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.

Juan Rivera (NPI 1114923851)

Field	Value
Entity Type	Individual
Organization	Juan Rivera
Address	Hospital Episcopal Cristo Redentor
City	Guayama
State	PR
ZIP	00785
Taxonomy	General Practice Physician
NPI Enumerated	June 27, 2005

Payer Source	Total Paid
Medicaid	$997K
Medicare	$0

Medicaid: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	2,870	$110	$321.2K
99218	N/A	5,010	$60	$285.3K
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…	3,950	$50	$185.5K
29581	The provider applies a layered bandage to the lower leg, ankle, and foot, to treat venous stasis ulcers and venous insufficiency, the failure of the blood veins immediately below the skin. A…	3,310	$30	$92.7K
97597	The provider excises devitalized (dead) tissue from an open wound, choosing from a variety of techniques; treatment may include topical application of medicine or materials, wound assessment,…	1,610	$40	$70.7K
29058	The provider applies a plaster cast to the upper forearm and shoulder. The plaster Velpeau cast holds a flexed forearm against the patient's trunk and prevents movement in all joints in the treatment…	280	$50	$14.9K
99217	N/A	520	$30	$13.5K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	140	$20	$2.9K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	410	$10	$2.9K
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…	40	$60	$2.3K

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Puerto Rico Distribution

Juan Rivera — 3 of 14 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. Puerto Rico median

16 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	196	340	210	$70	$81.7K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	158	180	170	$80	$55.3K
29581	The provider applies a layered bandage to the lower leg, ankle, and foot, to treat venous stasis ulcers and venous insufficiency, the failure of the blood veins immediately below the skin. A…	1	10	1,690	$30	$47.4K
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…	459	3,230	330	$10	$42.4K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	1	10	70	$100	$40.3K
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…	1,073	1,400	160	$50	$29.6K
99218	N/A	1	120	180	$50	$26.2K
97597	The provider excises devitalized (dead) tissue from an open wound, choosing from a variety of techniques; treatment may include topical application of medicine or materials, wound assessment,…	4	20	260	$20	$25.8K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	104	250	180	$30	$23.1K
29058	The provider applies a plaster cast to the upper forearm and shoulder. The plaster Velpeau cast holds a flexed forearm against the patient's trunk and prevents movement in all joints in the treatment…	1	10	280	$50	$15K

Showing 1–10 of 16

Nearby Providers

Other providers in the same ZIP code as Juan Rivera, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Luis Lugo Rivera	PR	General Practice Physician	$3K	$1M
Advanced Physical Therapy Inc	PR	Home Health Agency	$0	$1M
Southeastern Healthcare Holdings LLC	PR	Specialist	$0	$929.7K
Jose Rivera Rivera	PR	General Practice Dentistry	$0	$760.8K
Robert Santiago	PR	Physical Therapist	$5.8K	$0

Juan Rivera — Billing Profile & Reimbursement Data

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Juan Rivera — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References