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.

Guam E.n.t., LLC (NPI 1124782701)

Field	Value
Entity Type	Organization
Organization	Guam E.n.t., LLC
Address	341 S Marine Corps Dr Ste 104
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Otolaryngology Physician
NPI Enumerated	October 28, 2021

Payer Source	Total Paid
Medicaid	$216.4K
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file and all reported lifetime revenue is Medicaid-based, totaling $216.4K. The absence of Medicare activity suggests the practice’s current patient mix or contracting footprint is focused on Medicaid beneficiaries in Guam rather than dual Medicare/Medicaid panels.

Revenue is highly concentrated in a very small set of services: the precomputed top 3 Medicaid codes account for 92.1% of this provider’s total Medicaid revenue. In particular, 99213 alone represents $155K (71.6% of Medicaid revenue), making it the dominant source of payments for the practice.

The code mix indicates a predominantly ambulatory ENT practice that centers on evaluation and management office visits: 99213 (established patient office visit) and 99203 (new patient office visit) together drive most of the billing. The presence of 99223 (initial hospital inpatient/observation care) and 92504 (microscopic ear examination) in the mix shows occasional inpatient consults and in‑office diagnostic ear evaluations, but these are much smaller revenue contributors.

Volume and payment patterns reinforce the ambulatory focus: 99213 has 2.3K claims with an average paid/claim of $68, 99203 has 397 claims with $95 avg paid/claim, and 99223 has 40 claims with $167 avg paid/claim. These counts and average payments underline that routine office visits (both new and established patients) are the operational backbone of the practice.

Relative competitive standing is modest but serviceable for outpatient E/M codes within Guam: 99213 ranks #16 of 48 providers in-state (68th percentile) and is described as typical/ unremarkable volume, while 99203 ranks #7 of 24 (74th percentile) indicating a somewhat stronger position for new‑patient visits. By contrast, 99223 ranks #5 of 6 (20th percentile), signaling limited scale in inpatient initial care compared with the small peer set.

92504 (microscopic ear exam) appears as a niche service line: 164 claims generating $3.8K (1.7% of Medicaid revenue) and it ranks #1 of 1 providers in-state with a 0th percentile note that no state peer volume comparison is available. Reporting this code as a distinct line item suggests a local capability in direct ear visualization that could be a differentiator in the Guam market given the lack of peer comparators.

The provider’s NPI was enumerated on 2021-10-28 (~5 years ago), indicating a relatively recent enrollment period. Sustained Medicaid billing since enumeration focused on E/M services suggests the practice has established a steady ambulatory workflow centered on office visits rather than hospital- or procedure-heavy subspecialty activity.

Operational and revenue risk is concentrated: with $216.4K in lifetime Medicaid revenue and 71.6% coming from a single code (99213), the practice is sensitive to changes in Medicaid utilization or reimbursement for office E/M visits. Given the lack of Medicare activity, any payer changes that affect Medicaid reimbursement or patient access could disproportionately impact overall revenue.

Medicaid: Complete Services Breakdown

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

7 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…	2,280	$70	$155K
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…	400	$100	$37.7K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	40	$170	$6.7K
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…	60	$110	$6.4K
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…	40	$130	$5.2K
92504	In this diagnostic procedure, the provider uses a microscope to examine the ears of a patient. He may also sometimes examine the patient’s nose for direct visualization to help with diagnosis…	160	$20	$3.8K
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	$50	$1.6K

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

Guam E.n.t., LLC — 0 of 7 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

7 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…	16	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…	31	40	630	$90	$172.1K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	5	10	750	$140	$118K
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…	7	20	140	$110	$35.4K
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,…	15	20	120	$60	$35.1K
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…	12	20	60	$140	$20.8K
92504	In this diagnostic procedure, the provider uses a microscope to examine the ears of a patient. He may also sometimes examine the patient’s nose for direct visualization to help with diagnosis…	1	10	160	$20	$3.8K

Nearby Providers

Other providers in the same ZIP code as Guam E.n.t., LLC, ranked by combined Medicare and Medicaid revenue.

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

Guam E.n.t., LLC — Billing Profile & Reimbursement Data

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Guam E.n.t., LLC — 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