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NPI 1407953482 · Hialeah, FL · Cardiovascular Disease Physician
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Pablo Guala is a cardiovascular disease physician provider located in Hialeah, Florida. This profile covers 31 Medicare and 8 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 | Pablo Guala |
| Address | 4811 W 4th Ave |
| City | Hialeah |
| State | FL |
| ZIP | 33012 |
| Taxonomy | Cardiovascular Disease Physician |
| NPI Enumerated | September 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.9M |
| Medicaid | $1.5K |
Practice profile and service mix: Medicare billing is concentrated in endovascular peripheral vascular interventions and intravascular imaging — the top Medicare codes are 37229, 37227, and 37231, which together generate $1.6M, $1.2M, and $908.8K respectively. The presence of large volumes for add-on intravascular ultrasound codes such as 37252 (406 claims, $322.8K) and 37253 (406 claims, $60.5K) indicates routine use of IVUS during interventions, consistent with a specialty interventional vascular lab rather than a general cardiology clinic.
Medicare revenue concentration: The provider’s top three Medicare codes account for 76.6% of total Medicare revenue, reflecting heavy reliance on a small set of high-value interventional procedures. Those three codes alone represent the majority of the practice’s $4.9M Medicare revenue, indicating revenue sensitivity to volumes or reimbursement changes for those services.
Medicaid activity and payer mix: This provider is effectively Medicare-dominant: lifetime Medicare revenue is $4.9M versus lifetime Medicaid revenue of $1.5K, so Medicaid represents a negligible share of billed revenue. Medicaid billing appears concentrated in diagnostic cardiology (93306 at $962 or 66.2% of Medicaid revenue, 93000 at $292 or 20.1%, and 99214 at $200 or 13.8%), consistent with a practice that treats far fewer Medicaid procedural cases.
Competitive standing on key Medicare codes: The provider ranks at or near the top nationally for several high-revenue Medicare procedure codes — for example, 37229 ranks #9 of 603 nationally (99th percentile; extreme outlier), 37227 ranks #4 of 363 (99th percentile; extreme outlier), and 37231 ranks #2 of 45 (98th percentile; notably above typical national volume). These rankings characterize the provider as a nationally prominent executor of selected peripheral vascular procedures rather than a typical-volume practitioner.
Outlier indicators and operational intensity: Multiple codes are flagged as unusually high-volume compared with peers — beyond the top three, codes such as 37252 rank #6 of 1088 (100th percentile; extreme outlier) and 76937 ranks #52 of 12234 (100th percentile; extreme outlier). The combination of very high ranks and substantial average paid/claim values (e.g., $9772 for 37231) signals a high-intensity interventional caseload focused on complex endovascular care.
Medicaid reimbursement patterns: Several Medicaid claim lines for typically high-revenue interventional codes (37252, 37253, 37229, 76937, 75710) show nonzero claim counts but $0 average paid/claim and $0 total Medicaid revenue, suggesting that procedure-level activity recorded to Medicaid generates no material Medicaid-paid revenue. By contrast, Medicaid-paid dollars are primarily from lower-acuity diagnostic codes (93306, 93000, 99214), which together account for 100.0% of the provider’s Medicaid revenue.
Service mix implications for referral and capacity: The dominance of high-reimbursement interventional codes and routine IVUS use implies the provider operates with specialized equipment and referral relationships for peripheral vascular disease and endovascular stenting. Analysts should expect this provider’s capacity and revenue to be sensitive to referral patterns for peripheral interventions and to payer policies that affect endovascular device and imaging reimbursements.
