Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Indiana for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Indiana only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Indiana (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

St Vincent Pediatric Subspecialties (NPI 1013967736)

St Vincent Pediatric Subspecialties is a pediatrics physician provider located in Indianapolis, Indiana. This profile covers 0 Medicare and 114 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	St Vincent Pediatric Subspecialties
Address	2001 W 86th St
City	Indianapolis
State	IN
ZIP	46260
Taxonomy	Pediatrics Physician
NPI Enumerated	May 11, 2006

Payer Source	Total Paid
Medicaid	$20.8M
Medicare	$0

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

114 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	82,700	$70	$5.9M
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	16,000	$100	$1.7M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	34,320	$50	$1.6M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	9,190	$110	$992.1K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	12,590	$80	$982K
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3,810	$250	$937K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	10,450	$80	$877.5K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	13,940	$60	$822.3K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	8,500	$90	$748K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	3,800	$160	$612.4K

Showing 1–10 of 114

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Indiana providers billing the same CPT/HCPCS codes.

Claims Volume vs. Indiana Distribution

St Vincent Pediatric Subspecialties — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

114 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2	10	1,710	$370	$6.1M
31622	In this procedure, the provider performs diagnostic rigid or flexible bronchoscopy, a test to view airways and diagnose lung disease. He may or may not use fluoroscopic guidance to perform this test.…	4	10	970	$1,160	$1.6M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	2	10	340	$320	$899.7K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	2	10	520	$320	$716.5K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	418	580	710	$60	$582.9K
95720	A physician or other QHCP reviews recorded events and analyzes spike and seizure detection of a continuous electroencephalography, a study of the electrical activity of the brain. A video is…	5	10	460	$170	$523.4K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	30	2,120	870	$60	$450.6K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	511	690	1,070	$80	$422.3K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	111	2,380	920	$50	$376.8K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	20	250	$100	$344.7K

Showing 1–10 of 114

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Vincent Physician Services Hospital And Health Care Center	IN	Family Medicine Physician	$0	$14M
Saint Vincent Physician Services, Inc.	MA	Family Medicine Physician	$0	$6.1M
St. Vincent Williamsport Hospital	IN	Critical Access Hospital	$0	$2.7M
St. Vincent Hospital & Health Care Center, Inc.	IN	Psychiatry Physician	$0	$2.5M
Adam Duhl	NJ	Maternal & Fetal Medicine Physician	$128.8K	$1.5M
Andrew Beardsley	NC	Hematology & Oncology Physician	$958.6K	$0
Chirag Amin	TN	Hematology & Oncology Physician	$820K	$0
Bruce Waller	IN	Cardiovascular Disease Physician	$540.1K	$0
Marwan Mustaklem	IN	Internal Medicine Physician	$480.3K	$0
Enoch Kassa	IN	Ophthalmology Physician	$461.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Vincent Hospital & Health Care Center, Inc.	IN	General Acute Care Hospital	$0	$58.9M
Cep America LLC	IN	Emergency Medicine Physician	$0	$28.6M
Imaging Associates Of Indiana, PC	IN	Diagnostic Radiology Physician	$0	$9.7M
Rebecca Bolon	IN	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$9M
Shadeland Anesthesia & Pain Associates Inc.	IN	Interventional Pain Medicine Physician	$0	$7.1M
Singh Bullard Pediatric Dentistry, P.C.	IN	Pediatric Dentistry	$0	$7M
Alta Healthcare	IN	Home Health Agency	$0	$6.6M
Indiana Hemophilia & Thrombosis Center, Inc.	IN	Hematology & Oncology Physician	$0	$5.6M
St. Vincent Emergency Physicians, Inc.	IN	Emergency Medicine Physician	$0	$4.9M
Surgical Care Center, Inc.	IN	Ambulatory Surgical Clinic/Center	$3.1M	$1.7M

St Vincent Pediatric Subspecialties — Billing Profile & Reimbursement Data

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St Vincent Pediatric Subspecialties — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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