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NPI 1982710117 · Frederiksted, VI · Neurology Physician
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Luis Frias Mendoza is a neurology physician provider located in Frederiksted, U.S. Virgin Islands. This profile covers 4 Medicare and 1 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 | Luis Frias Mendoza |
| Address | 1 Estate Cane Ste 207 |
| City | Frederiksted |
| State | VI |
| ZIP | 00840 |
| Taxonomy | Neurology Physician |
| NPI Enumerated | August 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $19K |
| Medicaid | $1.7K |
LUIS FRIAS MENDOZA is a long-tenured Neurology Physician with an NPI enumerated on 2006-08-21 (~20 years ago), indicating sustained enrollment and likely continuous clinical activity in the Medicare/Medicaid systems over two decades. This tenure supports established referral relationships and ongoing outpatient and inpatient consult services consistent with neurology practice patterns.
Medicare revenue is modest at $19K lifetime while Medicaid revenue is very small at $1.7K, so this provider operates at a scale where Medicare is the dominant payer by absolute dollars; the practice should be considered effectively Medicare-primary rather than balanced across payers.
Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes account for 92.4% of the provider's total Medicare revenue, indicating reliance on a narrow set of high-acuity evaluation and management services rather than a broad procedure mix. The leading Medicare codes driving this concentration are 99215, 99205, and 99223, which together make up the lion's share of billed Medicare value.
The code mix points to a practice focused on high-complexity evaluation and management encounters. The top Medicare codes are 99215 and 99205 (high-level established and new patient E/M visits) and 99223 (initial inpatient/observation E/M), suggesting care delivered primarily through lengthy, decision-intensive office visits and some inpatient consults rather than procedure-driven revenue. This pattern is consistent with a diagnostically oriented neurology practice emphasizing comprehensive patient evaluation.
Competitive standing by code is mixed: for 99215 the provider ranks #46190 of 145531 nationally (68th percentile), which places them as a typical, unremarkable volume performer for that code on a national scale. For 99205 the provider ranks #12344 of 66257 nationally (81th percentile), showing relatively stronger activity for new high-complexity office visits compared with peers. In contrast, 99223 ranks #123465 of 139583 (9th percentile), indicating very low relative inpatient/observation activity for that code nationally.
The Medicaid picture is highly concentrated and minimal in scale: total Medicaid revenue is $1.7K and the precomputed top 3 Medicaid codes account for 100.0% of Medicaid revenue, with a single code, 99205, representing 100.0% of Medicaid billing (13 claims). That makes the provider effectively single-code for Medicaid activity, reflecting very limited Medicaid engagement.
In-state competitive standing for Medicaid is weak in absolute peer terms: the provider's Medicaid 99205 activity ranks #7 of 7 in-state (0th percentile), indicating the provider is a minor participant in Medicaid 99205 volume locally despite that code representing all of their Medicaid revenue. This suggests little Medicaid market presence or limited panel participation.
Payment-per-claim patterns show moderate average allowed amounts on the top Medicare codes (e.g., $121 avg paid for 99215 and $147 avg paid for 99205), consistent with typical reimbursement levels for high-complexity E/M visits; combined with the claim counts (65 claims for 99215 and 53 for 99205) these volumes generate the bulk of the $19K Medicare lifetime revenue. Given the small overall revenue base, the practice appears small or part-time in its Medicare/Medicaid billing footprint.
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 |
|---|---|---|---|---|
| 99215 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the… | 70 | $120 | $7.9K |
| 99205 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider… | 50 | $150 | $7.8K |
| 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… | 10 | $130 | $1.8K |
| 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 | $1.4K |
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99205 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider… | 10 | $130 | $1.7K |
How this provider's Medicaid billing volume and revenue compare to other U.S. Virgin Islands providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. U.S. Virgin Islands median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99205 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider… | 7 | 10 | 140 | $240 | $42.7K |
Other providers in the same ZIP code as Luis Frias Mendoza, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Frederiksted Health Care, Inc. | VI | Federally Qualified Health Center (FQHC) | $0 | $24.3M |
| First Step Therapy | VI | Rehabilitation Hospital | $0 | $757.8K |
| Rachel's Place | VI | Clinical Social Worker | $0 | $222.1K |
| Hercare Inc | VI | Obstetrics & Gynecology Physician | $0 | $182.9K |
| Kamaria Alexander | VI | Physician Assistant | $21.7K | $0 |
| Jozette Matthews | VI | Family Nurse Practitioner | $13.9K | $0 |
| Shavell Karel | VI | Obstetrics & Gynecology Physician | $4.1K | $0 |
| Shelley Timmons | VI | Physical Therapist | $2.1K | $0 |
| Neighborhood Pharmacy LLC | VI | Community/Retail Pharmacy | $1.6K | $0 |
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