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

Why is the Medicaid comparison limited to Colorado 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. Colorado (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 Partners Of The Southwest (NPI 1083717219)

Pediatric Partners Of The Southwest is a pediatrics physician provider located in Durango, Colorado. This profile covers 0 Medicare and 75 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 Partners Of The Southwest
Address	810 East 3rd St, Suite #301
City	Durango
State	CO
ZIP	81301
Taxonomy	Pediatrics Physician
NPI Enumerated	September 6, 2006

Payer Source	Total Paid
Medicaid	$5.8M
Medicare	$0

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

75 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…	28,060	$60	$1.5M
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…	7,950	$90	$684K
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…	8,580	$80	$678K
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.	21,050	$30	$673.6K
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…	7,080	$80	$594.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,580	$80	$446.6K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	14,580	$20	$218.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,630	$90	$138.6K
G8510	Screening for depression is documented as negative, a follow-up plan is not required	12,350	$10	$98.8K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	1,650	$50	$79.1K

Showing 1–10 of 75

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Colorado Distribution

Pediatric Partners Of The Southwest — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Colorado

Full comparison — all codes billed, vs. Colorado median

75 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1017	Targeted case management, each 15 minutes	102	310	640	$80	$494.3K
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…	72	2,520	330	$100	$352K
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…	234	2,630	430	$90	$268.2K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	787	1,670	550	$100	$229.3K
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…	9	240	550	$110	$208.5K
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,…	17	30	170	$100	$197.7K
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…	15	260	380	$100	$161.6K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	478	590	200	$80	$119.9K
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,…	411	690	140	$90	$118.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	12	290	160	$110	$111.1K

Showing 1–10 of 75

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Valley View Hospital Association	CO	General Acute Care Hospital	$0	$4.5M
Arvind Durvasan	AZ	Nephrology Physician	$639.3K	$8.9K
Haramandeep Singh	CA	Sleep Medicine (Psychiatry & Neurology) Physician	$592.2K	$0
Mandeep Sahani	AZ	Nephrology Physician	$403.6K	$0
Garrett Caputo	CO	Emergency Medicine Physician	$283.8K	$0
Michael Duehrssen	NE	Emergency Medicine Physician	$243.8K	$0
Mohamed Magdy	AL	Gastroenterology Physician	$240.6K	$0
Andrew Gisleson	CO	Family Medicine Physician	$224.7K	$8.3K
Walid Alami	VA	Interventional Cardiology Physician	$222K	$0
Tomas Pevny	CO	Sports Medicine (Orthopaedic Surgery) Physician	$221.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southwest Colorado Mental Health Center, Inc	CO	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$18.2M
Catholic Health Initiatives Colorado	CO	General Acute Care Hospital	$0	$6M
Southwest Colorado Mental Health Center, Inc	CO	Federally Qualified Health Center (FQHC)	$0	$4.5M
Southwest Colorado Mental Health Center, Inc	CO	Federally Qualified Health Center (FQHC)	$0	$4.3M
Nicholas Hugentobler	CO	Foot & Ankle Surgery Podiatrist	$1.9M	$0
Kyle Piwonka	CO	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Clayton Labaume	CO	Surgical Physician Assistant	$1.4M	$0
Sano Vita Inc	CO	Community/Retail Pharmacy	$86.6K	$359.1K
Joshua Zastrocky	CO	Ophthalmology Physician	$352.5K	$0
Jonathan Clark	CO	Radiation Oncology Physician	$340.9K	$0

Pediatric Partners Of The Southwest — 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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