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.

Oscar Soto Raices (NPI 1962441717)

Field	Value
Entity Type	Individual
Organization	Oscar Soto Raices
Address	576 Calle Cesar Gonzalez
City	San Juan
State	PR
ZIP	00918
Taxonomy	Rheumatology Physician
NPI Enumerated	June 6, 2006

Payer Source	Total Paid
Medicare	$126.8K
Medicaid	$0

Key Findings

This provider’s Medicare billing is small and highly concentrated: total Medicare revenue is $126.8K and there is no Medicaid billing on file, so the practice is effectively single‑payer (Medicare) based on the available claims data. The absence of any Medicaid revenue indicates limited payer diversification and that analyses should treat Medicare as the primary commercial signal for this entity.

Revenue is extremely concentrated in a single drug-related code: the top three Medicare codes together account for 98.4% of the provider’s Medicare revenue, with J0129 alone representing $113.1K (88.8% of total Medicare revenue). That concentration means the provider’s financial profile is dominated by abatacept administration rather than routine office visits or a broad set of services.

The code mix and descriptions align with a rheumatology practice that primarily bills for physician‑supervised biologic administration: J0129 (3.3K claims, $34 avg paid/claim, $113.1K revenue) is an injection of abatacept administered under direct physician supervision, which is consistent with specialty rheumatology infusion or in‑office biologic therapy services. This pattern suggests the practice’s operations are oriented toward regular in‑office or supervised administration of a high‑cost biologic rather than high volumes of evaluation-and-management encounters.

Supportive and E/M activity is present but small: 96413 (76 claims, $91 avg paid/claim, $6.9K revenue) and 99213 (93 claims, $57 avg paid/claim, $5.3K revenue) account for 5.4% and 4.2% of Medicare revenue respectively, while 99214 contributes $2K (1.6%). These codes indicate some infusion/administration procedure billing and routine established‑patient office visits, but together they are minor contributors relative to the abatacept drug code.

Competitive standing for the top codes is modest rather than dominant: J0129 ranks #1045 of 1221 providers nationally (14th percentile; typical, unremarkable volume), 96413 ranks #5077 of 7514 (32th percentile; typical, unremarkable volume), and 99213 ranks #196882 of 457151 (57th percentile; typical, unremarkable volume). In plain terms, the provider is not a high‑volume national outlier for these codes despite J0129 driving most revenue.

There are no top‑code statistical flags indicating extreme outlier behavior in the supplied labels; the leading codes are all described as “typical, unremarkable volume,” so while revenue is concentrated, utilization levels for those codes sit within common national ranges. That combination—high revenue concentration but typical national ranks—points to a business model focused on a commonly used, high‑cost biologic rather than unusually intensive or anomalous utilization.

Tenure in the Medicare program is long: the NPI was enumerated on 2006-06-06 (~20 years ago), which suggests an established practice and potential stability in referral patterns or patient base supporting recurring biologic administration over time. Analysts should consider longevity when assessing network relationships or continuity of care for infusion services.

From a payer or contracting perspective, this profile represents both risk and opportunity: heavy dependence on a single drug code (J0129) exposes the provider’s Medicare revenue to changes in drug pricing, coverage, or administration policy, while the lack of Medicaid billing limits opportunities for expansion into state programs without strategic changes. Contracting or utilization management strategies should therefore account for the concentration in abatacept administration and the provider’s modest competitive position on national ranking metrics.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0129	Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)	3,330	$30	$113K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	80	$90	$6.9K
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…	90	$60	$5.3K
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…	20	$90	$2K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Puerto Rico Distribution

Oscar Soto Raices — 0 of 4 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. state median

4 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0129	2	10	5,410	$30	$182.1K
96413	3	10	140	$90	$11.3K
99214	400	470	50	$80	$6.6K
99213	318	1,530	50	$60	$4.2K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Oscar Soto Raices, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sandra Gracia-lopez	PR	Nuclear Medicine Physician	$26.7K	$4.1M
Hector Velez Cortes	PR	Hematology & Oncology Physician	$4.3K	$4M
Hiram Ortega	PR	Gastroenterology Physician	$8.8K	$3.1M
Nelson Medina	PR	Gastroenterology Physician	$1.5K	$2.7M
Eduardo Perez Rodriguez	PR	Ophthalmology Physician	$21.7K	$2.3M
Santa Merle	PR	Hematology & Oncology Physician	$4.5K	$2M
Amarilys Santiago Rolon	PR	Gastroenterology Physician	$510	$1.6M
Harry Alverio Rodriguez	PR	Physical Medicine & Rehabilitation Physician	$3.7K	$1.5M
Adalberto Mendoza	PR	Anatomic Pathology & Clinical Pathology Physician	$13.3K	$1.5M
Luz Butler Moya	PR	Physical Therapist	$0	$1.5M

Nearby Providers

Other providers in the same ZIP code as Oscar Soto Raices, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratorio De Patologia Dr Noy	PR	Anatomic Pathology Physician	$0	$45.7M
Hato Rey Pathology Associates Inc	PR	Clinical Medical Laboratory	$58.5K	$42M
Home Orthopedics Corp	PR	Prosthetic/Orthotic Supplier	$0	$20.7M
Orthobone, Inc	PR	Customized Equipment (DME)	$0	$15.5M
Smith & Nephew Inc.	PR	Prosthetic/Orthotic Supplier	$0	$12M
Laboratorio Clinico Noy Inc	PR	Clinical Medical Laboratory	$76.1K	$9.9M
Servicios Radiologicos Asociados Jorge Perez Brais	PR	Diagnostic Radiology Physician	$0	$2.9M
Luis Torres Vera	PR	Allergy Physician	$21.5K	$2.7M
Inspira Psychiatric Services Psc	PR	Adult Mental Health Clinic/Center	$0	$2.5M
Frankie Alvarado	PR	Pulmonary Disease Physician	$7.3K	$2.4M

Oscar Soto Raices — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References