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

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

Optum Women's And Children's Health, LLC (NPI 1073561825)

Key Findings

Field	Value
Entity Type	Organization
Organization	Optum Women's And Children's Health, LLC
Address	877 Franklin Gtwy Se Ste 205
City	Marietta
State	GA
ZIP	30067
Taxonomy	Durable Medical Equipment & Medical Supplies
NPI Enumerated	May 4, 2006

Payer Source	Total Paid
Medicaid	$160.4M
Medicare	$0

This provider is effectively a Medicaid-focused operation: there is no Medicare billing on file (none) and total Medicaid revenue is $160.4M, so the entity functions as a single‑payer (Medicaid) revenue generator rather than a mixed Medicare/Medicaid practice. Analysts should treat Medicare comparisons as not applicable for this NPI.

Revenue is highly concentrated in a small set of service lines: the precomputed top three Medicaid codes account for 76.5% of total Medicaid revenue, driven by S9351 ($74.1M; 46.2% of Medicaid revenue), J1726 ($32.7M; 20.4%), and S9560 ($15.9M; 9.9%). This concentration indicates that a handful of recurring per‑diem infusion and injectable services dominate the financial profile.

The code mix points to a business built around home infusion and home injectable therapy plus per‑diem administrative and pharmacy services: high‑revenue per‑diem infusion codes S9351 (home infusion therapy per diem) and S9560 (home injectable hormonal therapy per diem) together with large J1726 volumes (hydroxyprogesterone caproate, Makena) indicate routine dispensing/administration of specialty injectable drugs and coordinated home nursing/pharmacy workflows. These codes suggest the provider operates as a DME/home infusion and maternal injectable services vendor rather than as an ambulatory clinic.

The provider is a leading in‑state biller for several of its highest‑revenue codes: S9351 ranks #1 of 4 providers in‑state (100th percentile; typical, unremarkable volume) and S9560 ranks #1 of 2 providers in‑state (100th percentile; typical, unremarkable volume). These rankings indicate the entity is a dominant statewide participant for core home infusion per‑diem services, even if state volumes are characterized as typical rather than unusually large.

For J1726 (hydroxyprogesterone caproate, Makena) the provider is the only state filer in the dataset (rank #1 of 1; 0th percentile; no state peer volume comparison available), and multiple other codes (e.g., S9379, S9353, J1729) also appear with rank #1 of 1. This pattern implies the provider is the sole or primary Medicaid biller in Georgia for several specialized injectable and home therapy codes, which can indicate niche specialization in maternal/prophylactic injections.

Beyond infusion and injectable per‑diems, the provider bills a range of maternal home‑management codes and nursing visit codes (S9211, S9214, S9213, S9212, S9123, H1000). Notably H1000 ($86.3K; ranks #1 of 7 providers in‑state, 100th percentile; notably above typical state volume) signals above‑typical activity in prenatal at‑risk assessment relative to peers, reinforcing a maternal/obstetric focus in its service mix.

Operational throughput is large for recurring home services: top line claim counts include S9351 at 170.4K claims, S9560 at 127.4K claims, and 99601 at 66.8K claims, with average paid/claim values of $435, $125, and $113 respectively. These volumes and per‑claim payments are consistent with a high-volume home infusion and nursing visit business model that relies on frequent, lower‑unit payments aggregated across many encounters.

The provider has long tenure in the NPI registry (NPI enumerated 2006-05-04, approximately 20 years), which combined with the concentrated Medicaid revenue mix suggests an established, Medicaid‑oriented DME/home infusion and maternal injectable business rather than a new entrant. Analysts should weigh both the revenue concentration in a few codes and the provider’s statewide leadership on several per‑diem infusion and injectable codes when considering contract negotiation, network capacity, or program integrity reviews.

Medicaid: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S9351	Home infusion therapy, continuous or intermittent anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment…	170,380	$440	$74.1M
J1726	Injection, hydroxyprogesterone caproate, (makena), 10 mg	31,230	$1,050	$32.7M
S9560	Home injectable therapy; hormonal therapy (e.g.; leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment…	127,450	$130	$15.9M
99601	The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for up to the first two hours of a visit.	66,760	$110	$7.5M
S9211	Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits…	111,860	$60	$6.6M
S9214	Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded…	21,620	$180	$3.9M
J1729	Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg	8,660	$450	$3.9M
S9379	Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and…	15,640	$230	$3.5M
S9353	Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing…	7,130	$290	$2M
S9213	Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded…	14,340	$140	$2M

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Optum Women's And Children's Health, LLC — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1726	Injection, hydroxyprogesterone caproate, (makena), 10 mg	1	10	31,230	$1,050	$32.7M
S9351	Home infusion therapy, continuous or intermittent anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment…	1	10	6,150	$430	$19.7M
S9560	Home injectable therapy; hormonal therapy (e.g.; leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment…	1	10	67,440	$120	$8.4M
J1729	Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg	1	10	8,660	$450	$3.9M
S9379	Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and…	1	10	15,640	$220	$3.5M
S9211	Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits…	1	10	56,670	$60	$3.3M
99601	The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for up to the first two hours of a visit.	1	10	27,540	$100	$3.1M
S9353	Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing…	1	10	7,130	$290	$2M
S9214	Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded…	1	10	11,370	$180	$2M
S9213	Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded…	1	10	14,340	$140	$2M

Showing 1–10 of 28

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nuestros Ninos Our Kids Pediatrics Inc.	GA	Pediatric Nurse Practitioner	$0	$11.4M
Tara Pursely	GA	Dentist	$0	$1.5M
Healthtrackrx Of Georgia LLC	GA	Clinical Medical Laboratory	$0	$1.3M
Ocmulgee Medical Pathology Association Inc	GA	Clinical Medical Laboratory	$958.1K	$84.9K
Atlanta Area Psychological Associates, P.C.	GA	Psychologist	$0	$1M
Kayla Dawson	GA	General Practice Dentistry	$0	$969.5K
Alan Gardner	GA	Dermatology Physician	$800.1K	$0
Northwest Georgia Orthopaedic Surgery Center, LLC	GA	Ambulatory Surgical Clinic/Center	$641K	$0
Shaun Lewis	GA	Professional Counselor	$0	$601.3K
Gi Diagnostics Endoscopy Center, LLC	GA	Endoscopy Clinic/Center	$571.3K	$0

Optum Women's And Children's Health, LLC — Billing Profile & Reimbursement Data

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Optum Women's And Children's Health, LLC — 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