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NPI 1184680480 · Aibonito, PR · Nuclear Medicine Physician
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Sandra Gracia-lopez is a nuclear medicine physician provider located in Aibonito, Puerto Rico. This profile covers 4 Medicare and 14 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 | Sandra Gracia-lopez |
| Address | Ave. Jose Vazquez Esq. Dr. Troyer |
| City | Aibonito |
| State | PR |
| ZIP | 00705 |
| Taxonomy | Nuclear Medicine Physician |
| NPI Enumerated | April 25, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $4.1M |
| Medicare | $26.7K |
This provider’s payer mix is heavily weighted to Medicaid: reported lifetime Medicare revenue is $26.7K while lifetime Medicaid revenue is $4.1M, making Medicaid by far the dominant source of billed revenue for the practice. In practical terms the operation functions as a Medicaid-focused nuclear medicine provider rather than a Medicare-driven practice.
Clinical/service-line mix centers on high-end nuclear imaging and radiopharmaceutical dispensing: top codes are PET FDG imaging 78816 and cardiac SPECT 78452, supported by frequent billing for radiopharmaceutical supply codes such as A9500 and A9552. The combination of diagnostic imaging codes and per‑dose drug codes is consistent with an outpatient imaging center or nuclear medicine service that administers tracers and performs both oncologic PET and cardiac perfusion studies.
Medicare revenue is extremely concentrated: the top 3 Medicare codes by revenue account for 96.7% of this provider’s total Medicare revenue, driven primarily by 78816 (61.1%), 78452 (22.6%), and A9500 (12.9%). Despite this concentration, each of those Medicare code lines registers at modest national volumes (for example, 78816 ranks #1722 of 1983 providers nationally, 9th percentile; 78452 ranks #13289 of 14946, 10th percentile), indicating a limited national footprint on Medicare.
Medicaid revenue is also concentrated but more substantial: the top 3 Medicaid codes by revenue account for 77.9% of this provider’s total Medicaid revenue, led by 78816 (42.9%), 78452 (24.2%), and A9552 (10.8%). This profile signals that Medicaid reimbursement for PET and cardiac nuclear studies plus associated tracer supply is the core revenue engine for the practice.
Within Puerto Rico the provider shows competitive strength on several Medicaid lines: 78816 ranks #4 of 10 providers in-state (67th percentile; typical, unremarkable volume for this code), while 78452 ranks #3 of 20 providers in-state (89th percentile; notably above typical state volume for this code). The practice is particularly prominent on radiopharmaceutical supply: A9500 ranks #1 of 10 providers in-state (100th percentile; notably above typical state volume for this code), marking it as a leading local supplier for that dose item.
By contrast, the provider’s Medicare standing is modest nationally across its core codes: 78816 ranks #1722 of 1983 providers nationally (9th percentile; typical, unremarkable volume for this code), 78452 ranks #13289 of 14946 providers nationally (10th percentile; typical, unremarkable volume), and A9500 ranks #3295 of 4099 providers nationally (19th percentile; typical, unremarkable volume). Those national percentiles point to low Medicare volume relative to peers despite concentration of Medicare revenue in a few codes.
The provider has long tenure in the NPI registry (enumerated 2006-04-25, ~20 years ago), which supports interpretation that current billing patterns reflect an established local practice rather than a short‑term or newly opened operation. Sustained enrollment combined with large Medicaid volumes suggests entrenched referral and operational relationships in Aibonito, PR.
Revenue concentration creates operational sensitivity: with Medicaid making up the bulk of receipts and the top 3 Medicaid codes accounting for 77.9% of Medicaid revenue, changes in Medicaid reimbursement policy, tracer pricing, or in-state referral patterns for PET/cardiac SPECT could materially affect total revenue. Conversely, the very small Medicare footprint ($26.7K lifetime) limits Medicare upside and increases the provider’s exposure to Medicaid market dynamics.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 78816 | The patient is injected with a radiopharmaceutical tracer called FDG (fluoro–deoxyglucose, a radioactive substance containing glucose) about one hour before the imaging is scheduled to begin. The… | 10 | $1,260 | $16.3K |
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 20 | $340 | $6K |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 40 | $90 | $3.5K |
| 93015 | The provider supervises the recording of the electrical activity of the heart to examine any abnormality in its functioning by obtaining blood pressure and electrocardiograph readings at regular… | 20 | $50 | $880 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.
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.
14 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 78816 | The patient is injected with a radiopharmaceutical tracer called FDG (fluoro–deoxyglucose, a radioactive substance containing glucose) about one hour before the imaging is scheduled to begin. The… | 930 | $1,880 | $1.7M |
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 2,370 | $410 | $981.2K |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 910 | $480 | $436.8K |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 2,440 | $170 | $405K |
| 93015 | The provider supervises the recording of the electrical activity of the heart to examine any abnormality in its functioning by obtaining blood pressure and electrocardiograph readings at regular… | 2,370 | $100 | $239K |
| J0153 | Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) | 1,260 | $130 | $169.1K |
| 78227 | The provider images the liver, bile, bile ducts, and gallbladder to follow the production and flow of bile from the liver to the small intestine to diagnose a bile duct obstruction or leakage;… | 150 | $310 | $47K |
| J2805 | Injection, sincalide, 5 micrograms | 150 | $70 | $10.2K |
| A9503 | Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries | 320 | $30 | $8.8K |
| 78306 | The provider performs a bone scan (also known as scintigraphy), a specialized nuclear medicine procedure in which the provider injects a radionuclide prior to imaging to examine the various bones of… | 30 | $250 | $6.4K |
Showing 1–10 of 14
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
14 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 78816 | The patient is injected with a radiopharmaceutical tracer called FDG (fluoro–deoxyglucose, a radioactive substance containing glucose) about one hour before the imaging is scheduled to begin. The… | 4 | 10 | 490 | $1,200 | $840.9K |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 6 | 10 | 830 | $450 | $450.4K |
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 3 | 20 | 260 | $250 | $174.9K |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 1 | 10 | 300 | $160 | $104.5K |
| J0153 | Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) | 1 | 10 | 430 | $110 | $65.8K |
| 93015 | The provider supervises the recording of the electrical activity of the heart to examine any abnormality in its functioning by obtaining blood pressure and electrocardiograph readings at regular… | 4 | 60 | 200 | $110 | $65.2K |
| 78315 | The provider performs a three–phase bone scan (also known as scintigraphy), a specialized nuclear medicine procedure in which the provider injects a radionuclide prior to imaging to examine the… | 4 | 10 | 40 | $180 | $53.9K |
| 78306 | The provider performs a bone scan (also known as scintigraphy), a specialized nuclear medicine procedure in which the provider injects a radionuclide prior to imaging to examine the various bones of… | 6 | 10 | 30 | $130 | $25.4K |
| 78227 | The provider images the liver, bile, bile ducts, and gallbladder to follow the production and flow of bile from the liver to the small intestine to diagnose a bile duct obstruction or leakage;… | 4 | 10 | 110 | $170 | $22K |
| A9503 | Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries | 3 | 10 | 180 | $30 | $16.6K |
Showing 1–10 of 14
Other providers in the same ZIP code as Sandra Gracia-lopez, ranked by combined Medicare and Medicaid revenue.
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