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.

Ricardo Reina-sanabria (NPI 1992782551)

Field	Value
Entity Type	Individual
Organization	Ricardo Reina-sanabria
Address	576 Ave Cesar Gonzalez
City	San Juan
State	PR
ZIP	00917
Taxonomy	Adult Reconstructive Orthopaedic Surgery Physician
NPI Enumerated	December 27, 2005

Payer Source	Total Paid
Medicare	$94K
Medicaid	$0

Key Findings

This provider is a specialist in major joint replacement, with Medicare billing dominated by high-complexity arthroplasty procedures. The top CPT code is 27447 (total knee arthroplasty) with 51 claims generating $51K in revenue, and 27130 (total hip arthroplasty) accounts for $16.9K; together these surgical codes define the clinical service line and indicate the practice focuses on adult reconstructive orthopaedic surgery rather than primarily office-based care.

Medicare revenue is modest in absolute scale at $94K lifetime, and is highly concentrated: the precomputed top 3 Medicare codes by revenue account for 82.5% of total Medicare revenue. This concentration implies that a few major procedures (notably 27447 and 27130) drive the bulk of Medicare payments for this provider, making overall revenue sensitive to surgical volume changes.

The provider has no Medicaid billing on file and therefore functions effectively as a single-payer (Medicare) reporter in the available data. Since total Medicaid revenue is reported as none, any analysis of payer mix should treat this entity as not participating in Medicaid, which has implications for network coverage and access for Medicaid enrollees in the local market.

On procedure-level competitive standing, the provider’s volume for knee replacement (27447) ranks #3249 of 12089 nationally, placing them in the 72th percentile; this indicates a typical but not leading national volume for that code and suggests they are an established, mid‑level contributor in knee arthroplasty. For hip replacement (27130) the rank is #5739 of 8062 (25th percentile), signaling lower relative national volume for hip arthroplasty compared with peers.

Office visit E/M activity is present but secondary to surgical revenue: 99213 and 99214 together represent about 20.4% of Medicare revenue ($9.7K and $9.5K respectively), with large counts of office claims (149 and 95). These E/M codes rank in typical volume percentiles (71th and 46th), indicating routine outpatient follow-up and pre/postoperative management consistent with a surgical orthopaedic practice rather than an office-centered practice.

Tenure is long-standing: the NPI was enumerated on 2005-12-27 (~21 years ago). This level of longevity supports interpreting current billing patterns as representative of an established practice rather than a new entrant or transient reporter.

Low-utilization ancillary procedures appear minimal in revenue contribution; for example 20610 (arthrocentesis without ultrasound) contributed $828 (0.9% of Medicare revenue) and ranks in a lower national percentile (12th). This reinforces that the provider’s service mix is concentrated on operative arthroplasty rather than procedural injections or nonoperative joint care.

Given the overall revenue and rank metrics, this provider should be viewed as a focused adult reconstructive orthopaedic surgeon with typical national volumes for knee arthroplasty, lower relative volume for hip arthroplasty, negligible Medicaid participation, and routine office-based E/M follow-up supporting the surgical practice. Payers or networks evaluating contracting or referral strategies should expect surgical knee replacements to be the core service line and should not rely on this provider for Medicaid-covered capacity.

Medicare: Complete Services Breakdown

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

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
27447	In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The…	50	$1,000	$51K
27130	In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or…	20	$990	$16.9K
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…	150	$70	$9.7K
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…	100	$100	$9.5K
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	$120	$4K
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…	30	$80	$2.1K
20610	In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a…	20	$50	$830

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 7 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Puerto Rico Distribution

Ricardo Reina-sanabria — 1 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. state median

7 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
27447	1	10	20	$1,610	$37.1K
27130	1	10	10	$670	$9.4K
99214	113	470	50	$80	$6.6K
20610	31	40	30	$50	$6.1K
99213	151	1,530	50	$60	$4.2K
99204	34	200	20	$110	$2.7K
99203	128	480	20	$70	$1.8K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Ricardo Reina-sanabria, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Edwin Rosado Hernandez	PR	Orthopaedic Surgery Physician	$25.1K	$0
Dencel Garcia Velez	PR	Adult Reconstructive Orthopaedic Surgery Physician	$1.9K	$0

Nearby Providers

Other providers in the same ZIP code as Ricardo Reina-sanabria, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Puerto Rico Pathology Associates P	PR	Anatomic Pathology & Clinical Pathology Physician	$0	$6.8M
Metro Pavia At Home LLC	PR	Home Health Agency	$0	$5.6M
Centro De Rehabilitacion Y Electrodiagnostico De Hato Rey, LLC	PR	Physical Medicine & Rehabilitation Physician	$0	$1.8M
Retina Consultants Of P.r.	PR	Ophthalmology Physician	$0	$1.7M
Er Specialized Care LLC	PR	Emergency Medical Services (Emergency Medicine) Physician	$0	$1.5M
Aid System LLC	PR	Diagnostic Radiology Physician	$0	$1.3M
Rvp Dental Medical Center, LLC	PR	Dental Clinic/Center	$0	$948.1K
Oncology & Body Imaging Psc	PR	Diagnostic Radiology Physician	$0	$905.6K
Endourological Institute Inc	PR	Ambulatory Surgical Clinic/Center	$16.9K	$609.4K
Mirelis Acosta	PR	Hematology & Oncology Physician	$6.3K	$215.1K

Ricardo Reina-sanabria — Billing Profile & Reimbursement Data

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Ricardo Reina-sanabria — 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