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

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

West Haven Pediatrics, LLC (NPI 1104294644)

West Haven Pediatrics, LLC is a pediatrics physician provider located in West Haven, Connecticut. This profile covers 0 Medicare and 55 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	West Haven Pediatrics, LLC
Address	367 Elm St
City	West Haven
State	CT
ZIP	06516
Taxonomy	Pediatrics Physician
NPI Enumerated	September 14, 2015

Payer Source	Total Paid
Medicaid	$3.5M
Medicare	$0

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

55 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	7,300	$100	$736.8K
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…	10,740	$70	$719.4K
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.	10,260	$40	$389.8K
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…	3,680	$100	$375K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,000	$100	$302.5K
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…	2,850	$100	$279.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,060	$110	$218.1K
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…	1,570	$140	$217.1K
99174	The provider uses instruments to conduct a vision screening exam on both eyes. The procedure includes analysis and report.	2,530	$20	$45.6K
99173	The provider checks the eyesight in both eyes of a pediatric patient by asking him to read letters of varying sizes on a standard chart, such as a Snellen’s chart, which he keeps 20 feet away from…	5,290	$10	$37K

Showing 1–10 of 55

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

West Haven Pediatrics, LLC — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

55 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…	219	1,590	740	$50	$331.8K
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…	184	1,710	750	$30	$243.3K
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…	38	170	850	$80	$203.5K
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…	39	160	680	$70	$166.1K
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.	38	240	1,560	$20	$159.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	38	180	710	$70	$151.2K
99204	The 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…	384	480	150	$90	$100.9K
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…	67	380	220	$70	$99.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	33	170	410	$70	$98K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	34	50	1,160	$10	$72.6K

Showing 1–10 of 55

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Apt Foundation Inc.	CT	Methadone Clinic	$0	$21.6M
West Haven Board Of Education	CT	Local Education Agency (LEA)	$0	$6.3M
Haven Pediatric Dentistry,llc	CT	Pediatric Dentistry	$0	$5.6M
Livwell Pain Management LLC	CT	Family Nurse Practitioner	$0	$3.9M
Shoreline Wellness Behavioral Health Clinic, LLC	CT	Community/Behavioral Health Agency	$0	$2.8M
Shoreline Wellness Behavioral Health Outreach Inc	CT	Community/Behavioral Health Agency	$0	$2.5M
Pediatric Advanced Care Of West Haven LLC	CT	Pediatric Nurse Practitioner	$0	$2.4M
True Pediatric Dental Care LLC	CT	Pediatric Dentistry	$0	$2M
Elvin Griffith, M.d. P.C.	CT	Internal Medicine Physician	$0	$1.7M
Elm Family Dental Associates LLC	CT	General Practice Dentistry	$0	$1.3M

West Haven Pediatrics, LLC — Billing Profile & Reimbursement Data

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West Haven Pediatrics, LLC — 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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