Loading...
NPI 1285664151 · San Luis, AZ · Physician Assistant
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Gilbert Vega is a physician assistant provider located in San Luis, Arizona. This profile covers 25 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 | Gilbert Vega |
| Address | 1962 E Juan Sanchez Blvd Ste C2 |
| City | San Luis |
| State | AZ |
| ZIP | 85336 |
| Taxonomy | Physician Assistant |
| NPI Enumerated | July 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.2M |
| Medicaid | $303.4K |
This provider’s revenue is heavily Medicare-weighted, with Total Medicare revenue of $2.2M compared with Total Medicaid revenue of $303.4K, indicating Medicare receipts are the dominant portion of lifetime billing. The gap in scale suggests the practice’s primary commercial footprint and revenue dependencies lie with Medicare populations rather than Medicaid.
Medicare billing is concentrated in clinical laboratory testing: the top Medicare revenue-driving codes are laboratory-focused (notably 81007, 82626, and 83970), which points to an operation that performs or orders high volumes of urine and endocrine/metabolic panels and similar lab services. High procedural volumes for blood draw 36415 further support a workflow centered on specimen collection and testing rather than exclusively on face-to-face office procedures.
Revenue concentration differs sharply by payer: the provider’s top 3 Medicare codes account for 29.4% of Medicare revenue, reflecting a somewhat diversified lab portfolio across many CPTs, whereas the top 3 Medicaid codes account for 93.1% of Medicaid revenue, indicating Medicaid dollars are extremely concentrated in a small set of office visit codes (99214, 99213, 99212). This contrast suggests Medicaid activity is primarily routine outpatient E&M, while Medicare revenue is driven by a broader set of lab services.
On Medicare competitive standing, the provider is a national high-volume outlier for several lab tests: 81007 and 82626 both rank #3 nationally (81007: #3 of 173 providers nationally (99th percentile; extreme outlier, far above typical national volume for this code); 82626: #3 of 115 providers nationally (98th percentile; extreme outlier, far above typical national volume for this code)). Multiple other lab CPTs (e.g., 80047, 82533, 82550, 83625) are also at or near the 99th–100th percentiles, signaling dominant national-level volume for specific assays.
By contrast, the provider’s Medicaid E&M volumes are unremarkable within the state: 99214 reports 3K claims and $174.8K revenue and ranks #863 of 3041 providers in-state (72th percentile; typical, unremarkable volume for this code), while 99213 ranks #780 of 2775 in-state (72th percentile; typical, unremarkable volume). These in-state percentile positions indicate the provider is a modest, mid-tier participant in Medicaid office-based care rather than a statewide leader.
The mixed payer pattern—Medicare-heavy lab revenues alongside Medicaid-dominant E&M revenue streams—suggests an operational model where the practice or affiliated lab captures significant test volume billed to Medicare while providing routine outpatient visits that generate most Medicaid receipts. In practical terms, payers should expect a lab-centric Medicare profile and a primary care/ambulatory E&M profile for Medicaid.
The provider has long tenure in the NPI registry (NPI enumerated 2006-07-04 (~20 years ago)), which, together with consistent high-volume Medicare lab billing, points to an established service pattern rather than a transient billing spike. Longevity increases the likelihood that the current mix of lab-heavy Medicare claims and E&M-driven Medicaid claims represents a stable business model.
