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.

Special Care Pharmacy Services, LLC (NPI 1205819729)

Field	Value
Entity Type	Organization
Organization	Special Care Pharmacy Services, LLC
Address	1109 Brumbaugh, Arzuaga 53,55
City	San Juan
State	PR
ZIP	00925
Taxonomy	Pharmacy
NPI Enumerated	November 29, 2005

Payer Source	Total Paid
Medicaid	$12.9M
Medicare	$0

Key Findings

This provider is effectively single‑payer in the available data: there is no Medicare billing on file and all reported lifetime revenue is Medicaid at $12.9M. That absence of Medicare activity indicates the organization operates primarily within the Medicaid channel rather than serving a mixed Medicare/Medicaid beneficiary base.

Revenue is highly concentrated in a very small set of drug codes: the precomputed top 3 Medicaid codes account for 75.7% of this provider's total Medicaid revenue, and a single code, J0178, contributes $7.7M or 59.9% of Medicaid revenue. This concentration means a large share of the business depends on utilization and reimbursement for aflibercept (J0178).

The claim and code mix point to a specialty infusion/pharmacy operation focused on oncology and high‑cost biologic agents: the largest codes are J0178 (aflibercept, 3.8K claims), J9035 (bevacizumab, 183 claims), and J9271 (pembrolizumab, 79 claims), and the roster also includes trastuzumab (J9355), rituximab (J9312), and multiple chemotherapy agents. The presence of nursing and home infusion codes such as T1030 and S9379 alongside high‑unit biologics suggests the provider offers coordinated home infusion or outpatient infusion support in addition to drug dispensing.

Competitive standing is mixed across products: for J0178 the provider ranks #1 of 3 providers in‑state and is listed at the 100th percentile while the statistical label given is "typical, unremarkable volume," indicating it is the leading in‑state supplier for that specific code but not flagged as an extreme statistical outlier. By contrast, for J9035 the provider ranks #14 of 23 (41th percentile; typical, unremarkable volume) and for J9271 it ranks #5 of 6 (20th percentile; typical, unremarkable volume), reflecting a more modest statewide position on other oncology biologics.

Operational footprint evidence supports an infusion‑centric workflow: high claim counts for J0178 (3.8K claims) and supportive home/nursing codes such as T1030 (2.5K claims) and S9379 (1.6K claims) indicate substantial per‑claim activity and capacity to manage drug administration and care coordination. Those claim volumes, coupled with high average paid/claim values reported for certain drugs (for example $2006 avg paid/claim for J0178 and $6125 avg paid/claim for J9035), imply the organization handles both frequent lower‑unit admin and fewer very high‑unit, high‑cost drug dispensations.

The code‑level statistical labels provided show most of this provider's activity described as "typical, unremarkable volume" across many listed drugs (e.g., J0178, J9035, J9271, J1569), despite strong revenue concentration in a single code. That pattern suggests the provider is not widely anomalous across many products statewide but is commercially dependent on a narrow set of high‑revenue items.

Concentration in one dominant product creates revenue sensitivity: with $7.7M attributed to J0178 (59.9% of Medicaid revenue) and the top 3 codes together making up 75.7% of Medicaid revenue, reimbursement or utilization shifts for aflibercept or the other two leading codes could materially impact total revenue. Payers and network analysts should view contracting or utilization management changes for these specific agents as high‑leverage for this provider’s financials.

The provider has an established presence over time, with NPI enumeration on 2005-11-29 (~21 years ago), which supports the interpretation that this specialty pharmacy/home infusion operation is a longstanding local participant rather than a recent entrant. Longevity combined with the narrow product concentration frames this entity as a focused, experienced Medicaid supplier with strategic exposure concentrated in a few oncology/biologic codes.

Medicaid: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	3,850	$2,010	$7.7M
J9035	Injection, bevacizumab, 10 mg	180	$6,130	$1.1M
J9271	Injection, pembrolizumab, 1 mg	80	$11,610	$917.5K
J9395	Injection, fulvestrant, 25 mg	480	$1,500	$713K
J9355	Injection, trastuzumab, excludes biosimilar, 10 mg	140	$4,640	$630.6K
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	90	$6,070	$551.9K
J0897	Injection, denosumab, 1 mg	220	$2,130	$464.6K
J9312	Injection, rituximab, 10 mg	20	$7,240	$151.9K
J0585	Injection, onabotulinumtoxina, 1 unit	130	$1,150	$149K
T1030	Nursing care, in the home, by registered nurse, per diem	2,470	$50	$133.3K

Showing 1–10 of 28

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

Special Care Pharmacy Services, LLC — 1 of 25 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

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	5	10	220	$9,780	$16.9M
J9299	Injection, nivolumab, 1 mg	4	10	1,120	$7,470	$8M
J9306	Injection, pertuzumab, 1 mg	4	10	420	$5,490	$5M
J9355	Injection, trastuzumab, excludes biosimilar, 10 mg	4	10	490	$4,520	$4.4M
J0178	Injection, aflibercept, 1 mg	1	10	1,480	$1,790	$3.7M
J9312	Injection, rituximab, 10 mg	4	10	720	$4,970	$3.3M
J0897	Injection, denosumab, 1 mg	3	10	940	$2,500	$3.2M
J9035	Injection, bevacizumab, 10 mg	14	20	370	$2,820	$2.3M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	2	10	440	$3,400	$1.5M
J9395	Injection, fulvestrant, 25 mg	3	10	750	$1,210	$903K

Showing 1–10 of 28

Nearby Providers

Other providers in the same ZIP code as Special Care Pharmacy Services, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratorio Clinico Rio Piedras I	PR	Clinical Medical Laboratory	$0	$702.3K
Laboratorio Clinico Borges	PR	Clinical Medical Laboratory	$0	$679.7K
Carmen Amaral	PR	Ophthalmology Physician	$990	$673.3K
Walgreen Co	PR	Pharmacy	$78.2K	$0
Maria Zweig	PR	Specialist	$26.8K	$0
Brenda Orta Rodriguez	PR	Geriatric Physical Therapist	$21.6K	$0
Gloriva Pina	PR	Counseling Psychologist	$0	$19.6K
Ivelisse Sambolin Jessurun	PR	Physical Medicine & Rehabilitation Physician	$19.4K	$0
Ricardo Gago Pinero	PR	Rheumatology Physician	$13.6K	$0
Roberto Buxeda	PR	Ophthalmology Physician	$5.6K	$5.5K

Special Care Pharmacy Services, LLC — Billing Profile & Reimbursement Data

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Special Care Pharmacy Services, 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