JULIO CESAR FERNANDEZ RODRIGUEZ, M.D
NPI 1245689413, individual, Cayey, PR, Pediatrics
- Hours beyond a day in 1 month under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99462 ($450 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 | 26.3 | 33.2 | 22.1 | 29.8 | 53 | 1 | 99223 99233 | $115K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | JULIO CESAR FERNANDEZ RODRIGUEZ, M.D |
| Type | Individual |
| Status | Active |
| NPI issued | June 8, 2016, last updated June 18, 2026 |
| Practice location | CALLE NUNEZ ROMEU, 51, Cayey, PR 00736, 787-738-4525 |
| Mailing address | 1 CALLE 12 H-4, JARDINES DE CAYEY, Cayey, PR 00736-4017 |
| Specialties | Student in an Organized Health Care Education/Training Program (390200000X, license 32856-R PR) Pediatrics (208000000X, primary, license 21436 PR) Student in an Organized Health Care Education/Training Program (390200000X, license 32267-R 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 | $266K | 62% | $450 | $96 (top 5% from $249) | 99th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $116K | 27% | $218 | $81 (top 5% from $170) | 98th percentile | |
| 99462 | Medicaid service code | $23K | 5% | $117 | $39 (top 5% from $59) | 100th percentile | |
| 99460 | Medicaid service code | $21K | 5% | $125 | $74 (top 5% from $106) | 98th percentile | |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $826 | 0% | $64 | $67 (top 5% from $174) | too few months to rank | |
| 99238 | Hospital discharge day management, 30 minutes or less | $417 | 0% | $32 | $48 (top 5% from $80) | too few months to rank | |
| 99243 | Medicaid service code | $350 | 0% | $27 | $87 (top 5% from $148) | too few months to rank | |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $74 | 0% | $0.18 | $44 (top 5% from $110) | 3rd percentile |
In this area
3 providers in Cayey Municipio County, PR carry an indicator in the public record, with $634K at stake between them. The most common is more hours than a day holds, on 3 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | LUIS SUAREZ ALMEDINA Cayey, PR, ranked 7968 | $394K |
|
| 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.