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.

Centro Oftalmologico Metropolitano Csp (NPI 1528022027)

Key Findings

Field	Value
Entity Type	Organization
Organization	Centro Oftalmologico Metropolitano Csp
Address	Ave Jesus T Pinero #1250 Caparra Terrace
City	San Juan
State	PR
ZIP	00922
Taxonomy	Ophthalmology Physician
NPI Enumerated	April 13, 2006

Payer Source	Total Paid
Medicaid	$4.2M
Medicare	$0

This provider is effectively a single-payer Medicaid practice: there is no Medicare billing on file and total Medicaid revenue is $4.2M, so the provider’s entire documented Medicare/Medicaid footprint in these data is driven by Medicaid activity. Analysts should treat this entity as Medicaid-centric when assessing payer strategy or network impact.

Revenue is heavily concentrated in a small number of ophthalmology evaluation codes: the top three Medicaid codes (92012, 92002, 92015) account for 68.0% of this provider's total Medicaid revenue. In dollar terms those codes are reported as 92012 $1.8M (43.6%), 92002 $615.9K (14.7%), and 92015 $410.4K (9.8%), indicating exams and refractions dominate receipts.

The code mix indicates a high-volume outpatient ophthalmology practice focused on routine and intermediate eye evaluations and diagnostic imaging rather than predominantly surgical volume. Large claim counts and revenue for evaluation codes (92012: 33.9K claims; 92002: 12.8K claims) combined with material revenue in fundus photography 92250 ($249.3K, 5.9%) and retinal imaging 92134 ($129.4K, 3.1%) point to a practice model built around frequent office-based visits and diagnostic testing.

Procedural and higher-acuity services are present but represent a smaller share of Medicaid revenue: cataract extraction with lens insertion 66984 accounts for $269K (6.4%) and intravitreal injection 67028 accounts for $226.1K (5.4%), while medication billing such as J9035 (bevacizumab) is $27.4K (0.7%). These figures show surgical and injection services contribute meaningfully but do not dominate the revenue base compared with evaluation and imaging codes.

This provider is a dominant statewide player for core ophthalmology evaluation services: 92002 ranks #1 of 444 providers in-state (100th percentile; extreme outlier), 92015 ranks #1 of 527 (100th percentile; extreme outlier), and 92012 ranks #2 of 353 (100th percentile; extreme outlier). Fundus photography 92250 also ranks #1 of 156 providers in-state (100th percentile; extreme outlier), underscoring market-leading volume for both exams and diagnostic imaging within the state.

Beyond the top exam codes, several diagnostic services are notably above typical state volume indicating broader diagnostic capacity: 76512 ranks #1 of 7 (100th percentile; notably above typical state volume), 92020 ranks #3 of 49 (96th percentile; notably above typical state volume), and 92225 ranks #4 of 115 (97th percentile; notably above typical state volume). At the same time, some procedural codes sit in more typical ranges (for example 66984 at the 64th percentile), signaling that the provider’s unusual scale is concentrated in evaluations and imaging.

The provider has an established presence in the market with an NPI enumerated on 2006-04-13 (~20 years ago), which, together with the high statewide ranks and extreme outlier designations for core codes, suggests a long-running, high-volume ophthalmology operation. This tenure supports the plausibility of persistent high utilization patterns rather than a short-term spike.

For payer strategy and utilization oversight, the profile suggests focusing on management of high-volume evaluation and diagnostic codes will capture the majority of fiscal exposure: the three exam/refraction codes alone represent 68.0% of Medicaid revenue. Given the provider’s state-level dominance on those codes, network planning or targeted program interventions (e.g., care pathways for exam frequency, diagnostic imaging appropriateness) are likely to influence Medicaid spend and access for a substantial patient population.

Medicaid: Complete Services Breakdown

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	33,920	$50	$1.8M
92002	The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.	12,830	$50	$615.9K
92015	The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.	18,660	$20	$410.4K
66984	The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…	400	$680	$269K
92250	Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…	10,390	$20	$249.3K
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	1,620	$140	$226.1K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	4,620	$30	$129.4K
92201	The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece…	5,050	$20	$101K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	830	$120	$100K
76512	The provider uses B–scan ultrasound imaging, with or without a non–qualitative A–scan superimposed, to examine the intraocular and orbital structures.	1,340	$40	$54.9K

Showing 1–10 of 26

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

Centro Oftalmologico Metropolitano Csp — 8 of 25 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

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9035	Injection, bevacizumab, 10 mg	10	20	370	$2,820	$2.3M
66984	The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…	22	60	160	$380	$270.5K
67028	The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye.	11	30	1,090	$130	$222.2K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	2	350	540	$50	$96.4K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	80	120	180	$80	$62.9K
C9257	Injection, bevacizumab, 0.25 mg	17	20	350	$50	$61.8K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	12	80	650	$20	$43.1K
92002	The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.	1	440	370	$40	$38.5K
92060	The basic eye sensorimotor exam checks the alignment of the eyes and their ability to move together in eight fields of gaze ( up, down, right, left, up–left, up–right, down–left, down–right) and…	49	60	300	$30	$32.7K
92015	The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.	1	530	630	$20	$32K

Showing 1–10 of 26

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jose Vega-martinez	PR	Gastroenterology Physician	$0	$1.7M
Adm Servicios Medicos De Puerto Rico	PR	Emergency Medicine Physician	$0	$1.2M
Ricardo Fontanet	PR	Orthopaedic Surgery Physician	$10.6K	$338.7K
Vital Care Ambulance LLC	PR	Land Ambulance	$46.8K	$204.9K
Julio Rodriguez Quinones	PR	Internal Medicine Physician	$42.6K	$0
Belkiss Murati Amador	PR	Anatomic Pathology & Clinical Pathology Physician	$31.3K	$0
Jose Munoz Acaba	PR	Gastroenterology Physician	$20K	$890

Centro Oftalmologico Metropolitano Csp — Billing Profile & Reimbursement Data

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Centro Oftalmologico Metropolitano Csp — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rafael Oms Rivera	PR	Physical Medicine & Rehabilitation Physician	$7.1K	$268.5K
Ian Piovanetti	PR	Ophthalmology Physician	$51K	$0
Rosaliz Portela	PR	Ophthalmology Physician	$34.1K	$0
Francisco Corretjer	PR	Ophthalmology Physician	$29K	$0
Francine Vivoni	PR	Ophthalmology Physician	$26.6K	$0
Luis De Corral	PR	Ophthalmology Physician	$25.2K	$0
Jorge Fernandez Bahamonde	PR	Ophthalmology Physician	$19.4K	$0
Vanessa Lopez Beauchamp	PR	Ophthalmology Physician	$12.9K	$0
Omar Piovanetti	PR	Ophthalmology Physician	$10.1K	$0
Julio Rodriguez	PR	Ophthalmology Physician	$8.7K	$0