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NPI 1366494247 · Las Vegas, NV · Cardiovascular Disease Physician
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Rafael Valencia is a cardiovascular disease physician provider located in Las Vegas, Nevada. This profile covers 43 Medicare and 9 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 | Rafael Valencia |
| Address | 3150 N Tenaya Way |
| City | Las Vegas |
| State | NV |
| ZIP | 89128 |
| Taxonomy | Cardiovascular Disease Physician |
| NPI Enumerated | May 17, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.3M |
| Medicaid | $121.1K |
Practice profile and tenure: RAFAEL VALENCIA is a cardiovascular disease physician with an NPI enumerated (registered) on 2006-05-17 (~20 years ago), indicating long-standing participation in Medicare and Medicaid billing streams. The longevity supports experience-based referral patterns and established clinical workflows in cardiology services, particularly imaging and stress testing.
Revenue scale and payer mix: This provider’s billing is Medicare-dominant with Total Medicare revenue of $2.3M versus Total Medicaid revenue of $121.1K, indicating Medicare is the primary revenue source by a large margin and Medicaid is a relatively small share of billed business. Analysts should treat this profile as effectively single-payer–weighted toward Medicare when modeling patient volume or payer exposure.
Service-line concentration — nuclear cardiology and pharmacologic stress: The top Medicare revenue-driving codes are heavily weighted toward myocardial perfusion PET/SPECT and pharmacologic stress agents (78492, 78431, A9555, A9526, J2785), with 78492 ($502.6K), 78431 ($419.6K) and A9555 ($358.7K) prominent in the mix. This code mix signals a core operational focus on advanced cardiac imaging and stress-testing workflows (both radiotracer dosing and interpreted imaging), implying on-site capabilities or partnerships that support high-volume nuclear cardiology studies.
Revenue concentration by payer: The provider shows high revenue concentration in a few codes for both payers — precomputed top-3 codes account for 57.7% of Medicare revenue and precomputed top-3 codes account for 73.7% of Medicaid revenue — meaning a small set of procedures (primarily perfusion imaging and associated agents) drive the majority of billed dollars. This concentration increases sensitivity of revenue to changes in utilization, reimbursement, or referral patterns for those specific services.
Competitive standing nationally (Medicare): Several nuclear cardiology codes rank very highly versus national peers — 78492 ranks #29 of 926 providers nationally (97th percentile; notably above typical national volume for this code), A9555 ranks #35 of 1266 (97th percentile), and J2785 shows extreme volume at #16 of 6388 (100th percentile; extreme outlier, far above typical national volume for this code). Those positions indicate this provider is a major national outlier for selected tracers and pharmacologic stress agent usage and competes at a high volume level for advanced cardiac imaging.
Competitive standing in-state (Medicaid): Medicaid activity is more modest in the Nevada market: the top Medicaid codes 78452 ($32.1K), 93306 ($32K) and 99214 ($25.1K) place the provider around mid-to-lower percentiles in-state (for example 78452 ranks in the 38th percentile and 93306 in the 50th percentile among in-state peers). This suggests that while the provider is a high-volume national player on Medicare for PET/SPECT and tracers, their Medicaid footprint is not comparably dominant within Nevada.
Operational implication from statistical outliers: The extremely high claim counts for J2785 (3.1K claims, $130.4K revenue) and very high ranks for tracer codes such as A9526 (578 claims, $337K revenue; ranks #3 of 28 providers nationally, 93th percentile; notably above typical national volume for this code) point to a workflow optimized for pharmacologic stress testing and frequent use of specific radiotracers. For payers and network managers, these patterns indicate predictable high utilization of associated supply lines and downstream interpretation services tied to these agents.
