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 Puerto Rico for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Puerto Rico 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. Puerto Rico (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.

Pablo Lopez-baez (NPI 1104987437)

Field	Value
Entity Type	Individual
Organization	Pablo Lopez-baez
Address	Santa Rosa Mall
City	Bayamon
State	PR
ZIP	00959
Taxonomy	Plastic Surgery within the Head & Neck (Otolaryngology) Physician
NPI Enumerated	December 12, 2006

Payer Source	Total Paid
Medicare	$105.9K
Medicaid	$0

Key Findings

This provider’s Medicare book of business is modest in absolute size, with total Medicare revenue reported as $105.9K and no Medicaid billing on file, meaning the provider is effectively a single-payer (Medicare) reporter in the available data. The absence of any Medicaid claims should be treated as a clear indicator that Medicaid does not contribute to this provider’s revenue mix in the dataset.

Revenue is highly concentrated in a small set of procedures: the precomputed top-3 Medicare codes account for 92.1% of the provider’s total Medicare revenue. The three dominant codes are 31233 ($59K, 55.7% of Medicare revenue), 99215 ($19.4K, 18.3% of Medicare revenue), and 69000 ($19.1K, 18.0% of Medicare revenue), showing reliance on a narrow set of services for almost all reported Medicare payments.

The procedural mix points to an operative, head-and-neck surgical focus consistent with the provider’s taxonomy (Plastic Surgery within the Head & Neck (Otolaryngology) Physician). Code 31233 describes endoscopic maxillary sinus access and opening, and code 69000 is an incision and drainage of an external ear abscess; together with high-level office visits (99215/99214), this suggests a practice that combines ambulatory procedural care with complex outpatient management.

31233 shows a relatively elevated national placement: 268 claims, $220 avg paid/claim, $59K revenue, ranked #4 of 31 providers nationally and at the 90th percentile; the dataset also characterizes the volume for this code as "typical, unremarkable." This combination (high percentile but described as typical) implies the provider performs this sinus procedure at a higher-than-average frequency among a small national peer set, but the underlying label cautions that the observed volumes are not flagged as unusual in the source characterization.

69000 (incision and drainage of an ear abscess) reports 265 claims, $72 avg paid/claim, $19.1K revenue and ranks #1 of 2 providers nationally (100th percentile) while being labeled "typical, unremarkable volume for this code." The #1 ranking is driven by a very small national denominator (2 providers), so the apparent top position should be interpreted cautiously and not automatically read as broad market dominance.

99215 (high-level established patient E/M) contributes $19.4K from 178 claims at $109 avg paid/claim and ranks #14029 of 145531 providers nationally (90th percentile) with the same "typical, unremarkable" volume characterization. This indicates the provider also delivers substantial complex office-based management alongside procedural work, and the 90th percentile rank reflects stronger relative positioning for E/M services compared with many peers.

The provider’s NPI was enumerated on 2006-12-12 (~20 years ago), indicating an established practice tenure. Combined with the concentrated Medicare revenue and the procedural/E/M mix, the tenure suggests an ongoing referral or patient base that supports both ambulatory procedures and higher-acuity outpatient visits.

For payers and network analysts, the small absolute Medicare revenue ($105.9K) and the extreme concentration in three codes imply that contracting, utilization review, or prior authorization focus could be narrowly targeted to a few high-impact services. The lack of Medicaid activity reduces the provider’s cross-payer negotiation leverage and means Medicaid-specific network strategies or performance comparisons are not supported by the claims on file.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
31233	The provider perforates the canine fossa or inferior meatus to advance an endoscope into the maxillary sinus. She then opens the maxillary sinus to perform a diagnostic endoscopy.	270	$220	$59K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	180	$110	$19.4K
69000	The provider performs a simple incision and drainage an abscess, i.e., a collection of pus, or a hematoma, i.e., a mass of blood, in the external ear. He performs this procedure to relieve pain and…	270	$70	$19.1K
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…	80	$100	$8.3K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Puerto Rico Distribution

Pablo Lopez-baez — 1 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. state median

4 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
31233	1	10	160	$220	$34.4K
69000	1	10	270	$70	$19.1K
99214	131	470	50	$80	$6.6K
99215	5	50	30	$110	$6K

Nearby Providers

Other providers in the same ZIP code as Pablo Lopez-baez, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ct Radiology Complex, LLC	PR	Diagnostic Radiology Physician	$0	$6.2M
Ruben Diaz - Rodriguez	PR	Pediatric Cardiology Physician	$0	$3.9M
Pk Industries Corp	PR	Oxygen Equipment & Supplies (DME)	$0	$3.3M
Doctors Center Hospital Bayamon Inc	PR	General Acute Care Hospital	$0	$3.1M
Laboratorios Clinico Bayamon Inc	PR	Clinical Medical Laboratory	$14K	$2.5M
Bayamon Medical Center Corp	PR	General Acute Care Hospital	$0	$2.3M
New Vision Medical Diagnostics Inc	PR	Clinical Medical Laboratory	$0	$1.9M
Centro De Patologia Avanzada De Pr Csp	PR	Clinical Pathology/Laboratory Medicine Physician	$0	$1.8M
Vitreo Retinal Consultants, Psc	PR	Specialist	$0	$1.5M
Stereotactic Breast Center Psc	PR	Ambulatory Surgical Clinic/Center	$0	$1.3M

Pablo Lopez-baez — Billing Profile & Reimbursement Data

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Pablo Lopez-baez — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References