Managed care
Critical Pulmonary Medical Services
Critical Pulmonary Medical Services was paid $411K by Medicaid between Jan 2018 and Sep 2024, across 6 billing codes. Its largest line is 99233, hospital visit by a doctor, follow-up day (complex) — 83% of everything it billed.
33Billing provider infoCRITICAL PULMONARY MEDICAL SERVICES
SAN JUAN, PR 00918
SAN JUAN, PR 00918
33aNPI1750660619assigned 08/10/2011
33bProvider typePreferred Provider Organization
28Total paid$411K
24GClaims8,028
24DCodes billed6
24AFirst – last monthJan 2018 – Sep 2024
Compared with peers
Next to other Preferred Provider Organization providers in Puerto Rico
Rank by total paid#1 of 5
Median peer was paid$277K
This provider vs. median1.5×
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 | 1,497 | $37K | |
| 2019 | 1,525 | $36K | |
| 2020 | 1,543 | $82K | |
| 2021 | 997 | $79K | |
| 2022 | 677 | $43K | |
| 2023 | 942 | $70K | |
| 2024incomplete | 847 | $65K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99233 | Hospital visit by a doctor, follow-up day (complex)Prolong inpt eval add15 m | 83% | 6,710 | 2,192 | $340K |
| 99253 | 5.8% | 586 | 558 | $24K | |
| 99223 | Prolong inpt eval add15 m | 5.6% | 163 | 162 | $23K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 4.2% | 396 | 370 | $17K |
| 99252 | 1.6% | 161 | 155 | $7K | |
| 99442 | 0% | 12 | 12 | $0.00 |
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.
From NPPES
Who's on the registration
Authorized officialGARCIA, CARLOS (PRESIDENTE)
| Provider | Location | Paid |
|---|---|---|
| Brookstone Retirement Ctr.,Llc. | Lexington, NC | $9.52M |
| Advantage Home Care Systems LLC | Auburn, MA | $4.33M |
| Salud Para LA Gente | Salinas, CA | $1.16M |
| C.G. Dental Care C.S.P. | Quebradillas, PR | $890K |
| RCTG, LLC | Sanford, NC | $811K |
| Carlos F Garcia DDS INC | Laguna Beach, CA | $729K |
| Garcia Dental INC | San Diego, CA | $315K |
| RCTG, LLC | Sanford, NC | $182K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.