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.

Recinto De Ciencias Medicas (NPI 1689752461)

Key Findings

Field	Value
Entity Type	Organization
Organization	Recinto De Ciencias Medicas
Address	Centro Comercial Reparto Metropolitano Suite 211
City	Rio Piedras
State	PR
ZIP	00921
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	November 1, 2006

Payer Source	Total Paid
Medicaid	$3.8M
Medicare	$0

This provider is effectively single-payer in scope for the period on file: there is no Medicare billing on file and all reported federal revenue is from Medicaid, totaling $3.8M. The NPI was enumerated on 2006-11-01 (~20 years ago), indicating an established practice footprint that appears to have focused its billing activity primarily within the Medicaid program.

Revenue for this provider is highly concentrated in a small set of outpatient E/M and obstetric codes: the precomputed top 3 Medicaid codes account for 80.8% of its Medicaid revenue, driven by 99213 ($2.4M revenue, 64.7% of total Medicaid revenue), 99203 ($316.4K, 8.4%), and 59515 ($296.4K, 7.8%). This concentration indicates the business depends heavily on routine office visits for established and new patients plus inpatient cesarean delivery services.

The code mix points to an OB/GYN practice model that is primarily ambulatory with a meaningful inpatient delivery capability: high-volume office visits (99213: 62.7K claims, $39 avg paid/claim) and new-patient visits (99203: 6.5K claims, $49 avg paid/claim) are the largest revenue drivers, while 59515 (304 claims, $975 avg paid/claim) shows active cesarean delivery services and associated global care. Additional obstetric and prenatal activity is visible through 76815 (2.5K claims, $83.4K revenue) and delivery code 59410 (66 claims, $43.1K revenue), supporting a combined ambulatory–hospital service line.

Competitive standing within the state is strong for ambulatory E/M volume: 99213 ranks #48 of 3229 providers in-state (99th percentile) and 99203 ranks #12 of 1397 providers in-state (99th percentile, described as an extreme outlier), signaling that this provider is a market leader for both established- and new-patient office visits in Puerto Rico. Those rank positions suggest above-typical patient volume and referral inflow for outpatient evaluation and management relative to peers.

By contrast, obstetric procedural volume is present but not dominant relative to other in-state hospitals/providers: 59515 ranks #8 of 33 providers in-state (78th percentile) and 59410 ranks #4 of 15 providers in-state (79th percentile), both characterized as typical or unremarkable volumes. This indicates that while the provider performs a meaningful number of deliveries, its statewide competitive position for inpatient obstetric procedures is more modest than its ambulatory E/M footprint.

Hospital-based and urgent care activity is also material: emergency department level E/M 99285 accounts for $257.2K (6.8% of Medicaid revenue) and ranks #12 of 178 providers in-state (94th percentile), and inpatient/observation codes such as 99221 (1.5K claims, $91.6K revenue) and 99231 (716 claims, $75.2K revenue) appear across the mix. These items indicate the provider bills across both outpatient clinic and inpatient/ED settings, consistent with an OB/GYN group that admits and manages inpatients as well as ambulatory patients.

Utilization patterns show very high claim counts for routine visits compared with delivery procedures: 62.7K claims for 99213 versus 304 claims for 59515, reinforcing an operational profile centered on high-volume clinic throughput with a lower, though clinically significant, volume of surgical deliveries. This mix suggests business sensitivity to changes in outpatient visit reimbursement and referral patterns as primary revenue levers.

Operational and payer-risk implications: because the practice reports no Medicare activity and $3.8M concentrated in Medicaid (with 80.8% of Medicaid revenue tied to the top 3 codes), policy or payment changes to those specific E/M and obstetric codes could disproportionately affect revenue. The ~20-year enumeration tenure supports that the pattern is longstanding, so payers and contracting teams should consider the provider a mature, Medicaid-focused ambulatory OB/GYN operation with supplementary inpatient and ED activity.

