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.

Pediatric Services Of America, LLC (NPI 1104848134)

Field	Value
Entity Type	Organization
Organization	Pediatric Services Of America, LLC
Address	1000 Bridgeport Ave Ste 309
City	Shelton
State	CT
ZIP	06484
Taxonomy	Home Health Agency
NPI Enumerated	July 25, 2006
NPI Deactivated	March 31, 2021

Payer Source	Total Paid
Medicaid	$92.9M
Medicare	$0

Key Findings

This provider is effectively single‑payer in scope: Medicare shows none (no Medicare billing on file) while Medicaid accounts for $92.9M in lifetime revenue, so all observed fee‑for‑service activity is concentrated in the Medicaid program. Analysts should treat Medicare exposure as nil when assessing payer risk and network positioning.

Revenue is highly concentrated: the top three Medicaid codes account for 99.9% of the provider’s total Medicaid revenue, with S9124 alone representing 74.7% and S9123 representing 25.1% of the $92.9M total. This degree of concentration indicates the business is driven almost entirely by a very small set of in‑home nursing services.

The code mix indicates a home‑health, hourly nursing operation: S9124 (Nursing care in the home by licensed practical nurse, per hour) and S9123 (Nursing care in the home by registered nurse, per hour) dominate billing, while ancillary codes such as T1016 (case management) and T1004 (qualified nursing aide services) are marginal. This pattern shows the organization primarily delivers in‑home skilled nursing on an hourly basis rather than a broader bundle of home‑health or ancillary services.

S9124 performance establishes the provider as a statewide outlier on LPN home‑care hours: 234.2K claims, $296 avg paid/claim, $69.3M revenue, and a rank of #2 of 65 providers in‑state at the 98th percentile, characterized as an extreme outlier and far above typical state volume for this code. That rank and volume profile signal market dominance for S9124 in Connecticut and suggest a capacity or strategic focus on high‑volume LPN hour delivery.

S9123 is also a material revenue source but occupies a different competitive posture: 84.3K claims, $276 avg paid/claim, $23.3M revenue, and a rank of #6 of 79 providers in‑state at the 94th percentile (noted as typical, unremarkable volume for this code). This positions the provider as a significant statewide participant for RN home‑care hours, though not as extreme an outlier as its LPN hours under S9124.

Smaller Medicaid lines are functionally peripheral: T1016 generated $164.9K (0.2% of Medicaid revenue) on ~1K claims and ranks #18 of 47 providers in‑state at the 63th percentile (typical, unremarkable volume), while T1004 generated $104.7K (0.1%) on ~1.1K claims and ranks #59 of 63 providers at the 6th percentile (typical, unremarkable volume). These figures indicate limited activity in case management and aide services relative to core nursing hours.

Operational and strategic implications follow from the concentrated mix: reliance on two hourly nursing codes (S9124 at 74.7% and S9123 at 25.1%) means reimbursement, utilization, or policy changes that affect in‑home nursing hourly rates or authorization practices could materially impact the provider’s revenue base. Payers and analysts should prioritize monitoring rate adjustments, utilization controls, or prior‑authorization edits tied to these specific codes.

The provider is long‑tenured in the NPI system, enumerated on 2006‑07‑25 (~20 years ago), which supports interpretation of the high volumes as sustained operational capacity rather than a short‑term spike. Longevity combined with the extreme S9124 outlier status suggests an established operational model focused on high‑volume LPN home‑care services rather than recent rapid entry.

Medicaid: Complete Services Breakdown

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

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S9124	Nursing care, in the home; by licensed practical nurse, per hour	234,180	$300	$69.3M
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	84,300	$280	$23.3M
T1016	Case management, each 15 minutes	1,020	$160	$164.9K
T1004	Services of a qualified nursing aide, up to 15 minutes	1,090	$100	$104.7K

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

Pediatric Services Of America, LLC — 1 of 4 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

4 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S9124	Nursing care, in the home; by licensed practical nurse, per hour	2	70	5,660	$150	$3.6M
T1004	Services of a qualified nursing aide, up to 15 minutes	59	60	26,810	$40	$2.8M
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	6	80	14,190	$80	$2.7M
T1016	Case management, each 15 minutes	18	50	220	$20	$50.8K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Pediatric Services Of America, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pediatric Services Of America, LLC	MA	Nursing Care Agency	$0	$47.8M
Pediatric Services Of America, LLC	PA	Home Health Agency	$0	$34.9M
Pediatric Services Of America, LLC	FL	Home Health Agency	$0	$33.5M
Pediatric Services Of America, LLC	NC	Nursing Care Agency	$0	$32.4M
Pediatric Services Of America, LLC	PA	Home Health Agency	$0	$31.5M
Pediatric Services Of America, LLC	TX	Nursing Care Agency	$0	$31.3M
Pediatric Services Of America, LLC	PA	Home Health Agency	$0	$30.3M
Pediatric Services Of America, LLC	MA	Nursing Care Agency	$0	$29M
Pediatric Services Of America, LLC	WA	Nursing Care Agency	$0	$26.8M
Pediatric Services Of America, LLC	PA	Home Health Agency	$0	$25.1M

Nearby Providers

Other providers in the same ZIP code as Pediatric Services Of America, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adult Day Care Of America, Inc.	CT	In Home Supportive Care Agency	$0	$35.1M
Dianon Systems, Inc	CT	Clinical Medical Laboratory	$4.9M	$8.5M
Option Care Enterprises, Inc	CT	Home Infusion Therapy Pharmacy	$0	$13.3M
Ameripath New York LLC	CT	Clinical Medical Laboratory	$2.9M	$7.7M
Esoterix Genetic Laboratories, LLC	CT	Clinical Medical Laboratory	$2.2M	$3.2M
Enzo Clinical Labs, Inc.	CT	Clinical Medical Laboratory	$0	$3.8M
Bridgeport Radiological Associates LLC	CT	Diagnostic Radiology Physician	$0	$2.9M
Shelton Pediatrics	CT	Pediatrics Physician	$0	$2.7M
Echo Hose Hook And Ladder Ambulance Corps., Inc.	CT	Land Ambulance	$568.5K	$1.7M
Shelton Dental Group LLC	CT	Dentist	$0	$2.1M

Pediatric Services Of America, LLC — Billing Profile & Reimbursement Data

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Pediatric Services Of America, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References