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.

Grupo Neonatal C.s.p. (NPI 1154487155)

Field	Value
Entity Type	Organization
Organization	Grupo Neonatal C.s.p.
Address	138 Ave Winston Churchill
City	San Juan
State	PR
ZIP	00926
Taxonomy	Neonatal-Perinatal Medicine Physician
NPI Enumerated	December 28, 2006

Payer Source	Total Paid
Medicaid	$6M
Medicare	$0

Key Findings

GRUPO NEONATAL C.S.P. is effectively a single‑payer operator: there is no Medicare billing on file and the practice reports $6M in lifetime Medicaid revenue, indicating Medicaid is the dominant — in practice sole — public payer for this provider’s billed services. This payer concentration shapes its revenue profile and competitive dynamics within Puerto Rico.

Revenue is highly concentrated in a small set of neonatal/critical‑care services: the top three Medicaid codes (99469, 99468, 99291) together account for 83.7% of this provider’s total Medicaid revenue. In particular, 99469 alone generates $4M (65.8% of Medicaid revenue), with 99468 contributing $606.2K (10.1%) and 99291 contributing $473.3K (7.9%).

The code mix and taxonomy align with a NICU‑focused practice model: 99469 (subsequent neonatal critical care), 99468 (initial neonatal critical care) and 99291 (critical care time) dominate revenue, which indicates the group provides both initial and ongoing high‑acuity neonatal care rather than only routine newborn evaluations. Average paid/claim values for those high‑revenue codes — e.g., $2948 for 99469 and $2191 for 99291 — reinforce that high‑acuity encounters drive the majority of dollars.

Competitive standing by code shows a mid‑tier to solid in‑state footprint rather than dominance: for its highest‑revenue code 99469 the group ranks #3 of 6 in Puerto Rico (60th percentile; typical, unremarkable volume), while 99468 ranks #2 of 4 (67th percentile; typical) and 99291 ranks #14 of 43 (67th percentile; typical). These positions indicate meaningful participation in neonatal critical care but not market leadership statewide on these specific codes.

The practice also reports very high volumes of routine newborn E/M claims that generate modest revenue per claim: 99462 appears with 4.2K claims and $249K revenue (4.1% of total Medicaid revenue) and 99460 with 4.2K claims and $245.3K revenue (4.1%). Both codes rank highly versus peers (99462 #4 of 26, 88th percentile; 99460 #4 of 24, 87th percentile), suggesting the group handles large numbers of standard newborn encounters even though those services contribute a small share of total dollars.

Some less‑frequent neonatal critical codes show low absolute volumes despite being present in the mix: examples include 99472 ($215K, 3.6% of revenue; ranks #4 of 4, 0th percentile; typical, unremarkable volume) and 99471 ($23.1K, 0.4% of revenue; ranks #3 of 3, 0th percentile; typical). These listings imply the practice’s critical‑care revenue is concentrated in a few high‑value codes rather than spread across many specialized CPTs.

Long tenure in the public billing system is evident: the NPI was enumerated 2006-12-28 (~20 years ago), which supports the interpretation of an established neonatal specialty practice in San Juan with sustained Medicaid reimbursement history. That longevity can be useful context for peer comparisons and operational stability assessments.

From a business perspective, the combination of heavy Medicaid dependence and extreme revenue concentration in a few neonatal critical‑care codes creates both a clear strategic identity and a potential vulnerability: policy or reimbursement changes affecting 99469, 99468, or 99291 would disproportionately affect this provider. At the same time, the high average paid/claim levels for the top codes show Medicaid presently reimburses these neonatal critical‑care services at materially higher amounts per encounter than routine newborn E/M codes, which is why fewer high‑volume, high‑acuity encounters produce the bulk of revenues.

Medicaid: Complete Services Breakdown

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
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	1,340	$2,950	$4M
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	1,030	$590	$606.2K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	220	$2,190	$473.3K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	4,150	$60	$249K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	4,230	$60	$245.3K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	120	$1,750	$215K
99464	The provider is present during the delivery, at the request of the delivering provider, and during the basic stabilization of the newborn immediately after birth, typically when fetal distress or…	2,740	$70	$186K
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…	1,290	$50	$61.9K
99471	The provider performs initial evaluation and management of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	80	$290	$23.1K

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

Grupo Neonatal C.s.p. — 0 of 9 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

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3	10	740	$1,410	$2.9M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	4	10	850	$660	$860.2K
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	2	10	590	$500	$535.1K
99471	The provider performs initial evaluation and management of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	3	10	200	$420	$223.2K
99464	The provider is present during the delivery, at the request of the delivering provider, and during the basic stabilization of the newborn immediately after birth, typically when fetal distress or…	3	10	1,460	$70	$144.1K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	14	40	130	$210	$122.8K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	4	30	250	$40	$108.9K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	4	20	210	$70	$98.8K
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…	33	250	180	$30	$23.1K

Nearby Providers

Other providers in the same ZIP code as Grupo Neonatal C.s.p., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Farmacia Doral, Inc.	PR	Specialty Pharmacy	$0	$115.6M
Aps Clinics Of Puerto Rico, Inc.	PR	Adult Mental Health Clinic/Center	$0	$5.7M
Alejandro Marmolejo	PR	General Practice Physician	$2.5K	$2.1M
Bvr Ambulance Best Care Inc	PR	Land Ambulance	$10.2K	$1.6M
Jan Rodriguez Ferrer	PR	Internal Medicine Physician	$60.6K	$1.4M
Nuvasive Pr, Inc.	PR	Durable Medical Equipment & Medical Supplies	$0	$1.2M
Rebeca Cuebas	PR	Pediatrics Physician	$0	$1M
Cck Medical Csp	PR	Cardiovascular Disease Physician	$0	$983K
Renato Rivera	PR	Family Medicine Physician	$0	$886.7K
Carlos Maldonado	PR	General Practice Dentistry	$0	$859K

Grupo Neonatal C.s.p. — Billing Profile & Reimbursement Data

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Grupo Neonatal C.s.p. — 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