Garcia Nieves, Rafael

Garcia Nieves, Rafael was paid $20K by Medicaid between Jan 2018 and May 2019, across 4 billing codes. Its largest line is 90960, End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits — 43% of everything it billed.

33Billing provider infoGARCIA NIEVES, RAFAEL
PONCE, PR 00716

33aNPI1497876916assigned 04/02/2007

33bProvider typeNephrology Physician

28Total paid$20K

24GClaims536

24DCodes billed4

24AFirst – last monthJan 2018 – May 2019

Compared with peers

Next to other Nephrology Physician providers in Puerto Rico

Rank by total paid#52 of 81

Median peer was paid$66K

This provider vs. median0.3×

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	369	$13K
2019	167	$7K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
90960	End-stage renal disease related services monthly, for patients 20 years and older, with 4 or more face-to-face visits	43%	92	88	$8K
99232	Hospital visit by a doctor, follow-up daySubsequent hospital care, per day, moderate complexity	32%	332	95	$6K
90935	Hemodialysis procedure with single evaluation by a physician	17%	66	12	$3K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	8.3%	46	43	$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.