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

Why is the Medicaid comparison limited to Massachusetts 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. Massachusetts (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's Healthcare Inc (NPI 1043364482)

Children's Healthcare Inc is a pediatrics physician provider located in Newburyport, Massachusetts. This profile covers 0 Medicare and 70 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	Children's Healthcare Inc
Address	257 Low St
City	Newburyport
State	MA
ZIP	01950
Taxonomy	Pediatrics Physician
NPI Enumerated	January 23, 2007

Payer Source	Total Paid
Medicaid	$6.3M
Medicare	$0

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

70 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…	42,770	$50	$2.1M
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…	18,130	$70	$1.2M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	20,050	$20	$441.1K
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…	5,690	$60	$352.9K
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…	5,110	$60	$321.8K
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…	31,810	$10	$318.1K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	5,840	$50	$297.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,480	$60	$286.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,760	$70	$204.2K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	2,080	$80	$155.6K

Showing 1–10 of 70

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Children's Healthcare Inc — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

70 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1502	Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit	128	130	34,780	$60	$7.4M
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…	1,574	1,620	580	$80	$599.6K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	91	950	90	$100	$212.9K
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…	129	5,040	200	$70	$209.5K
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…	412	670	120	$100	$169.2K
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…	59	5,300	230	$60	$164.5K
S0280	Medical home program, comprehensive care coordination and planning, initial plan	10	20	100	$120	$133.8K
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…	31	550	160	$90	$122.2K
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…	32	630	190	$90	$110.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	39	670	170	$80	$92.1K

Showing 1–10 of 70

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Anna Jaques Hospital	MA	General Acute Care Hospital	$0	$12.8M
Constellation Hospice Ma LLC	MA	Community Based Hospice Care Agency	$0	$10.5M
Shields Imaging At Anna Jaques Hospital LLC	MA	Mobile Radiology Clinic/Center	$470.6K	$335.6K
Kirubakaran Siva	MA	Family Medicine Physician	$773.7K	$1.7K
Guido Navarra	MA	Internal Medicine Physician	$423.2K	$153K
Salman Ghiasuddin	MA	Interventional Cardiology Physician	$561.3K	$0
Caitlin Carney	MA	Dermatology Physician	$512.8K	$710
Joshua Tarkan	MA	Nephrology Physician	$477.6K	$0
Isaac Pourati	MA	Clinical Cardiac Electrophysiology Physician	$420.9K	$1.3K
Stephen Beaudoin	MA	Internal Medicine Physician	$387.7K	$0

Children's Healthcare Inc — 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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