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.

Michael Agustin (NPI 1215248356)

Key Findings

Field	Value
Entity Type	Individual
Organization	Michael Agustin
Address	133 Route 3
City	Dededo
State	GU
ZIP	96929
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	June 23, 2010

Payer Source	Total Paid
Medicare	$39.9K
Medicaid	$0

This provider, MICHAEL AGUSTIN (Pulmonary Disease Physician) in DEDEDO, GU, has a modest lifetime Medicare footprint totaling $39.9K and no Medicaid billing on file (none (no Medicaid billing on file)), making the practice effectively single‑payer in the available data. The absence of any Medicaid claims suggests payer-mix analysis and network negotiations should be focused on Medicare dynamics rather than dual‑payer strategies.

Revenue is concentrated: the precomputed top-three Medicare codes (99214, 99213, 99222) account for 56.0% of this provider's total Medicare revenue, with 99214 alone representing $11.2K (27.9%) and 99213 contributing $6.5K (16.3%). This concentration indicates that a small number of office and initial hospital E/M codes drive the majority of reported Medicare income.

The code mix is consistent with a pulmonology practice that combines outpatient evaluation-and-management with inpatient consults and procedure-based pulmonary function testing. High-volume E/M office visit codes such as 99214 and 99213 alongside inpatient initial visit codes like 99222 (46 claims, $4.7K revenue) and subsequent visit code 99232 (69 claims, $4.2K revenue) show active involvement in both clinic and inpatient settings.

Although the provider's overall Medicare revenue is limited, relative volume by code shows contrasting competitive positions: 99214 ranks #188570 of 479517 providers nationally (60th percentile; typical, unremarkable volume for this code) and 99213 ranks #130619 of 457151 (71th percentile; typical, unremarkable volume for this code), indicating ordinary national standing on office visits. By contrast, pulmonary function testing codes demonstrate comparatively higher national rank percentiles—94010 ranks #570 of 8774 (93th percentile; typical, unremarkable volume for this code) and 94729 ranks #771 of 8928 (91th percentile; typical, unremarkable volume for this code)—which suggests stronger relative activity in PFT services versus peers.

The provider performs a substantial number of testing encounters: 94010 had 277 claims ($1.7K revenue, 4.2% of Medicare revenue), 94729 had 251 claims ($1.8K, 4.4%), 94726 had 177 claims ($1.6K, 4.0%), and 94618 had 99 claims ($1.7K, 4.2%). These volumes, combined with their higher national rank percentiles (many in the upper 80s–90s), indicate that pulmonary function testing is a meaningful operational service line that contributes a nontrivial share of the practice’s Medicare mix.

Hospital-based E/M involvement is notable: 99222 (46 claims, $4.7K, 11.7%) and 99232 (69 claims, $4.2K, 10.5%) together show the provider is doing moderate-complexity initial and subsequent inpatient/observation care. The presence of 99223 (14 claims, $2K, 4.9%) further indicates occasional higher-complexity inpatient evaluations, although 99223 ranks relatively low nationally (#123465 of 139583; 9th percentile; typical, unremarkable volume for this code).

The provider’s tenure is well-established: the NPI was enumerated 2010-06-23 (~16 years ago), which supports interpreting current billing patterns as those of an experienced, stable clinician rather than a new entrant. Analysts should consider that observed revenue and code mix reflect many years of possible practice evolution but a relatively small recorded Medicare revenue base in the available data.

Given the small absolute Medicare revenue ($39.9K) but focused service lines, competitive or contracting decisions should weigh strength in pulmonary function testing and mixed outpatient/inpatient E/M work rather than broad primary-care-level office visit dominance. The data suggest a niche operational profile—modest overall Medicare scale but comparatively higher activity in PFT-related codes relative to national peers—which could influence network value differently than headline revenue alone would imply.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	150	$70	$11.2K
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…	150	$40	$6.5K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	50	$100	$4.7K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	70	$60	$4.2K
99442	N/A	50	$50	$2.2K
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…	10	$140	$2K
94729	In this add on procedure, the provider tests the lungs’ diffusing capacity, the ability to exchange gases, moving oxygen into the bloodstream and letting in carbon dioxide from the bloodstream.	250	$10	$1.8K
94618	The provider performs pulmonary stress testing to evaluate lung function and to diagnose certain lung disorders. The stress component may include a six–minute walk test or other form of exercise.	100	$20	$1.7K
94010	The provider or technician administers a spirometry test to assess the patient's respiratory function. The spirometer is attached to a computer that records the total and timed vital capacity…	280	$10	$1.7K
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…	20	$110	$1.6K

Showing 1–10 of 13

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Guam Healthcare Development Incorporated	GU	Clinic/Center	$0	$30.8M
C V Alegria Dds Inc	GU	General Practice Dentistry	$0	$11.3M
Albert Huang	GU	Dentist	$0	$5.4M
Usrc Finegayan, LLC	GU	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.5M
Renal Centers Of Guam, LLC	GU	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.1M
Government Of Guam Department Of Administration	GU	Federally Qualified Health Center (FQHC)	$0	$2.4M
Maria Chela Mariano	GU	Family Medicine Physician	$0	$1.8M
Scott Shay	GU	Vascular & Interventional Radiology Physician	$1.2M	$0
Anthony Bekkerman	GU	Emergency Medicine Physician	$49.5K	$623.9K
Blue Ocean Medical Group LLC	GU	Family Medicine Physician	$0	$665.1K

Michael Agustin — Billing Profile & Reimbursement Data

Sign up for Michael Agustin — Billing Profile & Reimbursement Data policy alerts

Michael Agustin — Billing Profile & Reimbursement Data

Sign up for Michael Agustin — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	43	90	140	$90	$25.7K
99232	24	30	150	$60	$12.1K
99213	37	100	100	$60	$10.6K
99223	18	20	30	$130	$7K
99204	38	50	30	$110	$6.7K
99442	2	10	80	$50	$3.6K
99222	3	20	30	$100	$2.8K
99203	20	40	30	$70	$2.5K
94010	1	10	280	$10	$1.7K
94726	1	10	180	$10	$1.6K