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.

Puerto Rico Medical Emergency Group P.s.c. (NPI 1629261011)

Field	Value
Entity Type	Organization
Organization	Puerto Rico Medical Emergency Group P.s.c.
Address	Hospital Episcopal San Lucas
City	Ponce
State	PR
ZIP	00731
Taxonomy	Emergency Medicine Physician
NPI Enumerated	August 20, 2007

Payer Source	Total Paid
Medicaid	$8.2M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $8.2M in lifetime Medicaid revenue, making its public payer footprint effectively single‑payer (Medicaid) based on the available claims data. The absence of Medicare activity means all observed government revenue is concentrated in Medicaid flows rather than split across both major federal programs.

Revenue is extremely concentrated: the top 3 Medicaid billing codes account for 99.1% of this provider's total Medicaid revenue, driven by 99283 ($7M, 85.8%), 99284 ($930.3K, 11.4%), and 93010 ($158.1K, 1.9%). That concentration indicates a very narrow set of services produce virtually all reported Medicaid dollars for this entity.

The code mix — dominated by 99283 and 99284 emergency department E/M visits — identifies this organization as operating primarily as an emergency medicine provider handling mostly low to moderate complexity ED visits. High volume of 93010 (ECG interpretation) further supports a typical emergency-department case mix where cardiac monitoring and ECG interpretation are routine adjuncts to E/M encounters.

On statewide competitive standing the provider is a standout: 99283 ranks #1 of 495 providers in-state and is labeled an "extreme outlier," indicating far higher state volume for that ED low-complexity E/M code than typical peers. 99284 ranks #7 of 335 (98th percentile, "notably above typical state volume"), and 93010 ranks #4 of 510 (99th percentile, "extreme outlier"), collectively signaling a dominant presence in Puerto Rico for the emergency E/M and ECG codes it bills most.

Operationally and financially, the provider's reliance on a very small set of high-volume E/M codes suggests sensitivity to changes in Medicaid payment policy, coding guidance, or utilization patterns for ED visits. Because top codes drive nearly all revenue, shifts in reimbursement or utilization for 99283/99284/93010 could materially affect overall Medicaid income.

Ancillary and procedure codes appear but contribute negligible revenue relative to core ED E/M billing: 12001 ($57K), 12011 ($10.6K), 12002 ($4.6K), 15851 ($2.2K), and 29515 ($564). Several of these small-value codes are listed as #1 of 1 providers in-state or have limited peer benchmarks, which limits meaningful comparative interpretation of their procedural mix.

The provider has an established registration history (NPI enumerated 2007-08-20 (~19 years ago)), indicating a long-tenured operation in the market that has accumulated its current Medicaid billing profile over nearly two decades. That tenure may reflect stable site-based ED activity concentrated on Medicaid patients.

Given the lack of Medicare claims and the predominance of Medicaid revenue, this provider's payer mix is heavily skewed toward Medicaid payers, which has implications for average reimbursement levels and contracting dynamics compared with providers that maintain mixed Medicare/Medicaid portfolios. Analysts should treat this entity as a Medicaid-centric emergency medicine operator when benchmarking payment rates or negotiating network arrangements.

Medicaid: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	170,760	$40	$7M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	9,900	$90	$930.3K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	17,560	$10	$158.1K
12001	This CPT code is used for the simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 2.5 cm or less in…	1,160	$50	$57K
12011	This CPT code is used for the simple repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, that are 2.5 cm or less in size.	180	$60	$10.6K
12002	This CPT code is used for the simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 2.6 to 7.5 cm in…	150	$30	$4.6K
15851	With the patient under general anesthesia or moderate sedation, the provider removes sutures or staples.	450	$10	$2.2K
29515	The provider applies a short leg splint to treat injuries of the leg, including fractures, dislocations, and sprains of the lower leg, ankle, and foot. The splint covers and immobilizes the lower leg…	10	$50	$560

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

Puerto Rico Medical Emergency Group P.s.c. — 4 of 8 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

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	7	340	210	$70	$81.7K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	1	500	220	$40	$79.5K
12001	This CPT code is used for the simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 2.5 cm or less in…	1	10	1,160	$50	$57K
12011	This CPT code is used for the simple repair of superficial wounds to the face, ears, eyelids, nose, lips, and/or mucous membranes, that are 2.5 cm or less in size.	1	10	180	$60	$10.6K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	4	510	210	$10	$7.8K
29515	The provider applies a short leg splint to treat injuries of the leg, including fractures, dislocations, and sprains of the lower leg, ankle, and foot. The splint covers and immobilizes the lower leg…	5	10	60	$50	$6.4K
15851	With the patient under general anesthesia or moderate sedation, the provider removes sutures or staples.	1	10	450	$1	$2.2K
12002	This CPT code is used for the simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 2.6 to 7.5 cm in…	1	10	30	$30	$1.7K

Nearby Providers

Other providers in the same ZIP code as Puerto Rico Medical Emergency Group P.s.c., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southern Anesthesia Associates LLC	PR	Specialist	$0	$1.4M
First Choice Prosthetic & Otrhopedic Service Inc	PR	Customized Equipment (DME)	$0	$1.3M
Amilcar Rodriguez Melendez	PR	General Practice Dentistry	$0	$877.7K
Lionel Lugo	PR	Specialist	$0	$837.7K
Humberto Simonetti	PR	Internal Medicine Physician	$18.3K	$250.7K
Monica Portalatin Perez	PR	General Practice Physician	$2.2K	$0

Puerto Rico Medical Emergency Group P.s.c. — Billing Profile & Reimbursement Data

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Puerto Rico Medical Emergency Group P.s.c. — 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