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 Nebraska for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Nebraska 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. Nebraska (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.

Children & Adoleseant Clinic PC (NPI 1023125317)

Key Findings

Field	Value
Entity Type	Organization
Organization	Children & Adoleseant Clinic PC
Address	2115 N Kansas
City	Hastings
State	NE
ZIP	68701
Taxonomy	Pediatrics Physician
NPI Enumerated	August 24, 2006

Payer Source	Total Paid
Medicaid	$4.3M
Medicare	$0

This provider is effectively a Medicaid-focused pediatric practice: there is no Medicare billing on file and the reported lifetime Medicaid revenue is $4.3M, with the NPI enumerated 2006-08-24 (~20 years ago), indicating long tenure in the state Medicaid market. The absence of Medicare revenue makes Medicaid the dominant — essentially sole — payer exposure driving the practice’s financial profile.

Revenue is highly concentrated in a small set of outpatient visit codes: the precomputed top three Medicaid codes (99213, 99214, 99391) account for 60.4% of the provider’s total Medicaid revenue. Those three codes individually generated $1.1M (25.6%) for 99213, $938.8K (22.0%) for 99214, and $543.8K (12.7%) for 99391, signaling that routine office and preventive visits are the primary revenue drivers.

The code mix indicates a core business of pediatric primary care with an emphasis on established-patient evaluation/management and preventive medicine: high-volume E/M codes 99213 and 99214 together with preventive codes 99391/99392/99393/99394 and vaccine procedure codes (for example, 90686, 90670, 90698) show the practice is organized around well-child visits, routine immunizations, and longitudinal outpatient management. Developmental screening (96110, 96127) and point-of-care testing (87804, ) are also consistently billed, consistent with a full-service pediatric office model that handles preventive, developmental, and acute visits on-site.

Newborn and inpatient-related services are a meaningful secondary line: 99238 (hospital discharge day management) produced $122.2K and ranks #2 of 35 in-state (97th percentile; notably above typical state volume), while newborn initial and subsequent hospital services 99460 and 99462 produced $108.5K and $15K respectively, with 99462 ranking #1 of 10 (100th percentile; notably above typical state volume). These data points suggest the practice provides newborn hospital evaluation and early postnatal follow-up in addition to clinic-based pediatrics.

The practice shows unusually high volumes for several point-of-care infectious disease tests relative to peers: 87804 (influenza rapid test) had 4.6K claims for $74K and ranks #4 of 142 (98th percentile; extreme outlier), and 87807 (RSV test) ranks #1 of 34 with 965 claims for $13.5K (100th percentile; extreme outlier). Combined with substantial COVID testing (87426) and strep testing (87880), this pattern indicates operational capacity and workflow geared to on-site rapid testing during acute visits or surveillance periods.

Competitive standing is mixed but generally strong in-state for core pediatric E/M and preventive services: 99213 ranks #18 of 696 (98th percentile; labeled typical, unremarkable volume), 99214 ranks #26 of 596 (96th percentile; labeled typical, unremarkable volume), and 99391 ranks #9 of 69 (88th percentile; labeled typical, unremarkable volume). While descriptive labels call the volumes typical, the percentile ranks place the provider among the higher-volume peers in Nebraska for these codes, indicating a major regional presence in routine pediatric office care.

Integrated developmental and behavioral screening appears to be a systematic part of care delivery: 96110 recorded 9.2K claims generating $138.7K (3.3%) and ranks #3 of 21 in-state (90th percentile; typical, unremarkable volume), and 96127 produced $31.7K and ranks #10 of 72 (87th percentile; typical, unremarkable volume). This supports the conclusion that the practice routinely incorporates standardized developmental assessments into well-child workflows, which has implications for staffing and care coordination needs.

From an operational and revenue-risk perspective, the practice’s dependence on a narrow set of Medicaid outpatient visit codes (top three = 60.4% of Medicaid revenue) combined with no Medicare mix concentrates financial exposure to pediatric Medicaid reimbursement policy and patient-volume shifts. The long-tenured NPI (~20 years) suggests stability and established referral patterns, but the business would be sensitive to changes in Medicaid rates, coding patterns, or local demand for pediatric ambulatory visits.

Medicaid: Complete Services Breakdown

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

57 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	24,850	$40	$1.1M
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…	14,670	$60	$938.8K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	6,800	$80	$543.8K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	6,450	$80	$542.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2,020	$90	$177.8K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	9,240	$20	$138.7K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	1,700	$70	$122.2K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	1,020	$110	$108.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,130	$90	$103K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	4,630	$20	$74K

Showing 1–10 of 57

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Children & Adoleseant Clinic PC — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

57 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	18	700	660	$70	$305.1K
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…	26	600	610	$70	$251.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	9	70	360	$80	$234.7K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	6	70	230	$90	$222.7K
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…	506	510	440	$140	$155.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8	70	100	$100	$100.9K
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…	22	90	100	$80	$54.7K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	139	150	1,610	$10	$47K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	3	20	330	$20	$45.1K
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…	115	130	130	$90	$43.8K

Showing 1–10 of 57

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Midtown Health Center, Inc.	NE	Federally Qualified Health Center (FQHC)	$0	$10.1M
Faith Regional Health Services	NE	General Acute Care Hospital	$0	$7.3M
Faith Regional Physician Services, LLC	NE	Family Medicine Physician	$0	$5.5M
Behavioral Health Specialists Sunrise Place	NE	Substance Abuse Rehabilitation Facility	$0	$4.6M
The Well Ne	NE	Substance Abuse Rehabilitation Facility	$0	$3.1M
Nmg LLC	NE	Family Medicine Physician	$0	$2.9M
Cor Therapeutic Services, LLC	NE	Mental Health Counselor	$0	$2.2M
Rabih Fahed	NE	Hematology & Oncology Physician	$2M	$0
Oasis Counseling International	NE	Mental Health Counselor	$0	$2M
Liberty Centre Services, Inc.	NE	Case Manager/Care Coordinator	$0	$1.6M

Children & Adoleseant Clinic PC — Billing Profile & Reimbursement Data

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Children & Adoleseant Clinic PC — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References