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.

Jerry Castro (NPI 1326231655)

Key Findings

Field	Value
Entity Type	Individual
Organization	Jerry Castro
Address	341 S. Marine Corp Dr. - Suite 104
City	Tamuning
State	GU
ZIP	98913
Taxonomy	Otolaryngology Physician
NPI Enumerated	August 21, 2007

Payer Source	Total Paid
Medicare	$127.3K
Medicaid	$0

JERRY CASTRO is an Otolaryngology Physician based in TAMUNING, GU with an NPI enumerated on 2007-08-21 (~19 years ago), indicating long tenure in the Medicare program and an established local practice presence. The provider’s specialty and long registration suggest sustained outpatient ENT activity over nearly two decades.

This profile is effectively single-payer on the claims record: total Medicare revenue is $127.3K while there is no Medicaid billing on file, so Medicare accounts for all reported public-payer revenue. Analysts should treat Medicaid participation as absent for payer-mix modeling.

Revenue is highly concentrated in a small set of E/M codes: the top 3 Medicare codes by revenue (99213, 99203, 99214) account for 73.6% of this provider's total Medicare revenue. Individually those codes generated $60.7K (47.6%) for 99213, $18.6K (14.6%) for 99203, and $14.5K (11.3%) for 99214, making office visits the dominant revenue stream.

The code mix points to an office-based ENT practice focused on evaluation and management encounters with adjunctive diagnostic scope exams: high-volume E/M codes (99213/99203/99214) combined with procedures such as 31575 (flexible laryngoscopy, $11.9K, 9.4%) and 92511 (nasal endoscopy, $6.8K, 5.3%) indicate routine outpatient assessment of voice, airway, and sinonasal conditions. This pattern is consistent with a clinic-centric workflow that pairs new and established visits with in-office diagnostic endoscopy.

On competitive standing, the provider is an outlier nationally for core office-visit codes: 99213 ranks #7868 of 457151 providers nationally (98th percentile; extreme outlier, far above typical national volume for this code) and 99203 ranks #2052 of 161519 providers nationally (99th percentile; extreme outlier, far above typical national volume for this code). By contrast, 99214 ranks #192271 of 479517 (60th percentile; typical, unremarkable volume), indicating unusually high volume specifically for certain visit levels rather than across all E/M intensities.

Procedural activity contributes measurable but smaller shares of revenue: 31575 ($11.9K, 9.4%) ranks #1009 of 7800 providers nationally (87th percentile; typical, unremarkable volume) and 92511 ($6.8K, 5.3%) ranks #104 of 536 providers nationally (81th percentile; typical, unremarkable volume). These ranks show the provider performs diagnostic endoscopy at rates above many peers but not at the same national outlier level seen for certain E/M codes.

The concentration of revenue in E/M services (top-3 codes = 73.6% of Medicare revenue) implies sensitivity to changes in office-visit demand, coding intensity, or E/M reimbursement; the practice’s financial profile is driven primarily by visit volume rather than a diversified set of high-revenue procedures. For payers and network analysts, this signals that utilization management or referral shifts affecting office visits could materially change this provider’s Medicare revenue.

Secondary codes point to a predominantly outpatient footprint with limited inpatient or specialized-service billing: 99223 (initial hospital care) accounts for $3.7K (2.9%) and ranks #75389 of 139583 (45th percentile; typical, unremarkable volume), while vestibular repositioning 95992 is small ($704, 0.6%) and ranks #896 of 1382 (33th percentile; typical, unremarkable volume). Combined with no Medicaid activity, these data reinforce a clinic-centered practice with modest inpatient and vestibular volumes.

Medicare: Complete Services Breakdown

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

10 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…	920	$70	$60.7K
99203	The provider sees a new 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 provider…	260	$70	$18.6K
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	$100	$14.5K
31575	The provider uses a flexible laryngoscope to look inside the larynx, or voice box, to detect the presence of any abnormalities. This code applies to diagnostic services.	120	$100	$11.9K
92511	The provider examines the nasal passages and throat with an endoscope, a tubular instrument with a light source and camera.	70	$100	$6.8K
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…	50	$120	$6K
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…	40	$110	$3.7K
92504	In this diagnostic procedure, the provider uses a microscope to examine the ears of a patient. He may also sometimes examine the patient’s nose for direct visualization to help with diagnosis…	160	$20	$3.6K
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,…	20	$40	$940
95992	The provider moves the patient through a series of positions to treat benign paroxysmal positional vertigo. The position changes move canalith particles from parts of the inner ear where they cause…	20	$30	$700

Jerry Castro — Billing Profile & Reimbursement Data

Sign up for Jerry Castro — Billing Profile & Reimbursement Data policy alerts

Jerry Castro — Billing Profile & Reimbursement Data

Sign up for Jerry Castro — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	46	90	140	$90	$25.7K
31575	1	10	120	$100	$11.9K
99213	3	100	100	$60	$10.6K
99223	9	20	30	$130	$7K
92511	1	10	70	$100	$6.8K
99204	17	50	30	$110	$6.7K
92504	1	10	160	$20	$3.6K
99203	1	40	30	$70	$2.5K
99212	15	20	30	$30	$1.4K
95992	1	10	20	$30	$690