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NPI 1821056011 · Ponce, PR · Nuclear Imaging & Therapy Physician
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Rene Baez is a nuclear imaging & therapy physician provider located in Ponce, Puerto Rico. This profile covers 4 Medicare and 2 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 | Rene Baez |
| Address | 2213 Bypass Ave. |
| City | Ponce |
| State | PR |
| ZIP | 00717 |
| Taxonomy | Nuclear Imaging & Therapy Physician |
| NPI Enumerated | May 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $92.1K |
| Medicare | $86.3K |
The provider's taxonomy (Nuclear Imaging & Therapy Physician) and the Medicare code mix indicate a practice focused on FDG PET/CT diagnostic imaging and radiotracer services, while Medicaid billing is concentrated in cardiac SPECT studies. On Medicare the top codes are 78816 (26 claims, $1237 avg paid/claim), 78815 (25 claims, $1241 avg paid/claim) and A9552 (52 claims, $414 avg paid/claim), and on Medicaid the dominant code is 78452 (761 claims, $120 avg paid/claim).
Medicare revenue is tightly concentrated: the provider reported total Medicare revenue of $86.3K and the precomputed top-3 Medicare codes account for 98.2% of that Medicare revenue. Those top-three Medicare sources are 78816 (37.3%), 78815 (36.0%), and A9552 (25.0%), showing an outsized reliance on PET/CT procedures and FDG tracer billing for Medicare dollars.
Medicaid revenue is effectively mono-coded: total Medicaid revenue is $92.1K and the precomputed top-3 Medicaid codes account for 100.0% of Medicaid revenue, with 78452 representing 99.2% and 78226 representing 0.8% of Medicaid revenue. This indicates nearly all Medicaid activity is driven by myocardial perfusion SPECT (78452) rather than a diversified set of nuclear studies.
The provider's payer mix is balanced in scale: Medicare revenue of $86.3K is similar to Medicaid revenue of $92.1K, so the practice operates with meaningful activity in both payers rather than being effectively single-payer. Medicaid is slightly larger in absolute dollars, but neither payer is overwhelmingly dominant in the overall revenue picture.
On national Medicare comparisons this provider is a modest participant for its top PET/CT and tracer codes rather than a major national player. 78816 ranks #932 of 1983 nationally (52th percentile; typical, unremarkable volume for this code), 78815 ranks #5090 of 6566 nationally (21th percentile; typical, unremarkable volume for this code), and A9552 ranks #1254 of 2411 nationally (47th percentile; typical, unremarkable volume for this code), all characterizations that point to typical, unremarkable volumes versus national peers.
In-state competitive standing for Medicaid shows stronger positioning on cardiac imaging: 78452 ranks #5 of 20 providers in-state (79th percentile; typical, unremarkable volume for this code), indicating relatively high Medicaid SPECT volume within Puerto Rico. By contrast 78226 ranks #2 of 2 providers in-state (0th percentile; typical, unremarkable volume for this code), a comparison that should be interpreted cautiously given the very small in-state denominator.
The provider has a long billing history: the NPI was enumerated on 2006-05-04 (~20 years ago), which supports that these patterns reflect an established practice rather than a short-term or newly enumerated entrant. Tenure of approximately two decades increases confidence that the observed specialization in PET/CT and cardiac SPECT reflects an enduring service profile.
All of the top billed codes are described in the peer comparisons as typical, unremarkable volume for their respective cohorts, and there are no codes flagged as extreme outliers in the supplied data. Given the very high concentration of revenue in a small set of imaging services (Medicare top-3 = 98.2% and Medicaid top-3 = 100.0%), the provider's revenue is operationally sensitive to changes in PET/CT utilization, FDG tracer supply/pricing, or cardiac SPECT referral patterns.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 78816 | The patient is injected with a radiopharmaceutical tracer called FDG (fluoro–deoxyglucose, a radioactive substance containing glucose) about one hour before the imaging is scheduled to begin. The… | 30 | $1,240 | $32.2K |
| 78815 | PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.… | 30 | $1,240 | $31K |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 50 | $410 | $21.5K |
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 30 | $50 | $1.5K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 760 | $120 | $91.3K |
| 78226 | The provider images the liver, bile, bile ducts, and gallbladder to follow the production and flow of bile from the liver to the small intestine to diagnose a bile duct obstruction or leakage;… | 10 | $60 | $720 |
How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Puerto Rico median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 5 | 20 | 260 | $250 | $174.9K |
| 78226 | The provider images the liver, bile, bile ducts, and gallbladder to follow the production and flow of bile from the liver to the small intestine to diagnose a bile duct obstruction or leakage;… | 2 | 10 | 20 | $110 | $2.3K |
Other providers in the same ZIP code as Rene Baez, ranked by combined Medicare and Medicaid revenue.
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