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.

Pediatrix Medical Group, S.p. (NPI 1528046075)

Key Findings

Field	Value
Entity Type	Organization
Organization	Pediatrix Medical Group, S.p.
Address	917 Ave Tito Castro
City	Ponce
State	PR
ZIP	00716
Taxonomy	Neonatal-Perinatal Medicine Physician
NPI Enumerated	January 5, 2006

Payer Source	Total Paid
Medicaid	$3.8M
Medicare	$0

This provider is effectively a single-payer Medicaid practice: there is no Medicare billing on file and lifetime Medicaid revenue is $3.8M. The NPI was enumerated 2006-01-05 (~20 years ago), indicating long-tenured participation in the state Medicaid program rather than recent market entry.

Revenue is highly concentrated in a small set of neonatal codes: the precomputed top 3 Medicaid codes account for 64.7% of the provider's total Medicaid revenue. Specifically, 99462 ($1.1M, 28.6%), 99480 ($711.4K, 18.8%), and 99460 ($649.1K, 17.2%) are the dominant contributors to the $3.8M Medicaid footprint.

The code mix and volumes indicate a core business of in-hospital newborn evaluation and neonatal-perinatal services: large claim counts for 99462 (36K claims, $30 avg paid/claim) and 99460 (10K claims, $65 avg paid/claim) point to routine newborn rounds and immediate post-birth evaluations, while 99480 (2.1K claims, $344 avg paid/claim) signals active management of recovering low-birth-weight infants requiring specialized follow-up. These patterns align with the provider's Neonatal-Perinatal Medicine Physician taxonomy.

On competitive standing within Puerto Rico, the provider is a clear statewide leader for certain newborn services: 99462 ranks #1 of 26 providers and is labeled an "extreme outlier" at the 100th percentile, demonstrating an outsized share of state volume for this code. 99460 ranks #2 of 24 and sits at the 96th percentile ("notably above typical"), while 99480 is #2 of 2 with a neutral characterization ("typical, unremarkable"), reflecting dominance in some routine newborn services but more typical volumes for specialized low-birth-weight care.

Beyond the top three, the provider bills a mix of hospital inpatient E/M and neonatal critical-care codes that together show coverage across acuity levels: 99233 ($315.7K, 8.4%, 915 claims; 70th percentile) and the 9923x series (99231–99233) reflect ongoing inpatient follow-up, and intensive neonatal codes such as 99477 (98 claims, $33.8K, 0.9%) and 99469 (144 claims, $55.6K, 1.5%) indicate some NICU-level involvement. These secondary codes make meaningful but smaller contributions to total Medicaid revenue.

Operationally, the combination of extremely high claim volume for lower-paid routine newborn visits (e.g., 36K claims for 99462 at $30 avg) together with fewer, higher-paid specialized neonatal services (e.g., 99480 at $344 avg) suggests a care model built on high throughput of routine postnatal encounters supplemented by concentrated higher-acuity work. This mix implies staffing and scheduling patterns oriented to sustained inpatient coverage and repeated newborn rounds.

From a payer risk and contract management perspective, the provider's dependence on Medicaid (no Medicare revenue) and its concentration in a few neonatal codes mean that changes in Medicaid policy, rates, or network status could have outsized financial impact on the practice. At the same time, its extreme-state-level share for 99462 and high percentiles for other newborn codes position it as an important provider for neonatal capacity within Puerto Rico's Medicaid network.

Medicaid: Complete Services Breakdown

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	36,030	$30	$1.1M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2,070	$340	$711.4K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	9,990	$70	$649.1K
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…	920	$350	$315.7K
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…	3,240	$70	$223.6K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	1,110	$170	$191.9K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	6,670	$20	$153.5K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	2,500	$40	$107.3K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	290	$330	$96K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	990	$70	$65.2K

Showing 1–10 of 17

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

Pediatrix Medical Group, S.p. — 5 of 17 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

17 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	4	10	740	$1,410	$2.9M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	10	3,240	$240	$792.5K
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…	2	10	1,460	$70	$144.1K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	1	30	250	$40	$108.9K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	2	20	210	$70	$98.8K
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…	117	390	290	$80	$96.8K
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.	472	500	220	$40	$79.5K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	19	460	200	$50	$60.3K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	10	190	$300	$55.7K
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…	164	500	130	$90	$43.1K

Showing 1–10 of 17

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southern Pathology Services, Inc.	PR	Clinical Medical Laboratory	$6.2K	$5.7M
Tiber Health, Public Benefit Corporation	PR	Multi-Specialty Clinic/Center	$0	$5.1M
Med Centro, Inc.	PR	Clinical Medical Laboratory	$0	$3.6M
Ida Y Vuelta, Inc.	PR	Non-emergency Medical Transport (VAN)	$0	$3.3M
St Lukes Episcopal Church Home Care Program	PR	Community Based Hospice Care Agency	$0	$2.9M
Saint Lukes Memorial Hospital Inc	PR	General Acute Care Hospital	$0	$2.5M
Med Centro, Inc.	PR	Federally Qualified Health Center (FQHC)	$0	$2.3M
St Lukes Episcopal Church Home Care Program	PR	Home Health Agency	$0	$2.2M
Medical X Ray Center Ponce	PR	Radiology Clinic/Center	$0	$2.1M
Invasive Gastro-intestinal Medical Service Psc	PR	Medical Specialty Clinic/Center	$0	$2.1M

Pediatrix Medical Group, S.p. — Billing Profile & Reimbursement Data

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Pediatrix Medical Group, S.p. — 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