LUIS CESAR SUAREZ ALMEDINA, M.D.
NPI 1144234915, individual, Cayey, PR, Pediatrics
- Hours beyond a day in 2 months under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99233 ($665 per patient-month) sit in the top 5% of every provider billing that code.
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Oct 2024 | More hours than a day holds, even counting one unit per claim line | 29.8 | 37.4 | 24.9 | 33.6 | 75 | 1 | 99223 99233 | $130K |
| Nov 2024 | More hours than a day holds, even counting one unit per claim line | 62.4 | 79.6 | 53.1 | 75.8 | 110 | 1 | 99223 99233 | $265K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | LUIS CESAR SUAREZ ALMEDINA, M.D. |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | July 28, 2006, last updated January 30, 2019 |
| Practice location | CALLE JOSE CELSO BARBOSA, #64, Cayey, PR 00736, 787-738-1833 |
| Mailing address | P.O. BOX 373245, Cayey, PR 00737-3245 |
| Specialties | Pediatrics (208000000X, primary, license 8102 PR) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | $555K | 48% | $665 | $96 (top 5% from $249) | 100th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $199K | 17% | $280 | $81 (top 5% from $170) | 99th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $192K | 17% | $107 | $67 (top 5% from $174) | 80th percentile | |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | $80K | 7% | $49 | $63 (top 5% from $137) | 33rd percentile | |
| 99462 | Medicaid service code | $52K | 4% | $83 | $39 (top 5% from $59) | 99th percentile | |
| 99460 | Medicaid service code | $41K | 4% | $84 | $74 (top 5% from $106) | 73rd percentile | |
| 99251 | Medicaid service code | $29K | 2% | $33 | $33 (top 5% from $55) | 49th percentile | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $3K | 0% | $3.38 | $60 (top 5% from $133) | 4th percentile |
In this area
3 providers in Cayey Municipio County, PR carry an indicator in the public record, with $355K at stake between them. The most common is more hours than a day holds, on 3 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | JULIO FERNANDEZ RODRIGUEZ Cayey, PR, ranked 8062 | $115K |
|
| 5 | JUAN DELGADO RODRIGUEZ Cayey, PR, ranked 10427 | $139K |
|
| 5 | CLAUDINO ARIAS Cayey, PR, ranked 11624 | $101K |
Recent enforcement in PR
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.