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 1942370796)

Field	Value
Entity Type	Organization
Organization	Recinto De Ciencias Medicas
Address	Ave Americo Miranda Aptdo. 29134 Centro Medico De Pr
City	San Juan
State	PR
ZIP	00929
Taxonomy	Pediatrics Physician
NPI Enumerated	November 9, 2006

Payer Source	Total Paid
Medicaid	$4M
Medicare	$0

Key Findings

This provider effectively operates as a Medicaid-only biller: there is no Medicare billing on file and reported lifetime Medicaid revenue is $4M, indicating a single-payer footprint dominated by Medicaid business. The absence of Medicare activity is consistent with a pediatric-focused practice profile.

Revenue is highly concentrated in a very small set of inpatient/ED E/M codes: the precomputed top three codes account for 98.5% of total Medicaid revenue. Those three codes are 99233 ($2.8M, 70.0%), 99223 ($894.3K, 22.6%), and 99283 ($233K, 5.9%), showing that nearly all Medicaid dollars flow from these specific services.

The code mix (99233 and 99223 for subsequent and initial hospital inpatient/observation care, plus 99283 for ED visits) indicates a hospital-based pediatrics operation or pediatric hospitalist service line that captures high-acuity inpatient evaluation-and-management encounters and appreciable emergency department activity. The high-dollar inpatient E/M codes imply the provider spends substantial time on complex inpatient care rather than office-based outpatient pediatrics.

99233 is the single dominant activity: 49.4K claims generating $2.8M in revenue, and the provider ranks #1 of 386 in-state (100th percentile; extreme outlier, far above typical state volume for this code). This level of subsequent inpatient visit volume positions the provider as an outlier statewide for that specific service and suggests a very large role in managing inpatient pediatric stays.

99223 represents the second key inpatient driver with 9.1K claims and $894.3K revenue, ranking #2 of 503 in-state (100th percentile; extreme outlier, far above typical state volume for this code). The provider’s near-top statewide rank on initial high-complexity inpatient visits further reinforces its dominant role in pediatric inpatient admissions.

Emergency department activity is present but secondary: 99283 shows 5.3K claims and $233K revenue and ranks #24 of 495 in-state (95th percentile; typical, unremarkable volume for this code). Lower- and higher-acuity ED codes are much less material (for example, 99281: 3.4K claims, $50.5K, rank #7 of 92, 93th percentile; 99285: 32 claims, $3.8K, rank #143 of 178, 19th percentile), indicating most ED billing is concentrated at mid-level E/M visits rather than the extremes.

The provider’s NPI has been enumerated since 2006-11-09 (~20 years ago), indicating long tenure in the market; combined with the extreme-state outlier ranks on core inpatient codes, this suggests an established, high-volume inpatient pediatric presence rather than a recent or sporadic entrant.

For payers and network planners, this profile signals concentrated utilization and financial exposure in a few high-acuity inpatient E/M services: 98.5% of Medicaid revenue comes from three codes, so utilization management, rate negotiations, or capacity planning efforts should focus on 99233 and 99223 first. Given the extreme outlier status on those codes statewide, any contracting or quality-review initiative should account for unusually high inpatient volumes rather than expecting a typical community pediatric practice mix.

Medicaid: Complete Services Breakdown

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

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	49,440	$60	$2.8M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	9,130	$100	$894.3K
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.	5,300	$40	$233K
99281	The provider sees a patient for the lowest level emergency department visit.	3,370	$20	$50.5K
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.	30	$120	$3.8K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	20	$100	$1.6K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	20	$70	$1.5K

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 — 3 of 7 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

7 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	1	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.	24	500	220	$40	$79.5K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	414	460	200	$50	$60.3K
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.	143	180	170	$80	$55.3K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2	500	130	$90	$43.1K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	272	320	100	$80	$31.3K
99281	The provider sees a patient for the lowest level emergency department visit.	7	90	80	$10	$21.5K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Recinto De Ciencias Medicas, ranked by combined Medicare and Medicaid revenue.

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	Obstetrics & Gynecology Physician	$0	$3.8M
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

Nearby Providers

Other providers in the same ZIP code as Recinto De Ciencias Medicas, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Recinto De Ciencias Medicas	PR	Anesthesiology Physician	$0	$2.1M
Recinto De Ciencias Medicas	PR	Internal Medicine Physician	$0	$1.2M
Recinto De Ciencias Medicas	PR	Pediatric Hematology & Oncology Physician	$0	$879.8K
Jose Carlo-izquierdo	PR	Pain Medicine (Psychiatry & Neurology) Physician	$16.1K	$0

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