Multiple individual Medicare codes are flagged as statistical outliers or notably above typical national volume across different test families (for example, 81007 and 82626 are described as "extreme outlier"; 80047 and 83735 are at the 99th–100th percentiles and described as "extreme outlier" or "notably above typical national volume"). The recurrence of high-percentile and "extreme outlier" labels across many lab CPTs suggests repeated, concentrated ordering of specific assays rather than isolated episodes, which is a meaningful pattern for utilization review or network planning.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
25 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 81007 | The analyst uses a nonculture, nondipstick method to determine whether bacteriuria is present or absent. The specimen typically would be from a random urine collection. | 9,220 | $30 | $267.5K |
| 82626 | The lab analyst performs an analysis of dehydroepiandrosterone, known as an unconjugated form of DHEA. It is a major precursor of 17–ketosteroids, which the body forms when it breaks down certain… | 9,220 | $30 | $230.6K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 4,000 | $40 | $160K |
| 82677 | The lab analyst measures the level of estriol, a weak estrogen hormone, which is usually in high concentrations only during pregnancy. | 6,400 | $20 | $153.6K |
| 82533 | The lab analyst measures the amount of total cortisol in a patient specimen. Cortisol is a steroid hormone generated from the adrenal glands. | 9,220 | $20 | $147.6K |
| 83625 | The lab analyst measures the lactate dehydrogenase fractions, typically in a serum sample. Lactate dehydrogenase is found in many body tissues, especially in the liver, kidney, and heart, and also in… | 9,220 | $10 | $119.9K |
| 80047 | The lab analyst performs a basic metabolic panel (BMP) test in which he measures the blood level of eight chemicals identified in the descriptor including ionized calcium, sodium, potassium,… | 8,150 | $10 | $105.9K |
| 84403 | The lab analyst performs a test to measure total testosterone, typically in patient serum. | 4,000 | $30 | $100K |
| 84270 | The lab analyst performs a test to measure sex hormone binding globulin, or SHBG, typically in patient blood. | 4,000 | $20 | $83.9K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 11,930 | $10 | $83.5K |
Showing 1–10 of 25
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 25 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
25 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 82626 | 3 | 10 | 5,070 | $20 | $131.6K |
| 81007 | 3 | 10 | 4,020 | $30 | $131.1K |
| 82677 | 5 | 10 | 3,670 | $20 | $89.5K |
| 83625 | 3 | 10 | 5,070 | $10 | $65.5K |
| 84144 | 3 | 10 | 2,450 | $20 | $39.5K |
| 82533 | 3 | 30 | 120 | $20 | $37.9K |
| 83970 | 3 | 130 | 80 | $40 | $33K |
| 82670 | 3 | 30 | 50 | $30 | $29K |
| 82977 | 3 | 20 | 3,750 | $10 | $28.9K |
| 84403 | 3 | 70 | 40 | $30 | $26.9K |
Showing 1–10 of 25
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 |
|---|---|---|---|---|
| 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… | 2,960 | $60 | $174.8K |
| 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… | 2,340 | $40 | $96K |
| 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,… | 360 | $30 | $9.8K |
| 99394 | The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17. | 70 | $70 | $4.9K |
| 99396 | The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64. | 60 | $80 | $4.3K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 160 | $20 | $2.9K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 1,340 | $1 | $2.7K |
| 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… | 250 | $10 | $2.3K |
| 90460 | In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age. | 90 | $20 | $1.8K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 10 | $70 | $830 |
Showing 1–10 of 14
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
14 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 315 | 400 | 200 | $120 | $403K |
| 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… | 863 | 3,040 | 750 | $50 | $343.9K |
| 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… | 780 | 2,780 | 600 | $50 | $267K |
| 90460 | In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age. | 322 | 420 | 600 | $30 | $177K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 305 | 310 | 470 | $60 | $131.9K |
| 99394 | The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17. | 208 | 300 | 270 | $60 | $90.1K |
| 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,… | 347 | 850 | 230 | $40 | $72.5K |
| 99401 | At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient’s age, family history, and areas of concern. The subjects… | 79 | 110 | 160 | $30 | $54K |
| 99396 | The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64. | 173 | 290 | 100 | $50 | $28.9K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 319 | 630 | 160 | $10 | $12K |
Showing 1–10 of 14
Other providers in the same ZIP code as Gilbert Vega, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| San Luis Walk-in Clinic, Inc. | AZ | Urgent Care Clinic/Center | $0 | $17.8M |
| San Luis Walk-in Clinic, Inc. | AZ | Rural Health Clinic/Center | $0 | $8.3M |
| San Luis Walk-in Clinic, Inc. | AZ | Urgent Care Clinic/Center | $0 | $6.8M |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.