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.

Smith & Nephew Inc. (NPI 1558469403)

Field	Value
Entity Type	Organization
Organization	Smith & Nephew Inc.
Address	361 Calle Angel Buonomo
City	San Juan
State	PR
ZIP	00918
Taxonomy	Prosthetic/Orthotic Supplier
NPI Enumerated	September 21, 2006

Payer Source	Total Paid
Medicaid	$12M
Medicare	$0

Key Findings

SMITH & NEPHEW INC., registered in SAN JUAN, PR, is listed under the Prosthetic/Orthotic Supplier taxonomy and has an NPI enumerated 2006-09-21 (~20 years ago), indicating long-standing enrollment in federal programs and an established presence in the territory. The provider reports no Medicare billing on file and therefore operates, in this dataset, as effectively a Medicaid-only biller at scale.

On payer mix the record is clear: there is no Medicare revenue on file while total Medicaid revenue is $12M, so this entity is effectively single-payer (Medicaid) in the claims data provided. Analysts should treat Medicare comparators as not applicable for this provider and focus competitive analysis on Medicaid activity within PR.

Revenue concentration is extremely high: the precomputed top-3 summary shows the top 3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, and a single code, L8699, alone accounts for $12M (99.9% of the provider's Medicaid revenue). This level of concentration means the provider’s financial profile is driven almost entirely by activity tied to one HCPCS code.

The code mix and descriptions point to a focused prosthetics business model: L8699 (Prosthetic implant, not otherwise specified) is the dominant revenue driver, consistent with a supplier that primarily provides prosthetic implant devices or related implantable components, while L9900 (Orthotic and prosthetic supply, accessory, and/or service component) represents a very small ancillary service/supply role. The taxonomy and code mix together suggest core operations are centered on device/implant supply rather than broad orthotics service lines.

Unit-level economics reinforce the implant focus: L8699 shows 6K claims with an average paid per claim of $1989 and total reported revenue of $12M, indicating the provider’s Medicaid revenue is derived from high-unit-value prosthetic implant claims. By contrast, L9900 is modest in scale (106 claims, $162 avg paid/claim, $17.2K revenue) and contributes only 0.1% of Medicaid revenue, underscoring the ancillary nature of that code for this supplier.

Competitive standing for the flagship code is strong within the state: L8699 ranks #2 of 23 providers in PR and sits at the 95th percentile, described as notably above typical state volume for this code, which positions the provider as a major in-state participant for prosthetic implants. Conversely, L9900 ranks #2 of 2 providers (0th percentile) and is characterized as typical/unremarkable in volume, so the provider is not differentiated on accessory/supply components.

From a business-risk and strategy perspective, the combination of single-payer reliance (Medicaid-only billing) and extreme revenue concentration in L8699 represents both a competitive advantage in a specialized niche and a concentration risk if reimbursement, utilization, or network access for that code changes. Analysts should flag sensitivity to policy or procurement shifts affecting prosthetic implant billing in Puerto Rico and consider monitoring claim volume and rate trends for L8699 closely.

Given the provider’s long tenure (NPI since 2006-09-21, ~20 years) and top-state ranking on the implant code, commercial or plan-level contracting teams may treat SMITH & NEPHEW INC. as an established, high-volume prosthetic implant supplier in PR, but should also account for its near-total dependency on a single Medicaid revenue stream when assessing network redundancy and negotiating leverage.

Medicaid: Complete Services Breakdown

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

2 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
L8699	Prosthetic implant, not otherwise specified	6,020	$1,990	$12M
L9900	Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code	110	$160	$17.2K

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

Smith & Nephew Inc. — 1 of 2 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

2 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
L8699	Prosthetic implant, not otherwise specified	2	20	740	$2,660	$4.6M
L9900	Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code	2	10	120	$180	$21.6K

Nearby Providers

Other providers in the same ZIP code as Smith & Nephew Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratorio De Patologia Dr Noy	PR	Anatomic Pathology Physician	$0	$45.7M
Hato Rey Pathology Associates Inc	PR	Clinical Medical Laboratory	$58.5K	$42M
Home Orthopedics Corp	PR	Prosthetic/Orthotic Supplier	$0	$20.7M
Orthobone, Inc	PR	Customized Equipment (DME)	$0	$15.5M
Laboratorio Clinico Noy Inc	PR	Clinical Medical Laboratory	$76.1K	$9.9M
Servicios Radiologicos Asociados Jorge Perez Brais	PR	Diagnostic Radiology Physician	$0	$2.9M
Luis Torres Vera	PR	Allergy Physician	$21.5K	$2.7M
Inspira Psychiatric Services Psc	PR	Adult Mental Health Clinic/Center	$0	$2.5M
Frankie Alvarado	PR	Pulmonary Disease Physician	$7.3K	$2.4M
Boston Scientific Del Caribe, Inc	PR	Durable Medical Equipment & Medical Supplies	$0	$2.2M

Smith & Nephew Inc. — Billing Profile & Reimbursement Data

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Smith & Nephew Inc. — 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