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 Puerto Rico for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Puerto Rico 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. Puerto Rico (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.

Grupo Intensivo Pediatrico De San Juan (NPI 1477537892)

Key Findings

Field	Value
Entity Type	Organization
Organization	Grupo Intensivo Pediatrico De San Juan
Address	252 Calle San Jorge
City	San Juan
State	PR
ZIP	00912
Taxonomy	Pediatric Critical Care Medicine Physician
NPI Enumerated	November 30, 2005

Payer Source	Total Paid
Medicaid	$5.5M
Medicare	$0

GRUPO INTENSIVO PEDIATRICO DE SAN JUAN (Pediatric Critical Care Medicine Physician) is effectively a single-payer Medicaid provider: there is no Medicare billing on file and total Medicaid revenue is $5.5M. The provider’s NPI was enumerated on 2005-11-30 (~21 years ago), indicating a long-established presence in San Juan, PR.

Revenue is highly concentrated in a small set of critical-care codes: the top three Medicaid codes (99291, 99292, 99472) together account for 76.1% of this provider’s total Medicaid revenue. Those three codes individually generate $2.1M (38.2%), $1.3M (24.3%), and $743K (13.6%) respectively, showing the business is driven by a narrow set of high-acuity services.

The code mix (99291, 99292 and critical-infant codes such as 99472) indicates an operational focus on pediatric critical care and inpatient ICU-level management—services that require sustained, high-intensity clinical time and documentation of medical necessity. High per-claim payment for 99472 ($1976 avg paid/claim) further signals specialized follow-up care for critically ill infants as a meaningful revenue stream.

99291 volume is exceptionally large relative to in-state peers: 6.4K claims with $328 avg paid/claim and $2.1M revenue, and it ranks #2 of 43 providers in-state (98th percentile; extreme outlier, far above typical state volume for this code). This positioning identifies the provider as one of the largest state participants for first-interval pediatric critical care. 99292 also posts high absolute volume (3.9K claims, $340 avg paid/claim, $1.3M) but is described as a typical peer volume (ranks #1 of 3 providers in-state, 100th percentile; typical, unremarkable volume).

Beyond the top three, supporting inpatient E/M and monitoring codes contribute materially to Medicaid revenue: 99233 produced 1.3K claims, $476 avg paid/claim and $610.7K revenue (11.2%), and 99157 produced 1.2K claims, $305 avg paid/claim and $355.3K revenue (6.5%). These secondary codes reinforce that the practice mix centers on high-acuity inpatient care and procedural monitoring rather than routine outpatient pediatrics.

From a competitive and operational risk perspective, dependence on a few high-acuity Medicaid codes (76.1% of revenue from the top three) concentrates reimbursement risk: changes to Medicaid policy, fee schedules, or documentation requirements for codes like 99291/99292 could materially affect revenue. The provider’s status as an extreme outlier for 99291 amplifies this exposure, while the lack of Medicare billing means there is no offset from an alternative federal payer stream.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	6,380	$330	$2.1M
99292	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	3,920	$340	$1.3M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	380	$1,980	$743K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	1,280	$480	$610.7K
99157	A provider or other qualified healthcare professional, other than the provider performing a diagnostic or therapeutic procedure, administers medication to reduce consciousness, but not render the…	1,170	$310	$355.3K
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…	1,230	$150	$184.8K
99471	The provider performs initial evaluation and management of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	200	$380	$75.2K
99476	The provider performs follow up care for a critically ill child, ages two to five years, in an inpatient setting.	30	$1,380	$40.1K
99156	A provider or other qualified healthcare professional, other than the provider performing a diagnostic or therapeutic procedure, administers medication to reduce consciousness, but not render the…	220	$70	$15.5K
99155	A provider or other qualified healthcare professional, other than the provider performing a diagnostic or therapeutic procedure, administers medication to reduce consciousness, but not render the…	140	$90	$12.6K

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.

Claims Volume vs. Puerto Rico Distribution

Grupo Intensivo Pediatrico De San Juan — 3 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	3	10	850	$660	$860.2K
99292	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	1	10	80	$330	$446.1K
99471	The provider performs initial evaluation and management of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2	10	200	$420	$223.2K
99464	The provider is present during the delivery, at the request of the delivering provider, and during the basic stabilization of the newborn immediately after birth, typically when fetal distress or…	7	10	1,460	$70	$144.1K
99156	A provider or other qualified healthcare professional, other than the provider performing a diagnostic or therapeutic procedure, administers medication to reduce consciousness, but not render the…	14	20	330	$120	$131.8K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	2	40	130	$210	$122.8K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	85	390	290	$80	$96.8K
99157	A provider or other qualified healthcare professional, other than the provider performing a diagnostic or therapeutic procedure, administers medication to reduce consciousness, but not render the…	4	20	300	$90	$77.4K
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…	47	500	130	$90	$43.1K
99476	The provider performs follow up care for a critically ill child, ages two to five years, in an inpatient setting.	1	10	30	$1,380	$40.1K

Showing 1–10 of 13

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ghp C.s.p.	PR	Pediatrics Physician	$0	$3.6M
Villegas LLC	PR	Ophthalmology Physician	$0	$1.3M
Felix J Seda Ent Psc	PR	Pediatric Otolaryngology Physician	$0	$1.3M
San Jorge Children's Medical Specialties,psc	PR	Oncology Clinic/Center	$0	$1.2M
Luis Font	PR	Pediatric Endocrinology Physician	$0	$836.4K
San Jorge Associates	PR	Anesthesiology Physician	$0	$656.6K
Rafael Trinidad Hernandez	PR	Endocrinology, Diabetes & Metabolism Physician	$14.1K	$173.5K
Edwardo Ramos Cortes	PR	Physical Medicine & Rehabilitation Physician	$19.3K	$134.4K
Jorge Rivera-herrera	PR	Urology Physician	$62.6K	$0
Jaime Pinero-pares	PR	General Practice Physician	$41K	$0

Grupo Intensivo Pediatrico De San Juan — Billing Profile & Reimbursement Data

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Grupo Intensivo Pediatrico De San Juan — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References