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.

Sports And Pain Interventions Psc (NPI 1770954281)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sports And Pain Interventions Psc
Address	C55 Calle 4
City	Hormigueros
State	PR
ZIP	00660
Taxonomy	Pain Clinic/Center
NPI Enumerated	October 9, 2015

Payer Source	Total Paid
Medicaid	$6.1M
Medicare	$0

This provider is effectively a Medicaid-only billing entity: Total Medicaid revenue is $6.1M and there is no Medicare billing on file, so operational scale and payer exposure are concentrated entirely in Medicaid contracts and beneficiaries. Analysts should treat the provider as a single-payer (Medicaid) operation for comparative benchmarking.

Revenue concentration is heavy in a small set of physical-therapy/modality codes: the precomputed top three Medicaid codes (97110, 97032, 97035) account for 48.1% of this provider's total Medicaid revenue. Those top three line items are 97110 ($1.2M revenue, 53.4K claims, $22 avg paid/claim, 19.3%), 97032 ($919.2K revenue, 61.3K claims, $15 avg paid/claim, 15.1%), and 97035 ($830K revenue, 51.9K claims, $16 avg paid/claim, 13.6%).

The service mix points to a high-volume outpatient rehabilitation and pain-management practice focused on non‑procedural modalities: large volumes and revenue in 97110 (therapeutic exercise), 97032 (electrical stimulation), 97035 (therapeutic modalities), plus substantial revenue from 97140 (manual therapy, $668.6K, 39.3K claims, 11.0%) and 97124 (massage, $618.8K, 41.3K claims, 10.2%). This pattern is consistent with a clinic delivering recurring, time-based therapy sessions rather than an interventional spine center driven by imaging‑guided injections.

The provider is a dominant statewide participant for multiple therapy codes: 97110 ranks #1 of 182 providers (100th percentile; extreme outlier), 97032 ranks #1 of 163 providers (100th percentile; extreme outlier), 97035 ranks #1 of 125 providers (100th percentile; extreme outlier), and both 97140 and 97124 rank #1 in their respective denominators (each 100th percentile; extreme outlier). These ranks indicate the practice is a major outlier in Puerto Rico for delivery of these specific modalities and is operating at volumes far above typical state peers.

Evaluation/management and diagnostic electrodiagnostic services are meaningful adjuncts to the therapy-focused revenue mix: 99213 generates $673K (10.5K claims, 11.1% of Medicaid revenue) and 99203 generates $371.7K (4.8K claims, 6.1%), while nerve conduction and EMG codes such as 95911 ($97.3K, 597 claims, 1.6%) and 95886 ($79.9K, 655 claims, 1.3%) contribute modestly. Together, these codes suggest the clinic combines evaluation and diagnostic testing with high-volume therapeutic sessions, supporting longitudinal care pathways for patients.

Procedural, image‑guided injections represent a very small share of Medicaid revenue: 64493 ($8.2K, 65 claims, 0.1%), 64483 ($4.4K, 26 claims, 0.1%), and add‑on 64494 ($2K, 64 claims, 0.0%) together form only a negligible portion of total revenue. This reinforces that the practice’s business model is weighted toward non‑invasive therapy modalities rather than revenue from interventional procedures.

The NPI was enumerated on 2015-10-09 (~11 years ago), indicating an established presence in the market; combined with the extreme outlier volumes on core therapy codes, the provider appears to have scaled a high-throughput outpatient therapy operation over its tenure. Given the concentrated revenue in a small number of high-volume service codes and consistent top-state rankings, payers and network analysts should benchmark utilization and authorization patterns for these specific modality codes (especially 97110, 97032, 97035) against other high-volume state providers to validate network design and unitization assumptions.

Medicaid: Complete Services Breakdown

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	53,390	$20	$1.2M
97032	Electrical stimulation therapy uses electricity to stimulate the muscles for the treatment of pain and other disorders associated with muscles. Electrodes are placed on the affected muscle areas and…	61,280	$20	$919.2K
97035	Physical therapists use different treatment modalities that can help strengthen, relax, and heal muscles from their strained conditions.	51,880	$20	$830K
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…	10,520	$60	$673K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	39,330	$20	$668.6K
97124	Generally, massage is a technique of applying light or firm pressure, with different movement styles, using palms, fingers, and thumbs, over body muscles and tissues in order to restore better blood…	41,260	$20	$618.8K
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…	4,770	$80	$371.7K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	2,370	$90	$217.6K
97010	The provider, such as physical therapist, applies a hot or cold pack to a specific body site to treat an injury or disease.	38,670	$1	$154.7K
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,…	4,400	$20	$101.1K

Showing 1–10 of 29

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

Sports And Pain Interventions Psc — 9 of 25 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

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	24	40	1,150	$40	$135.4K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	1	180	2,150	$20	$95.2K
64493	The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance…	8	10	120	$230	$92.5K
97032	Electrical stimulation therapy uses electricity to stimulate the muscles for the treatment of pain and other disorders associated with muscles. Electrodes are placed on the affected muscle areas and…	1	160	3,960	$20	$89.7K
97124	Generally, massage is a technique of applying light or firm pressure, with different movement styles, using palms, fingers, and thumbs, over body muscles and tissues in order to restore better blood…	1	110	2,080	$20	$72.3K
97035	Physical therapists use different treatment modalities that can help strengthen, relax, and heal muscles from their strained conditions.	1	130	3,370	$10	$64.5K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	57	70	950	$20	$60.4K
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,…	137	230	410	$40	$51.9K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	1	80	1,220	$20	$51K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	5	70	510	$60	$44.8K

Showing 1–10 of 29

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Metro Pavia At Home LLC	PR	Home Health Agency	$0	$954.2K
Jeannette S. Troche	PR	Clinical Medical Laboratory	$3.2K	$699.6K

Sports And Pain Interventions Psc — Billing Profile & Reimbursement Data

Sign up for Sports And Pain Interventions Psc — Billing Profile & Reimbursement Data policy alerts

Sports And Pain Interventions Psc — Billing Profile & Reimbursement Data

Sign up for Sports And Pain Interventions Psc — Billing Profile & Reimbursement Data policy alerts

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