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 Guam for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Guam 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. Guam (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.

Edgar Magcalas (NPI 1578525168)

Field	Value
Entity Type	Individual
Organization	Edgar Magcalas
Address	590 S Marine Corps Dr
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Specialist
NPI Enumerated	April 6, 2006

Payer Source	Total Paid
Medicare	$120.4K
Medicaid	$0

Key Findings

This provider’s Medicare activity is small-to-midsize in absolute dollars with Total Medicare revenue of $120.4K and no Medicaid billing on file, making the practice effectively single-payer (Medicare) in the available claims dataset. The absence of any Medicaid claims suggests analyses of payer mix, access to dual-eligible populations, or state-program sensitivity will be limited or not applicable for this NPI.

Revenue concentration is extreme: the precomputed top-3 Medicare codes by revenue account for 90.0% of this provider's total Medicare revenue, indicating that a very small set of inpatient/critical-care services drive nearly the entire billed Medicare portfolio. This concentration raises operational sensitivity to changes in utilization or reimbursement for those specific codes.

The code mix (99233, 99291, 99223 as the top revenue drivers) points to a clinician focused on inpatient and critical care work rather than routine outpatient office practice. 99233 ($69.3K, 737 claims, $94 avg paid/claim) alone represents 57.7% of Medicare revenue, and 99232 and 99223 further indicate frequent subsequent and initial hospital inpatient visits — consistent with hospitalist or intensivist service lines.

99233 is a standout relative to national peers: it produces $69.3K (57.7% of revenue), with 737 claims and ranks #3729 of 128818 providers nationally (97th percentile; notably above typical national volume for this code). This ranking suggests the provider is a major national outlier on subsequent inpatient hospital care volume and likely maintains a high-intensity inpatient panel or receives a disproportionate share of such encounters in their market.

99291 (critical care) accounts for $28.7K or 23.9% of Medicare revenue, with 177 claims and $162 avg paid/claim; it ranks #6177 of 71290 providers nationally (91th percentile) and is described as typical, unremarkable volume for this code. The presence of significant critical care billing alongside dominant 99233 activity supports an operational profile that includes management of high-acuity hospitalized patients, though the critical care volumes are not flagged as unusually high for the code.

Other billed inpatient E/M codes such as 99223 ($10.2K, 87 claims, $117 avg paid/claim; 77th percentile) and 99232 ($9.2K, 146 claims, $63 avg paid/claim; 66th percentile) together reinforce an inpatient-focused practice pattern with a mix of initial and subsequent higher-complexity hospital visits. These additional E/M codes, while smaller individually, cumulatively contribute material revenue and reflect a full-spectrum hospitalist/intensivist workflow.

Office/outpatient billing is minimal relative to inpatient work: 99214 represents only $2.8K (45 claims, $63 avg paid/claim) and ranks in the 26th percentile nationally, indicating limited outpatient office volume. For payers or network planners, this asymmetry suggests credentialing, network participation, and referral discussions should emphasize inpatient coverage and on-call/ICU availability rather than ambulatory clinic capacity.

Tenure data show the NPI was enumerated on 2006-04-06 (~20 years ago), indicating long-standing presence in the Medicare program; combined with the concentrated, inpatient-heavy billing mix, this suggests an established clinician role within hospital-based services rather than a new entrant shifting service lines. Analysts should consider that historical presence may reflect embedded hospital privileges or long-term staffing relationships influencing current utilization patterns.

Medicare: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	740	$90	$69.3K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	180	$160	$28.7K
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…	90	$120	$10.2K
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…	150	$60	$9.2K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	50	$60	$2.8K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Guam Distribution

Edgar Magcalas — 1 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Guam

Full comparison — all codes billed, vs. state median

5 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	73	90	140	$90	$25.7K
99233	1	20	130	$90	$16.5K
99291	2	10	60	$170	$13.1K
99232	16	30	150	$60	$12.1K
99223	5	20	30	$130	$7K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Lee	GU	Dentist	$0	$10.9M
Guam Memorial Hospital	GU	General Acute Care Hospital	$0	$3.5M
Rsa - Tumon, LLC	GU	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.9M
Robert Yang	GU	Dentist	$0	$2.4M
Antonio Garcia	GU	Pediatrics Physician	$0	$2.2M
Ma Gladys Linsangan	GU	Pediatrics Physician	$0	$2.2M
Ari Katerelos	GU	Radiation Oncology Physician	$2.1M	$0
Guam X-ray	GU	Vascular & Interventional Radiology Physician	$0	$2.1M
Sarah Clegg	GU	General Practice Dentistry	$0	$1.7M
Peter Kh Go	GU	Surgery Physician	$152.8K	$1.5M

Edgar Magcalas — Billing Profile & Reimbursement Data

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Edgar Magcalas — 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