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

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

The Children's Hospital Of Alabama (NPI 1104903749)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Children's Hospital Of Alabama
Address	2001 Old Warrior River Rd
City	Hueytown
State	AL
ZIP	35023
Taxonomy	Pediatrics Physician
NPI Enumerated	November 1, 2006

Payer Source	Total Paid
Medicaid	$22.2M
Medicare	$0

This provider is effectively a single‑payer Medicaid operation: there is no Medicare billing on file and total Medicaid revenue is $22.2M, so Medicaid dominates the visible payer mix for this NPI. Analysts should treat Medicare comparisons as inapplicable for this entity and focus competitive analysis on in‑state Medicaid peers.

Revenue is highly concentrated in a few outpatient E/M and preventive visit codes: the top three Medicaid codes (99214, 99213, 99392) account for 62.2% of this provider’s Medicaid revenue. Specifically, 99214 represents $6.6M (30.4% of total Medicaid revenue), 99213 represents $5.5M (25.4%), and 99392 represents $1.4M (6.4%), indicating dependence on established patient evaluation/management and well‑child preventive visits for the bulk of receipts.

The code mix and volumes point to a high‑throughput pediatric ambulatory/well‑child operation: 99213 has 87.2K claims and 99214 has 68K claims, while well‑child codes 99391–99394 together appear prominently (for example, 99392 has 19.5K claims). These counts, combined with numerous vaccine and screening codes, are consistent with a large pediatric primary care or hospital‑based pediatric clinic providing routine preventive care, immunizations, and frequent follow‑up visits.

Ancillary services—diagnostic testing and immunizations—are material revenue drivers and suggest on‑site testing capacity and vaccine delivery. High volumes for COVID testing (87635: 22.4K claims, $918.6K), rapid strep testing (87880: 35.3K claims, $459.3K), influenza multiplex/antigen tests (87502: 13.2K claims, $593.7K; 87428: 13.3K claims, $586.7K), and multiple vaccine codes (90698, 90670, 90686 among others) indicate a throughput model where testing and vaccination are integrated into ambulatory pediatric visits.

Statewide competitive standing for core pediatric outpatient codes is dominant: 99213 ranks #8 of 1988 providers in‑state at the 100th percentile and is labeled an "extreme outlier," while 99214 ranks #13 of 1990 providers at the 99th percentile ("extreme outlier"). Multiple preventive and vaccination codes (e.g., 99392 rank #4 of 299, 99391 rank #4 of 270, 90677 rank #1 of 105) also sit at the 99th–100th percentiles, indicating this provider is a major Medicaid volume leader for pediatric services in Alabama.

Several individual codes are flagged as statistical outliers or notably above typical state volume, which reinforces the provider’s exceptional in‑state scale for pediatric care. Examples include 99214 and 99213 (both "extreme outlier"), 99392 and 99391 (both "extreme outlier"), and vaccine/test codes such as 87428 and 90698 (99th percentile, "extreme outlier" or "notably above typical"), suggesting unusual concentration of routine pediatric visits and on‑site clinical services relative to peers.

Operational scale is reflected in large absolute claim counts across diverse service lines: beyond the two high‑volume E/M codes (87.2K and 68K claims), the provider records very large screening and ancillary claim volumes such as 35.3K claims for 87880 (strep test), 33.9K claims for 99173 (vision screening), and 26.4K claims for 92551 (hearing screening). These volumes imply a system capable of high daily throughput and broad preventive service delivery to pediatric Medicaid enrollees.

This NPI shows institutional longevity that likely supports its referral and patient‑flow patterns: the NPI was enumerated on 2006-11-01 (~20 years ago). The combination of long tenure and concentrated Medicaid revenue suggests an established pediatric service footprint in the state, with business and staffing models optimized around high volumes of preventive care, routine E/M visits, vaccinations, and rapid diagnostic testing.

Medicaid: Complete Services Breakdown

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

72 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…	67,990	$100	$6.6M
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…	87,210	$60	$5.5M
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…	19,490	$70	$1.4M
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…	18,210	$70	$1.3M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	15,540	$70	$1.1M
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…	22,410	$40	$918.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	9,920	$70	$694.5K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	13,190	$50	$593.7K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	13,340	$40	$586.7K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	35,330	$10	$459.3K

Showing 1–10 of 72

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

The Children's Hospital Of Alabama — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

72 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	47	90	500	$40	$303.6K
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…	13	1,990	680	$60	$201.7K
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…	185	330	140	$240	$197.4K
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…	8	1,990	560	$40	$185.6K
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…	4	270	1,360	$60	$159.7K
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…	4	300	1,160	$50	$147.8K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	8	110	610	$40	$143.9K
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	11	60	350	$30	$136.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3	320	640	$50	$98.1K
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.	109	160	400	$10	$88.3K

Showing 1–10 of 72

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Michael Rosemore	AL	Physical Medicine & Rehabilitation Physician	$649.5K	$0
Rock Creek Pharmacy, Inc.	AL	Community/Retail Pharmacy	$50.4K	$0
Robert Cooper	AL	Physical Therapist	$44.3K	$0
Lauren Langley	AL	Physical Therapist	$40.4K	$0
Kimberly Stewart	AL	Family Nurse Practitioner	$39.5K	$0
Anne Long	AL	Occupational Therapist	$10.6K	$0

The Children's Hospital Of Alabama — Billing Profile & Reimbursement Data

Sign up for The Children's Hospital Of Alabama — Billing Profile & Reimbursement Data policy alerts

The Children's Hospital Of Alabama — Billing Profile & Reimbursement Data

Sign up for The Children's Hospital Of Alabama — Billing Profile & Reimbursement Data policy alerts

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Children's Hospital Of Alabama	AL	Children's Hospital	$0	$59M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$18.4M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$17.7M
The Children's Hospital Of Alabama	AL	Pediatric Otolaryngology Physician	$0	$15.8M
The Children's Hospital Of Alabama	AL	Psychologist	$0	$12M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$7.5M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$5.7M
The Children's Hospital Of Alabama	AL	Pediatric Pulmonology Physician	$0	$5.6M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$5.3M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$4.6M