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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Blue Ridge Pediatric & Adolescent Medicine, Inc (NPI 1114038163)

Field	Value
Entity Type	Organization
Organization	Blue Ridge Pediatric & Adolescent Medicine, Inc
Address	579 Greenway Rd
City	Boone
State	NC
ZIP	28607
Taxonomy	Pediatrics Physician
NPI Enumerated	August 31, 2006

Payer Source	Total Paid
Medicaid	$13.2M
Medicare	$0

Medicaid: Complete Services Breakdown

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

79 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…	56,610	$60	$3.3M
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…	33,870	$90	$2.9M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	293,560	$10	$1.5M
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…	9,860	$90	$877.1K
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…	10,190	$80	$825.7K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	13,760	$50	$729.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,090	$90	$630.8K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	25,800	$20	$490.2K
92552	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the lowest threshold at which the patient can hear.	19,480	$20	$292.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,880	$100	$279K

Showing 1–10 of 79

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Blue Ridge Pediatric & Adolescent Medicine, Inc — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

79 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	110	2,850	10,910	$10	$330.3K
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…	80	4,400	960	$60	$271.3K
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…	40	520	1,080	$80	$262.1K
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…	39	550	970	$90	$258.9K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	227	290	1,720	$10	$248.2K
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…	54	4,130	670	$50	$219.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	45	590	490	$90	$179.8K
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.	241	380	460	$40	$173.1K
A4627	Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler	40	60	190	$40	$118.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	69	530	270	$90	$112.8K

Showing 1–10 of 79

Nearby Providers

Other providers in the same ZIP code as Blue Ridge Pediatric & Adolescent Medicine, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Watauga Opportunities, Inc	NC	Developmentally Disabled Services Day Training Agency	$0	$7.9M
Ovidiu Negrea	NC	Medical Oncology Physician	$1.8M	$0
Watauga Medics Inc	NC	Ambulance	$487K	$387K
James Logan	NC	Rheumatology Physician	$533.1K	$0
Ronald Stanley	NC	Dermatology Physician	$519.2K	$0
Brittain Tulbert	NC	Dermatology Physician	$405K	$0
Daniel Krontz	NC	Ophthalmology Physician	$320K	$0
Aaron Westphal	NC	MOHS-Micrographic Surgery Physician	$291.4K	$0
David Whittaker	NC	Dermatology Physician	$273K	$0
Charles Miller	NC	Urology Physician	$259.4K	$0

Blue Ridge Pediatric & Adolescent Medicine, Inc — Billing Profile & Reimbursement Data

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Blue Ridge Pediatric & Adolescent Medicine, Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References