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    OpenPayerNPI Medicare & MedicaidUt Lebonheur Pediatric Specialists, Inc.
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    Ut Lebonheur Pediatric Specialists, Inc. — Billing Profile & Reimbursement Data

    NPI 1093024101 · Memphis, TN · Pediatrics Physician

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    Ut Lebonheur Pediatric Specialists, Inc. is a pediatrics physician provider located in Memphis, Tennessee. This profile covers 0 Medicare and 267 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationUt Lebonheur Pediatric Specialists, Inc.
    Address848 Adams Ave.
    CityMemphis
    StateTN
    ZIP38103
    TaxonomyPediatrics Physician
    NPI EnumeratedOctober 7, 2010

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$63.8M
    Medicare$0

    Key Findings

    UT LEBONHEUR PEDIATRIC SPECIALISTS, INC. reports no Medicare billing on file and $63.8M in lifetime Medicaid revenue, making its activity effectively single‑payer Medicaid at the claims level; there is no Medicare presence to compare against its Medicaid scale. This concentration in one public payer should frame any competitive or utilization analysis about the group.

    Revenue is heavily concentrated in a few outpatient evaluation/management codes: the top three Medicaid codes (99214, 99213, 99204) together account for 44.2% of the provider's total Medicaid revenue, with 99214 contributing $9.2M (19.1%), 99213 contributing $7.8M (16.3%), and 99204 contributing $4.2M (8.8%). This degree of concentration indicates that office‑based E/M visits are the primary revenue drivers.

    The code mix indicates an integrated pediatric specialty operation that spans high‑volume ambulatory care and substantial hospital‑based services: very large volumes of outpatient E/M (e.g., 114.5K claims for 99214 and 145.1K claims for 99213) sit alongside significant inpatient/subsequent care and critical care codes (99233, 99232, 99231, 99291) and neonatal follow‑up (99472). High utilization of cardiac imaging (93303, 93306, 93304, 93325) and EEG monitoring () suggests embedded diagnostic and procedural capacity supporting subspecialty pediatrics.

    Competitive standing in Tennessee is dominant for many specific services: 99213 ranks #17 of 4050 providers in‑state at the 100th percentile and is labeled an "extreme outlier," while 99214 ranks #20 of 3759 providers at the 99th percentile; multiple diagnostic and procedure codes (93304, 93325, 99243, 95812, 92060) are at or near the top rank (several #1 or #2) and described as extreme outliers or far above typical state volume. These ranks indicate the provider is a major statewide player for both high‑volume pediatric E/M and several specialized diagnostic services.

    Several top codes are explicitly flagged as statistical outliers in the provided data and should be interpreted as materially above typical state volumes: 99213 and 99214 are described as "extreme outlier," 99204 and 99215 are also labeled "extreme outlier," and multiple diagnostic codes (93304, 93325, 99243, 95812, 92060) carry similar outlier designations. The prevalence of these outlier labels across core E/M and diagnostic codes points to an unusually large service footprint rather than marginal participation in these lines.

    Preventive and pediatric well‑visit services represent a meaningful portion of activity: 99392 (18K claims, $1.5M, 3.1%), 99393 (12.8K claims, $1.1M, 2.3%), and 99391 (13.3K claims, $971.3K, 2.0%) are all notable revenue contributors. This mix indicates the practice handles high throughput of routine preventive pediatric care in addition to problem‑focused visits.

    Hospital and neonatal care compose a substantial operational component: inpatient/subsequent care codes such as 99232 (28.1K claims, $1.5M, 3.2%), 99233 (23.6K claims, $1.8M, 3.7%), and discharge management 99238 (12.2K claims, $697.3K, 1.5%) along with neonatal follow‑up 99472 (7.2K claims, $2.6M, 5.5%) indicate significant inpatient throughput and neonatal critical care follow up. These volumes imply that the group operates with considerable hospital integration and handles a high mix of inpatient pediatric acuity.

