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NPI 1659467504 · Tamuning, GU · Orthopaedic Surgery Physician
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Ruben Arafiles is a orthopaedic surgery physician provider located in Tamuning, Guam. This profile covers 3 Medicare and 1 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 | Ruben Arafiles |
| Address | 633 Gov. Carlos Camacho Rd |
| City | Tamuning |
| State | GU |
| ZIP | 96913 |
| Taxonomy | Orthopaedic Surgery Physician |
| NPI Enumerated | October 5, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.2K |
| Medicaid | $1.6K |
Service mix is dominated by evaluation-and-management activity: the Medicare top codes are 99202 (new outpatient E/M), 99221 (initial hospital inpatient/observation E/M), and 99212 (established outpatient E/M), with per-code claims of 38, 29, and 37 respectively and revenues of $2.1K, $1.7K, and $1.4K. This pattern suggests Ruben Arafiles operates primarily as an office-based orthopaedic evaluator who also performs initial inpatient evaluations rather than producing significant procedure-driven surgical revenue.
Medicare revenue is narrowly concentrated: the precomputed top-3 Medicare codes account for 100.0% of this provider's total Medicare revenue, with 99202 at 40.4% ($2.1K), 99221 at 32.5% ($1.7K), and 99212 at 27.2% ($1.4K). That concentration indicates a very tight dependence on a small set of E/M encounters for Medicare billing.
Medicaid billing is effectively single-code driven: 99202 represents 100.0% of this provider's total Medicaid revenue, with 25 claims, a $66 avg paid/claim, and $1.7K in revenue. Medicaid activity therefore mirrors the provider’s Medicare pattern in focusing on new-patient outpatient E/M visits rather than diverse procedure codes.
Payer mix shows Medicare as the larger revenue stream in scale: total Medicare revenue is $5.2K versus total Medicaid revenue of $1.6K, so Medicare accounts for the majority of reported public-payer receipts while both totals remain small in absolute terms. These dollar levels imply a modest footprint in both payers rather than a high-volume practice.
Competitive standing on Medicare E/M codes is modest: 99202 ranks #4773 of 20840 providers nationally (76th percentile), 99221 ranks #5729 of 20230 (70th percentile), and 99212 ranks #42343 of 99011 (56th percentile), each described as typical, unremarkable volume. Taken together, these ranks indicate the provider is a routine participant nationally on these codes rather than a dominant regional or national provider.
State-level standing for Medicaid is also modest: Medicaid 99202 ranks #6 of 11 providers in-state (40th percentile) and is described as typical, unremarkable volume, so this provider is not a leading Medicaid E/M biller in Guam.
Tenure on file is long: the NPI was enumerated on 2006-10-05 (~20 years ago), indicating an established presence in the market despite low recent billing totals. The long enumeration suggests continuity of practice that may not be fully reflected in the small public-payer revenue reported.
No code appears as a statistical outlier in the supplied descriptors: all listed codes are labeled as typical, unremarkable volume. Claim counts per reported code are modest (Medicare: 38, 29, 37; Medicaid: 25), reinforcing that the provider’s public-payer activity is low-volume and concentrated in a narrow set of E/M 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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 40 | $60 | $2.1K |
| 99221 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical… | 30 | $60 | $1.7K |
| 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,… | 40 | $40 | $1.4K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes.
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 30 | $70 | $1.6K |
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
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 6 | 10 | 30 | $80 | $16.2K |
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