| 92134 | The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes. | 160 | $20 | $2.6K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 20 | $20 | $290 |
How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Puerto Rico median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 177 | 350 | 540 | $50 | $96.4K |
| 92134 | The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes. | 64 | 80 | 650 | $20 | $43.1K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 69 | 80 | 200 | $20 | $15.1K |
Other providers in the same ZIP code as Maria Berrocal-fernandez, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Precision Hearing Center Inc | PR | Audiologist | $0 | $7.3M |
| Laboratorio Clinico Dr. Gualberto Rabell | PR | Clinical Medical Laboratory | $0 | $1.5M |
| Sandra Hurtado Ponce De Leon | PR | Driver | $0 | $1.3M |
| Ubaldo Santiago Buono | PR | Geriatric Medicine (Internal Medicine) Physician | $11.5K | $1.2M |
| Hope Health Psc | PR | Corporate Health Clinic/Center | $0 | $920.7K |
| Francisco Ojeda | PR | General Practice Physician | $0 | $818.2K |
| Raul Montilla | PR | Dentist | $0 | $681.7K |
| Antonio Orraca-gotay | PR | Cardiovascular Disease Physician | $42.3K | $196.7K |
| Carlos Jimenez | PR | Nuclear Medicine Physician | $236.5K | $0 |
| Nanette De Leon | PR | Ophthalmology Physician | $45.9K | $135.7K |
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