Tenure and stability: The provider’s NPI was enumerated on 2006-09-20 (~20 years ago), indicating a long-standing presence in the market. The combination of long tenure and concentrated high-volume procedural billing for specific interventional codes supports the interpretation of an established interventional specialty practice rather than a recent or opportunistic operation.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
31 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 37229 | N/A | 270 | $5,900 | $1.6M |
| 37227 | N/A | 160 | $8,010 | $1.2M |
| 37231 | N/A | 90 | $9,770 | $908.8K |
| 37225 | N/A | 90 | $3,760 | $331.1K |
| 37252 | In this add–on procedure, the provider inserts a specially designed catheter with an ultrasound transducer, a device that sends high–frequency sound waves through the tissues and detects their… | 410 | $800 | $322.8K |
| 37233 | N/A | 90 | $900 | $81.9K |
| 37238 | The physician inserts a stent in a vein using a catheter. Access may be either open or percutaneous. Radiological supervision and interpretation are included. | 30 | $2,880 | $71.9K |
| 37221 | N/A | 40 | $1,430 | $61.4K |
| 37253 | In this add–on procedure, the provider inserts a specially designed catheter with an ultrasound transducer, a device that sends high–frequency sound waves through the tissues and detects their… | 410 | $150 | $60.5K |
| A9502 | Technetium tc-99m tetrofosmin, diagnostic, per study dose | 100 | $350 | $34K |
Showing 1–10 of 31
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 31 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
31 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 37229 | 3 | 70 | 20 | $6,370 | $350.1K |
| 37231 | 1 | 10 | 30 | $9,080 | $336K |
| 37227 | 1 | 50 | 20 | $7,720 | $254.7K |
| 37225 | 5 | 90 | 20 | $4,570 | $164.7K |
| 37238 | 15 | 30 | 30 | $2,680 | $91K |
| A9502 | 205 | 380 | 110 | $280 | $45.6K |
| 37252 | 1 | 110 | 30 | $650 | $30.5K |
| 37233 | 2 | 20 | 30 | $850 | $30.5K |
| 36011 | 8 | 20 | 40 | $420 | $29.2K |
| 78452 | 867 | 1,330 | 70 | $250 | $25.3K |
Showing 1–10 of 31
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.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 30 | $40 | $960 |
| 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… | 290 | $1 | $290 |
| 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… | 40 | $10 | $200 |
| 37229 | N/A | 190 | $0 | $0 |
| 37252 | In this add–on procedure, the provider inserts a specially designed catheter with an ultrasound transducer, a device that sends high–frequency sound waves through the tissues and detects their… | 60 | $0 | $0 |
| 37253 | In this add–on procedure, the provider inserts a specially designed catheter with an ultrasound transducer, a device that sends high–frequency sound waves through the tissues and detects their… | 60 | $0 | $0 |
| 75710 | Angiography is an X–ray study of the blood vessels that helps physicians diagnose and treat medical conditions. Angiography uses a radiopaque substance (dye) to make the blood vessels visible under… | 40 | $0 | $0 |
| 76937 | The provider uses ultrasound to help guide procedures requiring vascular access including central venous, peripheral venous, or arterial access procedures. | 210 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Florida providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Florida median
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 5,425 | 6,380 | 430 | $50 | $139.3K |
| 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… | 611 | 680 | 340 | $70 | $98.7K |
| 37229 | N/A | 2 | 10 | 60 | $110 | $32.2K |
| 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… | 284 | 700 | 160 | $10 | $6.5K |
| 37252 | In this add–on procedure, the provider inserts a specially designed catheter with an ultrasound transducer, a device that sends high–frequency sound waves through the tissues and detects their… | 2 | 10 | 20 | $10 | $2.8K |
| 76937 | The provider uses ultrasound to help guide procedures requiring vascular access including central venous, peripheral venous, or arterial access procedures. | 23 | 70 | 70 | $1 | $1.2K |
| 37253 | In this add–on procedure, the provider inserts a specially designed catheter with an ultrasound transducer, a device that sends high–frequency sound waves through the tissues and detects their… | 2 | 10 | 30 | $1 | $810 |
| 75710 | Angiography is an X–ray study of the blood vessels that helps physicians diagnose and treat medical conditions. Angiography uses a radiopaque substance (dye) to make the blood vessels visible under… | 5 | 10 | 50 | $1 | $360 |
Other providers in the same ZIP code as Pablo Guala, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Caring Professional Services Inc | FL | Home Health Agency | $0 | $158.8M |
| Agape Nurse Registry | FL | Home Health Agency | $0 | $101.7M |
| At Talitha Cumi Home Care, Inc | FL | Attendant Care Provider | $0 | $50.6M |
| Citrus Health Network Inc | FL | Community/Behavioral Health Agency | $0 | $50.5M |
| Angel Speech And Therapy Services, Inc. | FL | Clinic/Center | $0 | $20.6M |
| Kidscare Therapy Center Inc | FL | Clinic/Center | $0 | $16.7M |
| Variety Children's Hospital | FL | Children's Hospital | $0 | $15.5M |
| Florida Children's Dentistry, P.A. | FL | Pediatric Dentistry | $0 | $14.8M |
| Get A Grip 123 LLC | FL | Durable Medical Equipment & Medical Supplies | $0 | $13.2M |
| Healing Touch C&c Inc | FL | Health Service Clinic/Center | $0 | $10.8M |
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