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

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

South Sound Pediatrics PLLC (NPI 1073684692)

South Sound Pediatrics PLLC is a pediatrics physician provider located in Olympia, Washington. This profile covers 0 Medicare and 62 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	South Sound Pediatrics PLLC
Address	3516 12th Ave Ne
City	Olympia
State	WA
ZIP	98506
Taxonomy	Pediatrics Physician
NPI Enumerated	November 13, 2006

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.

62 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…	33,790	$80	$2.6M
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…	11,870	$110	$1.2M
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…	6,410	$100	$653.7K
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…	6,730	$90	$633K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,460	$100	$349.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,220	$110	$132.9K
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…	510	$150	$77.5K
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	2,400	$30	$64.9K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	4,950	$10	$64.3K
99429	Use 99429 to report a preventive medicine service that does not have a specific code.	2,400	$30	$62.4K

Showing 1–10 of 62

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

South Sound Pediatrics PLLC — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

62 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	161	1,820	480	$60	$379.6K
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…	84	1,860	610	$40	$295.5K
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…	32	280	540	$70	$166.5K
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…	31	300	400	$80	$164.4K
D0120	Periodic oral evaluation - established patient	357	920	690	$20	$131.3K
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…	147	540	130	$90	$128.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	40	320	290	$70	$104.8K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	548	730	730	$20	$98.5K
D9999	N/A	115	290	690	$30	$75.9K
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,…	389	700	180	$50	$59.3K

Showing 1–10 of 62

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Behavioral Health Resources	WA	Community/Behavioral Health Agency	$0	$40.7M
Providence Health & Services Washington	WA	General Acute Care Hospital	$0	$39.9M
Providence Health & Services Washington	WA	Family Medicine Physician	$0	$20M
Harbor Health Solutions LLC	WA	Home Health Agency	$0	$8.6M
Olympia Emergency Services, PLLC	WA	Emergency Medicine Physician	$0	$6.5M
Healthy Future Pediatrics	WA	Pediatrics Physician	$0	$4.3M
Neighborcare Health	WA	Federally Qualified Health Center (FQHC)	$0	$3.9M
Sea Mar Community Health Centers	WA	Federally Qualified Health Center (FQHC)	$0	$3.4M
Olympia Pediatrics, PLLC	WA	Specialist	$0	$2.7M
Gastroenterology Associates, LLC	WA	Ambulatory Surgical Clinic/Center	$1.2M	$1.2M

South Sound Pediatrics PLLC — Billing Profile & Reimbursement Data

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South Sound Pediatrics PLLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References