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.

Southern Health Care Group, Inc. (NPI 1780770917)

Southern Health Care Group, Inc. is a internal medicine physician provider located in Guayama, Puerto Rico. This profile covers 0 Medicare and 119 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Southern Health Care Group, Inc.
Address	Southern Medical Plaza
City	Guayama
State	PR
ZIP	00784
Taxonomy	Internal Medicine Physician
NPI Enumerated	October 5, 2006

Payer Source	Total Paid
Medicaid	$588.2K
Medicare	$0

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

119 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…	91,950	$1	$183.9K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	1,820	$30	$52.7K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	490	$70	$34K
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…	1,440	$20	$31.7K
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,…	9,910	$1	$29.7K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	460	$60	$27.5K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	5,570	$1	$22.3K
99441	N/A	3,660	$10	$21.9K
Q0091	Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory	1,490	$10	$20.8K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	3,390	$10	$20.4K

Showing 1–10 of 119

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

Southern Health Care Group, Inc. — 2 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

119 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90396	Report this code for the supply of intramuscular human varicella–zoster immune globulin to prevent and boost immunity against chickenpox.	3	10	210	$210	$77.6K
99050	In this procedure, the provider renders services to a patient in his office at a time when that office would otherwise be closed.	89	90	1,090	$10	$47K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	97	280	210	$30	$43.8K
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…	162	900	360	$30	$42.5K
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…	30	3,230	330	$10	$42.4K
99245	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a high level of medical decision making or the provider spends…	31	90	190	$30	$32.6K
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…	158	1,400	160	$50	$29.6K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	127	170	1,560	$10	$28K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	90	210	1,600	$10	$27.7K
99204	The provider sees a new 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 provider…	404	530	100	$70	$22.9K

Showing 1–10 of 119

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Apcg Urology C S P	PR	Exclusive Provider Organization	$0	$2M
Alberto Corica Guinle	PR	Urology Physician	$0	$2M
James Ojago	PR	General Practice Physician	$0	$1.6M
Jorge Robles	PR	Anesthesiology Physician	$0	$1.5M
Heriberto Martinez Lebron	PR	Ophthalmology Physician	$2.7K	$1.4M
Gastroenterology Centre C.s.p.	PR	Gastroenterology Physician	$0	$1.4M
Marimar Caban	PR	Speech-Language Pathologist	$0	$1.4M
Hospital Menonita Guayama Inc	PR	Critical Access Hospital	$0	$1.3M
Jdo Servicios Pediatricos De Sur	PR	Pediatrics Physician	$0	$1.3M
Laboratorio Beiro Inc	PR	Clinical Medical Laboratory	$1.8K	$967.6K

Southern Health Care Group, Inc. — Billing Profile & Reimbursement Data

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Southern Health Care Group, Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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