Medicaid: Complete Services Breakdown

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

20 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…	62,730	$40	$2.4M
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…	6,460	$50	$316.4K
59515	In this global service, the provider provides admission to the hospital for cesarean delivery of the fetus and placenta via an abdominal incision, and inpatient and outpatient postpartum care.…	300	$980	$296.4K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	2,280	$110	$257.2K
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…	1,480	$60	$91.6K
76815	The provider performs a limited examination of the fetus using ultrasound. The provider performs the examination of certain parameters for one or more fetuses.	2,450	$30	$83.4K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	720	$110	$75.2K
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…	230	$230	$52.4K
59410	In this global service, the provider admits the patient to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal…	70	$650	$43.1K
G0101	Cervical or vaginal cancer screening; pelvic and clinical breast examination	2,700	$20	$40.4K

Showing 1–10 of 20

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

Recinto De Ciencias Medicas — 2 of 16 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

20 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
59515	In this global service, the provider provides admission to the hospital for cesarean delivery of the fetus and placenta via an abdominal incision, and inpatient and outpatient postpartum care.…	8	30	100	$310	$109.3K
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…	211	390	290	$80	$96.8K
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.	347	500	220	$40	$79.5K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	12	180	170	$80	$55.3K
76815	The provider performs a limited examination of the fetus using ultrasound. The provider performs the examination of certain parameters for one or more fetuses.	3	30	210	$60	$53.9K
99070	Then provider utilizes items or supplies materials to the patient in excess of what is normally utilized or provided during an encounter. These items might include medical supplies, medications,…	50	230	410	$40	$51.9K
59410	In this global service, the provider admits the patient to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal…	4	20	30	$640	$50.5K
57454	In this procedure, the provider examines the cervix, including the upper/adjacent portion of the vagina, using an instrument called a colposcope, and also performs biopsy(s) of the cervix and…	12	10	60	$140	$42.8K
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…	48	3,230	330	$10	$42.4K
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…	18	170	140	$40	$34.3K

Showing 1–10 of 20

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jose Garcia Gonzalez	PR	Retina Specialist (Ophthalmology) Physician	$1.9M	$3.4M
Medical Pharmacy And Lab	PR	Exclusive Provider Organization	$0	$2.5M
Metrohealth Radiation Oncology Group, Inc.	PR	Specialist	$0	$2.5M
Metropolitan Mri Associates Psc	PR	Neuroradiology Physician	$0	$2.1M
Pediatrics Management Services	PR	Medical Specialty Clinic/Center	$0	$1.8M
Luis Rodriguez	PR	Diagnostic Radiology Physician	$2K	$1.3M
Metrohealth, Inc.	PR	General Acute Care Hospital	$0	$905.1K
Minerva Nunez	PR	General Practice Dentistry	$0	$761.4K
Elizabeth Calderon-alicea	PR	Hematology & Oncology Physician	$0	$707.2K
Las Lomas Laboratory Inc.	PR	Clinical Medical Laboratory	$29.6K	$630.1K

Recinto De Ciencias Medicas — Billing Profile & Reimbursement Data

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Recinto De Ciencias Medicas — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Recinto De Ciencias Medicas	PR	Emergency Medicine Physician	$0	$6.8M
Recinto De Ciencias Medicas	PR	Neonatal-Perinatal Medicine Physician	$0	$5.4M
Recinto De Ciencias Medicas	PR	Diagnostic Radiology Physician	$0	$4.2M
Recinto De Ciencias Medicas	PR	Pediatrics Physician	$0	$4M
Recinto De Ciencias Medicas	PR	Internal Medicine Physician	$0	$3.4M
Recinto De Ciencias Medicas	PR	Pediatric Cardiology Physician	$0	$3.1M
Recinto De Ciencias Medicas	PR	Clinical Medical Laboratory	$0	$3.1M
Recinto De Ciencias Medicas	PR	Orthopaedic Surgery Physician	$0	$3M
Recinto De Ciencias Medicas	PR	Maternal & Fetal Medicine Physician	$0	$2.7M
Recinto De Ciencias Medicas	PR	Ophthalmology Physician	$0	$2.4M