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.

Island Surgical Center, P.C. (NPI 1972033538)

Field	Value
Entity Type	Organization
Organization	Island Surgical Center, P.C.
Address	171 Farenholt Ave
City	Tamuning
State	GU
ZIP	96913
Taxonomy	Surgery Physician
NPI Enumerated	June 15, 2017

Payer Source	Total Paid
Medicaid	$5.2K
Medicare	$0

Key Findings

This provider has no Medicare billing on file and only $5.2K in lifetime Medicaid revenue, meaning its documented public-payer footprint is effectively single-payer and very small in absolute terms. The absence of Medicare activity prevents any national Medicare competitiveness analysis for this NPI.

Medicaid revenue is highly concentrated: the precomputed top-3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with the two reported codes alone making up that full share. Specifically, 99204 generates $3.1K (59.1% of Medicaid revenue) and 99213 generates $2.1K (40.9% of Medicaid revenue), indicating virtually all Medicaid receipts come from standard office evaluation-and-management visits.

Operationally, the provider is listed under the Surgery Physician taxonomy but the Medicaid code mix is dominated by office/outpatient evaluation and management codes (99204 and 99213). This pattern suggests the NPI’s Medicaid activity centers on E&M encounters—new and established patient visits—rather than surgical procedure billing to Medicaid.

Claim-level detail shows modest case volume: 99204 appears on 27 claims with a $114 avg paid/claim totaling $3.1K, while 99213 appears on 38 claims with a $56 avg paid/claim totaling $2.1K. These per-claim averages and low claim counts underline the small scale of Medicaid operations under this NPI.

Competitive standing within the state is modest for both top codes: 99204 ranks #14 of 20 providers in-state (32th percentile; typical, unremarkable volume), and 99213 ranks #43 of 48 providers in-state (11th percentile; typical, unremarkable volume). Neither code shows a dominant or above-typical presence statewide, consistent with the low total Medicaid revenue.

The NPI was enumerated on 2017-06-15 (~9 years ago), so the provider has been active for several years despite limited public-payer billing. The combination of multi-year enumeration and minimal Medicaid revenue suggests the practice either has a small Medicaid panel, focuses on non-public payers, or bills other NPIs for higher-acuity procedure work.

From a risk/variance perspective, neither reported Medicaid code is flagged as an outlier in the supplied labels—both are described as "typical, unremarkable volume for this code." Given that characterization and the small absolute revenue ($5.2K), there is no statistical indication in the Medicaid data of unusually high or anomalous billing behavior for the codes on file.

Medicaid: Complete Services Breakdown

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
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…	30	$110	$3.1K
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…	40	$60	$2.1K

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

Island Surgical Center, P.C. — 0 of 2 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

2 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…	43	50	900	$80	$201.7K
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…	14	20	60	$140	$20.8K

Island Surgical Center, P.C. — Billing Profile & Reimbursement Data

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Island Surgical Center, P.C. — 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

Frequently Asked Questions

References