Loading...
NPI 1609937762 · Upper Tumon, GU · Family Medicine Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Patrick Santos is a family medicine physician provider located in Upper Tumon, Guam. This profile covers 1 Medicare and 15 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Patrick Santos |
| Address | 125 Carlos Lane |
| City | Upper Tumon |
| State | GU |
| ZIP | 96913 |
| Taxonomy | Family Medicine Physician |
| NPI Enumerated | December 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $550.7K |
| Medicare | $6.7K |
This provider is overwhelmingly Medicaid-facing: total Medicaid revenue is $550.7K compared with total Medicare revenue of $6.7K, so the practice’s billing scale is effectively dominated by Medicaid. The disparity implies the clinic’s patient mix and reimbursement exposure are concentrated in the state program rather than Medicare beneficiaries.
Medicare activity for this NPI is narrowly focused and small in scale: top 3 Medicare codes account for 100.0% of this provider's total Medicare revenue, and the sole reported Medicare driver is 99213 (110 claims, $61 avg paid/claim, $6.7K revenue). The 99213 national rank (#173425 of 457151, 62th percentile; typical, unremarkable volume) indicates a modest, routine volume of low‑complexity established-patient visits among Medicare peers.
On the Medicaid side the top three codes are a dominant share of revenue: the top 3 Medicaid codes by revenue account for 71.5% of this provider's total Medicaid revenue. Within that concentration, 99213 alone is responsible for $244.8K (44.4% of Medicaid revenue; 2.9K claims, $83 avg paid/claim) which signals that office-based established-patient E/M visits are the single largest Medicaid revenue stream.
Immunization delivery is a clear operational focus under Medicaid: 90472 generated $92.4K (16.8% of Medicaid revenue; 2.6K claims) and ranks #1 of 7 providers in-state (100th percentile; notably above typical state volume). The companion vaccine administration code 90471 also shows high throughput (3.3K claims, $52.4K revenue; rank #1 of 15, 100th percentile; notably above typical), together implying the practice handles large vaccine volumes and likely runs a high-frequency immunization workflow.
Preventive and pediatric care is a meaningful component of the Medicaid mix: 99392 contributed $56.5K (10.3% of Medicaid revenue; 471 claims) and ranks #3 of 5 in-state (50th percentile; typical). Additional pediatric preventive codes (99393, 99391, 99381, 99394) appear repeatedly in the top Medicaid list, indicating family-medicine services that include routine well-child and adolescent visits.
The provider’s revenue profile shows both concentration and specialization risks/opportunities: Medicare revenue is entirely concentrated in 99213 (top 3 Medicare codes = 100.0% of Medicare revenue), while Medicaid revenue relies heavily on the top three codes (71.5%). That concentration means changes to E/M or vaccination reimbursement or policy could disproportionately affect this clinic’s cash flow, but it also identifies clear operational strengths to scale or contract.
Competitive standing is mixed by payer and service line. Nationally the provider’s Medicare 99213 volume is typical (62th percentile), but statewide the practice is a leading immunization provider (100th percentile for 90472 and 90471), while its Medicaid 99213 position (#14 of 48, 72th percentile; typical) and preventive visit positions are solid but not dominant.
The NPI has long tenure in the system (NPI enumerated: 2006-12-13, ~20 years ago), which together with the heavy Medicaid revenue and high immunization volumes suggests an established family-medicine practice embedded in the local care network and oriented toward routine primary and pediatric preventive services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 110 | $60 | $6.7K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
1 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 99213 | 45 | 100 | 100 | $60 | $10.6K |
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 2,950 | $80 | $244.8K |
| 90472 | This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection. | 2,570 | $40 | $92.4K |
| 99392 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 470 | $120 | $56.5K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 3,280 | $20 | $52.4K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 300 | $120 | $34.6K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 1,070 | $30 | $28.9K |
| 86580 | The lab analyst performs an intradermal skin test on a patient to test for tuberculosis. | 1,330 | $10 | $13.3K |
| 99203 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider… | 80 | $110 | $8.8K |
| 99391 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 50 | $110 | $5.7K |
| 99394 | The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17. | 40 | $120 | $4.9K |
Showing 1–10 of 15
How this provider's Medicaid billing volume and revenue compare to other Guam providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Guam median
15 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 14 | 50 | 900 | $80 | $201.7K |
| 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… | 34 | 40 | 630 | $90 | $172.1K |
| 99392 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 3 | 10 | 470 | $110 | $69.9K |
| 99391 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 5 | 10 | 80 | $100 | $44.8K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 4 | 10 | 130 | $110 | $42.8K |
| 99394 | The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17. | 6 | 10 | 60 | $120 | $39K |
| 99203 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider… | 16 | 20 | 140 | $110 | $35.4K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 21 | 20 | 120 | $60 | $35.1K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 7 | 10 | 780 | $20 | $30.2K |
| 90472 | This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection. | 1 | 10 | 180 | $30 | $16.7K |
Showing 1–10 of 15
Other providers in the same ZIP code as Patrick Santos, 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 |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.