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 Armed Forces Europe for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Armed Forces Europe 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. Armed Forces Europe (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.

Guillermo Navarro (NPI 1528031986)

Field	Value
Entity Type	Individual
Organization	Guillermo Navarro
Address	Psc 819 Box 4488
City	Fpo
State	AE (Armed Forces Europe)
ZIP	09645
Taxonomy	Emergency Medicine Physician
NPI Enumerated	February 8, 2006

Payer Source	Total Paid
Medicare	$25.8K
Medicaid	$0

Key Findings

This provider is an Emergency Medicine Physician whose billed services are concentrated entirely in emergency department evaluation-and-management care. The top three Medicare codes are 99285, 99284, and 99283, each described as ED E/M visits with high, moderate, and low levels of medical decision making respectively, indicating the practice’s Medicare activity is focused on front-line emergency care rather than procedure- or outpatient-focused services.

Revenue for this provider’s Medicare activity is narrowly concentrated: the precomputed top three codes account for 100.0% of total Medicare revenue. Those three codes break down to $13.2K (51.2%) for 99285, $10.3K (39.8%) for 99284, and $2.3K (9.0%) for 99283, showing that a small set of ED E/M codes fully explains the provider’s Medicare receipts.

Payer mix is effectively single-payer on file: lifetime Medicare revenue is $25.8K and there is no Medicaid billing on file. This provider therefore has a Medicare-only billing footprint in the available dataset, with no recorded Medicaid revenue to diversify payer exposure.

Competitive standing by code is mixed. For 99285 the provider ranks #32553 of 61347 providers nationally (47th percentile; typical, unremarkable volume for this code), for 99284 the provider ranks #13690 of 64306 providers nationally (78th percentile; typical, unremarkable volume for this code), and for 99283 the provider ranks #4967 of 31069 providers nationally (83th percentile; typical, unremarkable volume for this code); overall this indicates modest participation on the highest-severity ED code and stronger-than-average billing activity on the moderate- and low-severity ED visit codes relative to peers.

Claims and average payments show operational detail that helps explain revenue mix: 99284 has the highest claim count at 108 claims with $95 avg paid/claim, 99285 has 95 claims with $139 avg paid/claim, and 99283 has 44 claims with $53 avg paid/claim. Although 99284 is billed more frequently by claim count, 99285 produces the largest single-code revenue ($13.2K) due to a higher average payment per claim.

The provider’s lifetime Medicare revenue of $25.8K represents a relatively small Medicare billing footprint overall. Coupled with the fact that the top three codes make up 100.0% of that revenue, this suggests a narrow scope of Medicare activity concentrated in ED E/M encounters.

The coding mix—dominated by 99285 and 99284—implies the provider sees a meaningful share of moderate- and high-acuity emergency visits for Medicare beneficiaries. The presence of 99285 as the single largest revenue contributor (51.2%) indicates a non-trivial proportion of higher-complexity emergency encounters among the billed visits.

The NPI was enumerated on 2006-02-08 (~20 years ago), indicating long-standing enrollment in Medicare. Despite long tenure, the documented Medicare billing volume and revenue remain modest, pointing to either limited Medicare patient volumes, part-time emergency coverage, or billing activity concentrated in settings not captured here.

Medicare: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	100	$140	$13.2K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	110	$100	$10.3K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	40	$50	$2.3K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes. Note: this provider's state, "AE," is a US military postal designation for Armed Forces stationed in Europe, the Middle East, Africa, or Canada — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.

View: State1 / 2

Claims Volume vs. Armed Forces Europe Distribution

Guillermo Navarro — 1 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Armed Forces Europe

Full comparison — all codes billed, vs. state median

3 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	4	10	80	$130	$17.4K
99284	4	10	90	$90	$6.9K
99283	1	10	30	$50	$1.7K

Nearby Providers

Other providers in the same ZIP code as Guillermo Navarro, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
William Selde	AE (Armed Forces Europe)	Emergency Medicine Physician	$17.2K	$0
Corey Shaw	AE (Armed Forces Europe)	Diagnostic Radiology Physician	$13.5K	$0
Alan Cantrell	AE (Armed Forces Europe)	Optometrist	$0	$7.4K

Guillermo Navarro — Billing Profile & Reimbursement Data

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Guillermo Navarro — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References