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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Knox Clinic Pediatrics (NPI 1063500908)

Knox Clinic Pediatrics is a specialist provider located in Wilmington, North Carolina. This profile covers 0 Medicare and 65 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	Knox Clinic Pediatrics
Address	2304 Delaney Rd
City	Wilmington
State	NC
ZIP	28403
Taxonomy	Specialist
NPI Enumerated	October 10, 2006

Payer Source	Total Paid
Medicaid	$9.9M
Medicare	$0

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

65 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…	29,790	$90	$2.6M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	309,780	$10	$1.5M
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…	6,590	$120	$797.6K
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…	11,760	$60	$705.8K
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…	7,260	$80	$609.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,110	$80	$589.7K
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…	6,770	$80	$548.3K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	3,560	$130	$463.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,880	$90	$438.9K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	19,590	$20	$352.6K

Showing 1–10 of 65

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Knox Clinic Pediatrics — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

65 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	15	90	250	$110	$352.3K
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	102	2,850	10,910	$10	$330.3K
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…	98	4,400	960	$60	$271.3K
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…	72	520	1,080	$80	$262.1K
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…	65	550	970	$90	$258.9K
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…	350	4,130	670	$50	$219.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	44	590	490	$90	$179.8K
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.	231	380	460	$40	$173.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	35	530	270	$90	$112.8K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	43	630	840	$30	$101.2K

Showing 1–10 of 65

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wilmington Medical Supply Inc	NC	Durable Medical Equipment & Medical Supplies	$0	$47.8M
A2z Home Medical Supplies, Inc	NC	Durable Medical Equipment & Medical Supplies	$0	$47.4M
Maxim Healthcare Services, Inc.	NC	Home Health Agency	$0	$33.8M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$28.3M
Physician Alliance For Mental Health, LLC	NC	Community/Behavioral Health Agency	$0	$28M
Easter Seals Ucp North Carolina & Virgiinia, Inc.	NC	Community/Behavioral Health Agency	$0	$19.2M
Bayada Home Health Care, Inc.	NC	Developmental Disabilities Clinic/Center	$0	$18M
Therapy Works Of Wilmington	NC	Speech-Language Pathologist	$0	$12.2M
Coastline Therapy Group, LLC	NC	Speech-Language Pathologist	$0	$11.8M
Pd Of Wilmington Inc	NC	In Home Supportive Care Agency	$0	$11.4M

Knox Clinic Pediatrics — Billing Profile & Reimbursement Data

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Knox Clinic Pediatrics — 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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References