Broader clinical mix and ancillary services: Beyond high-volume imaging, the provider bills substantial volumes for E/M and remote monitoring codes (e.g., 99214: 732 Medicare claims, $63K revenue; 99490: 715 Medicare claims, $33.6K revenue; 99457/99454 remote monitoring codes also present), indicating a combination of procedural imaging services with ongoing ambulatory chronic care management and remote physiologic monitoring. This blend suggests the practice supports both episodic high-intensity imaging and longitudinal management for cardiac patients, which has implications for care coordination, capitation risk models, and ancillary revenue streams.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
43 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 78492 | In this diagnostic procedure, the provider performs a myocardial perfusion PET imaging study which means it reveals the flow of oxygenated blood to the heart muscles. The service also includes… | 440 | $1,130 | $502.6K |
| 78431 | The provider performs a PET myocardial imaging scan, a type of nuclear imaging test, with CT transmission scan that reveals blood flow to and from the heart (perfusion). Ejection fraction and… | 290 | $1,450 | $419.6K |
| A9555 | Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries | 890 | $400 | $358.7K |
| A9526 | Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries | 580 | $580 | $337K |
| J2785 | Injection, regadenoson, 0.1 mg | 3,100 | $40 | $130.4K |
| 78434 | The provider performs a positron emission tomography (PET) study at both rest and stress to measure myocardial blood flow. Stress is induced by injection of a drug. Report this code in conjunction… | 610 | $110 | $64.2K |
| 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… | 730 | $90 | $63K |
| 93015 | The provider supervises the recording of the electrical activity of the heart to examine any abnormality in its functioning by obtaining blood pressure and electrocardiograph readings at regular… | 830 | $50 | $44.7K |
| 93306 | The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent… | 350 | $110 | $39.1K |
| 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… | 540 | $70 | $36.2K |
Showing 1–10 of 43
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 43 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
43 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| A9526 | 2 | 10 | 90 | $580 | $168.3K |
| 78492 | 2 | 20 | 40 | $980 | $107.9K |
| A9555 | 3 | 30 | 60 | $410 | $90.5K |
| 78431 | 4 | 40 | 30 | $1,050 | $88.2K |
| 93229 | 33 | 50 | 30 | $660 | $56.3K |
| 99233 | 1,070 | 1,150 | 150 | $90 | $26.8K |
| 99232 | 454 | 1,340 | 140 | $60 | $23.7K |
| 93306 | 65 | 250 | 190 | $90 | $22.5K |
| 99214 | 218 | 3,610 | 110 | $80 | $19K |
| J2785 | 2 | 90 | 180 | $40 | $16.7K |
Showing 1–10 of 43
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.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 60 | $510 | $32.1K |
| 93306 | The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent… | 180 | $180 | $32K |
| 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… | 240 | $110 | $25.1K |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 60 | $180 | $11.6K |
| 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… | 60 | $170 | $9.4K |
| 93015 | The provider supervises the recording of the electrical activity of the heart to examine any abnormality in its functioning by obtaining blood pressure and electrocardiograph readings at regular… | 110 | $70 | $7.3K |
| 93000 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 120 | $20 | $1.8K |
| 93224 | In this procedure, the provider applies an electrocardiographic, or ECG recorder, to a patient for up to 48 hours to detect abnormal heart rates and rhythms. He analyzes, compiles, and interprets the… | 10 | $80 | $1.2K |
| 93010 | The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram. | 130 | $10 | $650 |
How this provider's Medicaid billing volume and revenue compare to other Nevada providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Nevada median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 32 | 50 | 120 | $240 | $209.3K |
| 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… | 1,220 | 2,250 | 290 | $60 | $138K |
| 93306 | The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent… | 87 | 170 | 180 | $80 | $120.5K |
| 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… | 471 | 780 | 90 | $100 | $46.6K |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 17 | 30 | 90 | $60 | $39.6K |
| 93010 | The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram. | 128 | 210 | 200 | $1 | $21.9K |
| 93015 | The provider supervises the recording of the electrical activity of the heart to examine any abnormality in its functioning by obtaining blood pressure and electrocardiograph readings at regular… | 12 | 30 | 60 | $30 | $19.6K |
| 93000 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 125 | 230 | 150 | $10 | $10.6K |
| 93224 | In this procedure, the provider applies an electrocardiographic, or ECG recorder, to a patient for up to 48 hours to detect abnormal heart rates and rhythms. He analyzes, compiles, and interprets the… | 13 | 10 | 110 | $60 | $10.4K |
Other providers in the same ZIP code as Rafael Valencia, ranked by combined Medicare and Medicaid revenue.
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