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

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

Medical Center For Children & Adolescents, PA (NPI 1073528998)

Key Findings

Field	Value
Entity Type	Organization
Organization	Medical Center For Children & Adolescents, PA
Address	3430 Washington Pkwy
City	Idaho Falls
State	ID
ZIP	83404
Taxonomy	Pediatrics Physician
NPI Enumerated	July 29, 2006

Payer Source	Total Paid
Medicaid	$8.8M
Medicare	$0

MEDICAL CENTER FOR CHILDREN & ADOLESCENTS, PA is effectively a Medicaid-focused pediatrics practice: there is no Medicare billing on file while lifetime Medicaid revenue is $8.8M, indicating the organization serves a predominantly pediatric, non-Medicare population. The provider's NPI has been active since 2006-07-29 (~20 years ago), showing long tenure in the market which supports established relationships with Medicaid patients and payers.

Revenue concentration is high: the precomputed top 3 Medicaid codes account for 66.3% of this provider’s total Medicaid revenue. The single largest revenue driver is 99213 (office/outpatient E/M for established patients) contributing $3.8M or 43.9% of Medicaid revenue, with 54.9K claims, signaling heavy reliance on routine pediatric office visits.

The code mix and service line implications point to a primary-care and preventive pediatrics model. High volumes for preventive medicine codes 99392 ($997.7K, 11.4%) and 99391 ($971.2K, 11.1%), together with substantial vaccine administration (90460, 90461, 90471 series), indicate that well-child visits and immunizations are core services and likely a structured clinic workflow emphasizing preventive care.

Competitive standing in-state is strong on several core pediatric codes: the provider ranks #11 of 669 for 99213 (99th percentile), #6 of 79 for 99392 (94th percentile), and #5 of 84 for 99391 (95th percentile), which describes the practice as a high-volume, top-tier Medicaid pediatric provider within Idaho for these services. Multiple additional codes (e.g., 90461 at rank #3 of 58, 87651 at rank #3 of 42) are described as "notably above typical state volume," reinforcing that this provider is a major in-state deliverer of pediatric preventive and diagnostic services.

Several specific codes are statistical outliers in state comparisons and highlight operational focus areas. For example, 99212 ranks #6 of 208 providers and is labeled an "extreme outlier, far above typical state volume," and G2211 ranks #1 of 35 providers (100th percentile) and is described as "notably above typical state volume." These labels suggest unusually high use of low- to mid-level E/M visits and an emphasis on complexity add-on reporting for ongoing care.

The practice shows sustained high throughput for immunization services: 90460 ($556.4K, 6.3%), 90461 ($241.7K, 2.8%), and 90471 ($201.9K, 2.3%) together reflect routine vaccine administration at scale, consistent with a pediatric clinic that integrates vaccination into most well-child encounters rather than referring out.

Laboratory and screening services are also prominent but secondary to office and preventive visits. High state rankings for streptococcal testing 87651 (#3 of 42, $174.1K) and rapid antigen testing 87880 (rank #10 of 79) indicate on-site infectious disease diagnostics support episodic care in addition to preventive services. Vision screening G8510 ranks #1 of 18 providers (100th percentile) and is marked an "extreme outlier," highlighting systematic screening workflows.

Although the provider generates meaningful revenue across many Medicaid codes, there is limited complexity-weighted E/M volume relative to preventive services: 99214 contributes $350.9K (4.0%) and ranks in the 83rd percentile, described as "typical, unremarkable volume." This suggests the practice is more heavily weighted toward routine and preventive visits than toward higher-complexity outpatient management.

For payer mix and strategic implications, the absence of Medicare revenue combined with dominant Medicaid income ($8.8M) makes this operation effectively single-payer (Medicaid) in orientation. Payers and analysts should treat this entity as a high-volume pediatric Medicaid provider with deep in-state reach and operational emphasis on well-child visits, immunizations, and office-based infectious testing rather than adult or complex inpatient services.

Medicaid: Complete Services Breakdown

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
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…	54,950	$70	$3.8M
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…	9,780	$100	$997.7K
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…	10,910	$90	$971.2K
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.	10,300	$50	$556.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,440	$100	$544.3K
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…	3,370	$100	$350.9K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	8,060	$30	$241.7K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	11,220	$20	$201.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,700	$110	$190.3K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	4,970	$40	$174.1K

Showing 1–10 of 65

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Medical Center For Children & Adolescents, PA — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

65 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…	11	670	740	$40	$193.6K
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…	108	620	560	$60	$191.8K
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	80	450	$80	$171.3K
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…	5	80	380	$70	$151.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6	80	130	$80	$91.4K
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.	5	80	460	$30	$77.7K
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…	7	50	210	$80	$51.4K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	3	60	290	$30	$48.7K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	70	70	2,170	$10	$42.9K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	7	10	140	$120	$37.8K

Showing 1–10 of 65

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mountain View Hospital LLC	ID	General Acute Care Hospital	$0	$45.7M
Eastern Idaho Health Services Inc	ID	General Acute Care Hospital	$0	$12.1M
Rm Lab LLC	ID	Clinical Medical Laboratory	$1.1M	$8.2M
Aaa American Healthcare LLC	ID	Mental Health Counselor	$0	$8.7M
Intermountain Emergency Physicians	ID	Emergency Medicine Physician	$0	$6.6M
24-7 Professional Solutions	ID	In Home Supportive Care Agency	$0	$5.9M
Just 4 Kids Health LLC	ID	Urgent Care Clinic/Center	$0	$5.2M
Foothills Rehabilitation & Performance Services, PLLC	ID	Physical Therapist	$0	$5M
Innovative Health Care Concepts, Inc	ID	Developmental Disabilities Clinic/Center	$0	$4.8M
Kyle Thompson	ID	Retina Specialist (Ophthalmology) Physician	$4.5M	$0

Medical Center For Children & Adolescents, PA — Billing Profile & Reimbursement Data

Sign up for Medical Center For Children & Adolescents, PA — Billing Profile & Reimbursement Data policy alerts

Medical Center For Children & Adolescents, PA — Billing Profile & Reimbursement Data

Sign up for Medical Center For Children & Adolescents, PA — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References