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.

Carlos Jimenez (NPI 1609841667)

Field	Value
Entity Type	Individual
Organization	Carlos Jimenez
Address	Ashford Presby Hospital Nuclear Medicine Laboratory
City	San Juan
State	PR
ZIP	00907
Taxonomy	Nuclear Medicine Physician
NPI Enumerated	February 22, 2006

Payer Source	Total Paid
Medicare	$236.5K
Medicaid	$0

Key Findings

This provider’s Medicare billing profile is dominated by PET/CT and associated radiopharmaceutical services: 78815 ($65.4K), 78816 ($42.6K) and A9552 ($41.6K) together account for the majority of activity in revenue-driving imaging studies. The precomputed top-3 share confirms that these three codes alone account for 63.2% of the provider’s total Medicare revenue, indicating a concentrated service line focused on PET/CT diagnostics and FDG tracer-based imaging.

Total Medicare revenue reported is $236.5K and there is no Medicaid billing on file, so this provider functions effectively as a Medicare-only biller in the available data. The absence of Medicaid activity means payer mix is highly skewed and any competitive or utilization comparisons should be interpreted only within the Medicare population.

Competitive standing on core PET/CT codes is modest rather than dominant: 78815 is ranked #3192 of 6566 (51th percentile) and explicitly noted as "typical, unremarkable volume," while 78816 ranks #522 of 1983 (73th percentile) and A9552 ranks #711 of 2411 (70th percentile) and are also labeled typical. These percentile positions indicate the provider is an ordinary national participant for these services, with somewhat higher-than-median activity on 78816 and A9552 but not an outlier.

Beyond PET/CT, the code mix shows a broader nuclear medicine footprint including cardiac SPECT and bone imaging: 78452 ($13.3K), 78803 ($10.3K), and 78306 ($7.6K) appear in the top codes. This distribution suggests the practice delivers multi-modality diagnostic nuclear imaging (oncologic PET/CT plus SPECT bone and cardiac studies) rather than a single narrow procedure line.

Several low-dollar-high-volume items appear in the top 25, reflecting throughput of lower-paid diagnostic or support services: 99214 shows 102 claims totaling $4.6K (1.9% of Medicare revenue) and 77080 shows 200 claims totaling $4.4K (1.9% of Medicare revenue). The combination of relatively high claim counts with small per-claim payments points to routine outpatient encounter and screening/diagnostic volumes that supplement the primary PET/CT workload.

One statistical outlier in peer-comparison terms is A9557 (Technetium tc-99m bicisate) which is listed as rank #1 of 1 providers nationally with no national peer volume comparison available; that code generated $3.6K (1.5% of Medicare revenue) for this provider. This unique rank suggests the provider reports a radiopharmaceutical dose code that has very limited or non-comparable national reporting in the dataset, rather than indicating an unusually large revenue contribution.

The provider’s enrollment tenure (NPI enumerated 2006-02-22, ~20 years ago) shows long-standing Medicare enrollment. Coupled with a total Medicare revenue of $236.5K and the concentrated PET/CT revenue mix, the profile is consistent with an established, small-to-mid scale nuclear medicine practice focused on diagnostic imaging rather than broad primary care or inpatient services.

Medicare: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
78815	PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.…	60	$1,110	$65.4K
78816	The patient is injected with a radiopharmaceutical tracer called FDG (fluoro–deoxyglucose, a radioactive substance containing glucose) about one hour before the imaging is scheduled to begin. The…	50	$910	$42.6K
A9552	Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries	100	$400	$41.6K
78814	In this diagnostic procedure, the provider performs both positron emission tomography and computed tomography together to evaluate the location and metabolic actions of tumors or cancer inside the…	20	$1,270	$24.1K
78452	In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood…	60	$220	$13.3K
78803	The provider uses a nuclear imaging test called SPECT to localize a tumor, inflammatory process, or radioactive tracer distribution. Vascular flow and blood pool imaging are included if performed.…	40	$250	$10.3K
78306	The provider performs a bone scan (also known as scintigraphy), a specialized nuclear medicine procedure in which the provider injects a radionuclide prior to imaging to examine the various bones of…	40	$190	$7.6K
A9500	Technetium tc-99m sestamibi, diagnostic, per study dose	80	$90	$6.9K
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…	100	$50	$4.6K
77080	The provider performs an imaging procedure, called dual–energy X–ray absorptiometry (DXA), of one or more bony areas on the trunk to determine the bone mineral density (BMD) and whether the patient…	200	$20	$4.4K

Showing 1–10 of 19

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Puerto Rico Distribution

Carlos Jimenez — 6 of 19 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. state median

19 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
78815	2	10	30	$870	$35.7K
78814	1	10	20	$1,270	$24.1K
78816	1	10	20	$980	$23.5K
A9552	1	10	50	$410	$17.4K
78803	2	10	40	$270	$11.4K
78452	6	20	60	$210	$10.1K
A9500	5	10	80	$90	$7.6K
99214	95	470	50	$80	$6.6K
78315	3	10	20	$230	$3.9K
78306	1	10	20	$160	$3.6K

Showing 1–10 of 19

Related Providers

Other providers that share a Tax Identification Number (TIN) with Carlos Jimenez, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Confesor Lasalle-ruiz	PR	Cardiovascular Disease Physician	$1.7K	$876.5K
Fernando Zalduondo	PR	Diagnostic Radiology Physician	$125.9K	$0
Gory Ballester Ortiz	PR	Diagnostic Radiology Physician	$72.6K	$0
Frank Gaudier Guerra	PR	Vascular & Interventional Radiology Physician	$19.8K	$51.8K
Eva Cruz Jove	PR	Diagnostic Radiology Physician	$53.2K	$0
Alex Cedeno Rodriguez	PR	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$19.2K	$0
Angela Mendez De Guzman	PR	Diagnostic Radiology Physician	$10.6K	$0
Joanne Marin	PR	Diagnostic Radiology Physician	$10.4K	$0
Ricardo Olazabal	PR	Specialist	$7.3K	$0
Jose Maldonado Vargas	TN	Diagnostic Radiology Physician	$4.6K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Precision Hearing Center Inc	PR	Audiologist	$0	$7.3M
Laboratorio Clinico Dr. Gualberto Rabell	PR	Clinical Medical Laboratory	$0	$1.5M
Sandra Hurtado Ponce De Leon	PR	Driver	$0	$1.3M
Ubaldo Santiago Buono	PR	Geriatric Medicine (Internal Medicine) Physician	$11.5K	$1.2M
Hope Health Psc	PR	Corporate Health Clinic/Center	$0	$920.7K
Francisco Ojeda	PR	General Practice Physician	$0	$818.2K
Raul Montilla	PR	Dentist	$0	$681.7K
Antonio Orraca-gotay	PR	Cardiovascular Disease Physician	$42.3K	$196.7K
Nanette De Leon	PR	Ophthalmology Physician	$45.9K	$135.7K
Monica Cespedes Santana	PR	Infectious Disease Physician	$7.9K	$162.2K

Carlos Jimenez — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References