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

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

Pediatric Academic Association, Inc. (NPI 1063419943)

Pediatric Academic Association, Inc. is a pediatrics physician provider located in Columbus, Ohio. This profile covers 0 Medicare and 77 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	Pediatric Academic Association, Inc.
Address	700 Childrens Dr
City	Columbus
State	OH
ZIP	43205
Taxonomy	Pediatrics Physician
NPI Enumerated	July 7, 2005

Payer Source	Total Paid
Medicaid	$37.2M
Medicare	$0

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

77 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	29,830	$280	$8.3M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	166,800	$30	$5.5M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	83,790	$60	$4.6M
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.	9,330	$280	$2.6M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	21,410	$80	$1.8M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	20,760	$90	$1.8M
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	22,370	$70	$1.5M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	26,660	$50	$1.2M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	43,600	$30	$1.2M
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…	39,250	$30	$1.1M

Showing 1–10 of 77

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Pediatric Academic Association, Inc. — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

77 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	6	480	4,510	$90	$1.8M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	32	660	460	$90	$1.5M
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.	4	10	1,020	$280	$1.3M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	90	580	510	$100	$1.3M
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.	1	10	480	$290	$1.2M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	4	20	4,730	$90	$818.4K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	20	1,320	$90	$727.9K
36512	Apheresis (also known as pheresis or therapeutic pheresis) is a medical procedure utilizing specialized equipment to remove selected blood constituents (plasma, leukocytes, platelets, or cells) from…	2	10	320	$1,210	$705.2K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	42	230	2,200	$100	$530.1K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	1	30	620	$130	$428.2K

Showing 1–10 of 77

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nationwide Children's Hospital	OH	General Acute Care Hospital	$0	$777.8M
Ohiohealth Corporation	OH	Family Medicine Physician	$0	$89.1M
Adena Medical Group LLC	OH	Family Medicine Physician	$0	$39.9M
Dayton Children's Specialty Physicians, Inc.	OH	Pediatrics Physician	$0	$31.8M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Lester E Cox Medical Centers	MO	Family Medicine Physician	$0	$17M
Marion Area Physicians LLC	OH	Internal Medicine Physician	$0	$15.7M
Bruce Buerk	OH	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
Scott Schoenberger	OH	Retina Specialist (Ophthalmology) Physician	$2.1M	$0
Martin Wilkes	OH	Retina Specialist (Ophthalmology) Physician	$2.1M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Vincent Family Centers	OH	Adolescent and Children Mental Health Clinic/Center	$0	$29.6M
River's Crossing Home Care LLC	OH	Home Health Agency	$0	$15.2M
Nationwide Children's Hospital	OH	Multi-Specialty Clinic/Center	$0	$13M
Pediatric Ophthalmology Associates Inc.	OH	Ophthalmology Physician	$0	$9.5M
Columbus Neighborhood Health Center Inc	OH	Federally Qualified Health Center (FQHC)	$0	$8.7M
Manmohan Katapadi	OH	Cardiovascular Disease Physician	$183.2K	$25.3K
Thomas Keeling	OH	Infectious Disease Physician	$204.5K	$0
James Smith	OH	Infectious Disease Physician	$190.3K	$0
Matthew Robertson	OH	Diagnostic Radiology Physician	$108.7K	$0
Rodney Kusumi	OH	Infectious Disease Physician	$96.8K	$0

Pediatric Academic Association, Inc. — Billing Profile & Reimbursement Data

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Pediatric Academic Association, 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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