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 Guam for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Guam 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. Guam (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.

Antonio Garcia (NPI 1841480050)

Key Findings

Field	Value
Entity Type	Individual
Organization	Antonio Garcia
Address	428 Chalan San Antonio
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Pediatrics Physician
NPI Enumerated	July 25, 2007

Payer Source	Total Paid
Medicaid	$2.2M
Medicare	$0

This provider is effectively single‑payer at the federal level: there is no Medicare billing on file while Medicaid billing totals $2.2M, so the practice’s reimbursement and utilization profile is driven almost entirely by Medicaid patients rather than a mixed Medicare/Medicaid panel. That payer concentration should be considered when assessing contracting leverage and population served.

Revenue is highly concentrated in a small set of outpatient E/M and preventive codes: the precomputed top three Medicaid codes account for 68.5% of total Medicaid revenue, driven by 99213 ($1.2M; 52.2%), 99212 ($217.3K; 9.8%), and 99392 ($144.1K; 6.5%). This concentration indicates that a majority of dollars come from routine, office‑based pediatric visits and scheduled preventive care.

The service mix aligns with a high‑volume pediatric primary care operation: 99213 shows 15.3K claims at $76 avg paid/claim and 99212 shows 3.7K claims at $58 avg paid/claim, while well‑child codes such as 99392 (1.5K claims, $99 avg) and immunization administration codes 90460 (6.9K claims, $20 avg) and 90461 (4.7K claims, $26 avg) also contribute materially. Taken together, these volumes and code types are consistent with routine established‑patient visits, preventive visits, and frequent vaccine administration typical of a pediatric clinic.

The provider is a clear statewide leader on core pediatric E/M codes: 99213 ranks #1 of 48 providers in-state (100th percentile; labeled an extreme outlier, far above typical state volume) and 99212 ranks #1 of 21 providers in-state (100th percentile; notably above typical state volume). These rank/percentile positions identify the provider as a dominant in‑state performer for established‑patient office visits.

Preventive care and vaccination activity are also concentrated but occur in a small peer set: 99392 and 99391 both rank #1 of 5 providers in-state (100th percentile), though 99392 is characterized as typical/unremarkable volume within that small group. Immunization administration codes such as 90460 (rank #3 of 8, 71st percentile) and 90461 (rank #2 of 7, 83rd percentile) show the practice provides substantial vaccination throughput relative to peers.

Although many vaccine product codes appear with nonzero claim counts, several vaccine product CPTs report $0 avg paid/claim on file (examples in this file include 90658, 90670, 90700, 90657, 90633, 90716, 90707, 90680, 90713). The presence of claims with $0 recorded payment may reflect how vaccine product reimbursement is processed or billed in this dataset rather than absence of immunization activity, given the sizable volumes reported on vaccine administration codes (e.g., 90460 and 90461).

The provider’s revenue profile implies operational scale centered on high visit volume rather than high per‑visit margins: top E/M reimbursement levels are relatively low per encounter ($76 avg for 99213, $58 avg for 99212) while total revenue is driven by claim volume. This mix is consistent with a practice model that relies on frequency of visits and bundled preventive services to generate Medicaid revenue.

The provider has long tenure in the enrollment file, with NPI enumerated 2007-07-25 (~19 years ago), indicating an established presence and likely an entrenched patient panel within the local market; combined with the ranking data, this suggests durable in‑state market position for pediatric outpatient services.

Medicaid: Complete Services Breakdown

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

26 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…	15,260	$80	$1.2M
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,…	3,750	$60	$217.3K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,460	$100	$144.1K
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.	6,910	$20	$138.2K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,280	$100	$125K
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…	4,700	$30	$122.1K
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…	970	$120	$112.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,150	$100	$111.3K
86580	The lab analyst performs an intradermal skin test on a patient to test for tuberculosis.	3,540	$10	$35.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	210	$100	$22.3K

Showing 1–10 of 26

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Guam providers billing the same CPT/HCPCS codes.

Claims Volume vs. Guam Distribution

Antonio Garcia — 5 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Guam

Full comparison — all codes billed, vs. Guam median

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	1	50	900	$80	$201.7K
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…	2	10	2,360	$30	$101.9K
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.	3	10	2,980	$20	$81.4K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1	10	470	$110	$69.9K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1	10	80	$100	$44.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2	10	130	$110	$42.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3	10	60	$120	$39K
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…	3	20	140	$110	$35.4K
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,…	1	20	120	$60	$35.1K
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…	9	10	30	$80	$16.2K

Showing 1–10 of 26

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Lee	GU	Dentist	$0	$10.9M
Guam Memorial Hospital	GU	General Acute Care Hospital	$0	$3.5M
Rsa - Tumon, LLC	GU	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.9M
Robert Yang	GU	Dentist	$0	$2.4M
Ma Gladys Linsangan	GU	Pediatrics Physician	$0	$2.2M
Ari Katerelos	GU	Radiation Oncology Physician	$2.1M	$0
Guam X-ray	GU	Vascular & Interventional Radiology Physician	$0	$2.1M
Sarah Clegg	GU	General Practice Dentistry	$0	$1.7M
Peter Kh Go	GU	Surgery Physician	$152.8K	$1.5M
Leopoldo Arcilla	GU	Internal Medicine Physician	$81.3K	$1.5M

Antonio Garcia — Billing Profile & Reimbursement Data

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Antonio Garcia — 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

Nearby Providers

Frequently Asked Questions

References