    The provider's NPI was enumerated on 2010-10-07 (~16 years ago), signaling an established presence in the market; combined with $63.8M in Medicaid revenue and the repeated top‑percentile rankings, this tenure supports a picture of an entrenched regional referral and service hub for pediatric outpatient, inpatient, and diagnostic care. Continued monitoring should focus on the dominant Medicaid footprint and the specific high‑volume codes that drive nearly half of Medicaid revenue.

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.

    View: By Year1 / 3

    Medicaid Revenue by Year vs. Tennessee Providers
    7 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier

    Medicaid: Complete Services Breakdown

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

    267 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    99214The 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…114,500$80$9.2M
    99213The 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…145,080$50$7.8M
    99204The provider sees a new 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 provider…34,620$120$4.2M
    99203The provider sees a new 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 provider…31,210$90$2.7M
    99472The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.7,210$370$2.6M
    99233The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…23,600$80$1.8M
    99215The 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…16,600$100$1.7M
    93303The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…14,970$110$1.7M
    99232The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…28,130$60$1.5M
    99392Preventive 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…18,020$80$1.5M

    Showing 1–10 of 267

    • More pages

    Medicaid: Competitive Analysis & Benchmarks

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

    Claims Volume vs. Tennessee Distribution
    Ut Lebonheur Pediatric Specialists, Inc. — 22 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Tennessee

    Full comparison — all codes billed, vs. Tennessee median

    267 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    99472The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.4101,110$340$3.6M
    92507The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…1272302,130$40$616.8K
    42820The provider removes the tonsils and adenoids in a patient younger than 12 years old.550140$850$541.1K
    93303The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…2301,060$130$484.1K
    95782A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.5101,440$370$450.5K
    69436This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.470160$500$421.5K
    97530The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.823401,400$40$354.2K
    95165In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.6580330$170$342.3K
    00170The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.1660110$130$236.7K
    01922The provider performs anesthesia services for a patient undergoing non–invasive imaging or radiation therapy.52060$170$222.4K

    Showing 1–10 of 267

    • More pages

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Ut Lebonheur Pediatric Specialists, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Methodist Healthcare - Memphis HospitalsTNGeneral Acute Care Hospital$0$105.6M
    Methodist Healthcare - Memphis HospitalsTNChildren's Hospital$0$84.4M
    Primary Care Group LLCTNFamily Medicine Physician$0$23.5M
    Methodist Healthcare - Olive Branch HospitalMSGeneral Acute Care Hospital$0$18.1M
    Alliance Health Services Inc.TNDurable Medical Equipment & Medical Supplies$0$11.2M
    Methodist Inpatient Physicians LLCTNInternal Medicine Physician$0$4.8M
    Lebonheur Patient TransportationTNLand Ambulance$0$4.5M
    Specialty Physician Group LLCTNCardiovascular Disease Physician$0$3.3M
    Methodist Healthcare - Memphis HospitalsTNChildren's Hospital$0$3.3M
    Ut Methodist Physicians LLCTNInternal Medicine Physician$0$2.7M

    Nearby Providers

    Other providers in the same ZIP code as Ut Lebonheur Pediatric Specialists, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Shelby County Health Care CorporationTNGeneral Acute Care Hospital$0$56.1M
    City Of Memphis General City Govt.TNLand Ambulance$3.8M$52M
    Pediatric Emergency Specialists, PCTNPediatric Emergency Medicine (Emergency Medicine) Physician$0$39.1M
    Ut Regional One Physicians IncTNSurgery Physician$0$24.1M
    Meritan, IncTNHome Health Agency$0$16.9M
    Pediatric Anesthesiologists P ATNAnesthesiology Physician$0$4.4M
    University Of TennesseeTNDentist$0$3.1M
    Ut Regional One Physicians IncTNAnesthesiology Physician$0$2.3M
    Utmg Dermatopathology, LLCTNClinical Medical Laboratory$1.5M$127.6K
    Hamilton Eye Institute Surgery Center, L.P.TNAmbulatory Surgical Clinic/Center$1M$1.1K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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