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

Why is the Medicaid comparison limited to Virginia 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. Virginia (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.

Carlos A. Cruz, Md, PC (NPI 1205221942)

Carlos A. Cruz, Md, PC is a pediatrics physician provider located in Alexandria, Virginia. This profile covers 0 Medicare and 64 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Carlos A. Cruz, Md, PC
Address	3327 Duke St
City	Alexandria
State	VA
ZIP	22314
Taxonomy	Pediatrics Physician
NPI Enumerated	March 31, 2015

Payer Source	Total Paid
Medicaid	$5.6M
Medicare	$0

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

64 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…	21,530	$80	$1.8M
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…	5,900	$120	$702K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,250	$110	$551.5K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	4,660	$110	$488.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3,790	$120	$435.3K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3,010	$100	$292.2K
92552	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the lowest threshold at which the patient can hear.	9,910	$30	$247.7K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	5,690	$20	$119.4K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	3,500	$30	$87.5K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	5,000	$20	$80K

Showing 1–10 of 64

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Carlos A. Cruz, Md, PC — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

64 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	421	3,520	370	$70	$280.7K
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…	145	4,010	290	$50	$199.8K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	63	650	150	$80	$115.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	90	580	150	$70	$109K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	31	630	110	$80	$78.1K
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,…	808	980	140	$70	$70.9K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	47	440	170	$30	$67.4K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	40	370	210	$40	$62.9K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	126	650	440	$20	$60.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	14	430	160	$80	$60.2K

Showing 1–10 of 64

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
City Of Alexandria	VA	Ambulance	$967.2K	$1.4M
Lori Alexander	VA	Physical Therapist	$146.9K	$0
Richard Lee	VA	Foot & Ankle Surgery Podiatrist	$143.5K	$0
Ogechi Onwudiwe	VA	Dermatology Physician	$98.1K	$0
John Charalambopoulos	VA	Internal Medicine Physician	$88.6K	$0
David Weintritt	VA	Surgery Physician	$76.4K	$0
Christina Smith	VA	Physical Therapist	$70.6K	$0
David Macias	VA	Orthopaedic Surgery Physician	$61.8K	$0

Carlos A. Cruz, Md, PC — Billing Profile & Reimbursement Data

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Carlos A. Cruz, Md, PC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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