Physician
Cartagena Ayala, Edgardo
Cartagena Ayala, Edgardo was paid $291K by Medicaid between Jan 2018 and Oct 2024, across 14 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 37% of everything it billed.
33Billing provider infoCARTAGENA AYALA, EDGARDO
SAN JUAN, PR 00923
SAN JUAN, PR 00923
33aNPI1033262555assigned 01/19/2007
33bProvider typePulmonary Disease Physician
28Total paid$291K
24GClaims8,564
24DCodes billed14
24AFirst – last monthJan 2018 – Oct 2024
Compared with peers
Next to other Pulmonary Disease Physician providers in Puerto Rico
Rank by total paid#10 of 55
Median peer was paid$68K
This provider vs. median4.3×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 1,115 | $23K | |
| 2019 | 1,480 | $29K | |
| 2020 | 632 | $22K | |
| 2021 | 1,878 | $68K | |
| 2022 | 1,124 | $41K | |
| 2023 | 1,307 | $64K | |
| 2024incomplete | 1,028 | $44K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 37% | 2,548 | 2,320 | $107K |
| 99204 | Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | 12% | 498 | 443 | $34K |
| 94727 | 11% | 725 | 661 | $32K | |
| 94726 | 9.6% | 684 | 626 | $28K | |
| 94060 | 9.2% | 778 | 660 | $27K | |
| 94729 | 8.0% | 632 | 575 | $23K | |
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | 4.7% | 371 | 125 | $14K |
| 94375 | 3.0% | 701 | 636 | $9K | |
| 99223 | Prolong inpt eval add15 m | 2.2% | 49 | 40 | $6K |
| 94664 | 1.8% | 717 | 652 | $5K | |
| 94200 | <1% | 140 | 123 | $2K | |
| 94760 | <1% | 567 | 506 | $2K |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.