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.

Rmc Orthopedic & Surgical, Inc. (NPI 1568415834)

Field	Value
Entity Type	Organization
Organization	Rmc Orthopedic & Surgical, Inc.
Address	74 Ave Lopategui Ste. 204
City	Guaynabo
State	PR
ZIP	00969
Taxonomy	Prosthetic/Orthotic Supplier
NPI Enumerated	May 18, 2006

Payer Source	Total Paid
Medicaid	$7.5M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and a Medicaid lifetime revenue total of $7.5M, making it effectively a single‑payer (Medicaid-focused) operation in the available claims data. The NPI was enumerated 2006-05-18 (~20 years ago), indicating a long-tenured presence in the market despite the single‑payer footprint.

Revenue is highly concentrated: the precomputed top-3 Medicaid codes account for 100.0% of this provider's Medicaid revenue, with a single code, L8699, representing $7.5M or 99.7% of the provider's Medicaid receipts. This concentration indicates that nearly all of the provider’s Medicaid billing is driven by one procedure category.

Code-level mix and taxonomy align: the provider’s taxonomy is Prosthetic/Orthotic Supplier and the dominant code, L8699 (Prosthetic implant, not otherwise specified), together with L9900 (Orthotic and prosthetic supply, accessory, and/or service component), indicates an operational focus on prosthetic implants and related supplies rather than broader durable medical equipment or clinical services. L8699 shows 4.4K claims with an average paid per claim of $1704, consistent with higher-cost prosthetic devices as the core service line.

Competitive standing on L8699 is middle-to-upper within the state: L8699 ranks #4 of 23 providers in-state (86th percentile) and is characterized in the data as 'typical, unremarkable volume.' This suggests the provider is a meaningful but not dominant supplier of this prosthetic implant code statewide — larger competitors exist but this entity is a notable participant.

L9900 is small in revenue share but top-ranked among a tiny peer group: the code contributes $26K (0.3% of total Medicaid revenue) from 132 claims at $197 average paid/claim, and it ranks #1 of 2 providers in-state (100th percentile) while also being labeled 'typical, unremarkable volume.' This implies leadership among very few billers for accessory/supply components, but the line itself is not material to total revenue.

The extreme dependence on a single high-cost code (L8699 at 99.7% of Medicaid revenue) creates business concentration risk: changes in Medicaid coverage policy, reimbursement, or coding guidance for prosthetic implants could materially affect the provider’s revenue. Analysts should treat Medicaid revenue trends for L8699 as the primary driver when evaluating financial or contract negotiations.

Taken together, the data describe a long-established, Medicaid-focused prosthetic/orthotic supplier whose financial profile is almost entirely driven by prosthetic implant billing (L8699). State-level ranks indicate it is a notable participant for that code (86th percentile) and a top biller for accessory/supply coding among very few peers, but the overall competitive posture is specialized rather than broadly dominant across multiple code lines.

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	4,400	$1,700	$7.5M
L9900	Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code	130	$200	$26K

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

Rmc Orthopedic & Surgical, 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	4	20	740	$2,660	$4.6M
L9900	Orthotic and prosthetic supply, accessory, and/or service component of another hcpcs "l" code	1	10	120	$180	$21.6K

Nearby Providers

Other providers in the same ZIP code as Rmc Orthopedic & Surgical, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Elderly Transportation Services, LLC	PR	Transportation Broker	$0	$25.7M
Surgical Solutions-j.a. Puerto Rico, Inc	PR	Durable Medical Equipment & Medical Supplies	$0	$7.1M
Bless Therapy Place Psc	PR	Hearing and Speech Clinic/Center	$0	$3.7M
Elderly Transportation Services Management LLC	PR	Transportation Broker	$0	$3.4M
Osvaldo Niebla Diaz	PR	General Practice Physician	$2.9K	$3.1M
Four Molar Psc	PR	Oral and Maxillofacial Surgery (Dentist)	$0	$3M
Ccs Psc	PR	Cardiovascular Disease Physician	$0	$2.3M
Johnson & Johnson Medical Caribbean	PR	Prosthetic/Orthotic Supplier	$0	$2.2M
J.e.r.i. Cardiomed, P.s.c.	PR	Cardiovascular Disease Physician	$0	$1.1M
Rs Gastroenterology, LLC	PR	Gastroenterology Physician	$0	$896.6K

Rmc Orthopedic & Surgical, Inc. — Billing Profile & Reimbursement Data

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Rmc Orthopedic & Surgical, 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