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

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

Northeast Wyoming Pediatric Associates, P.C. (NPI 1114998259)

Key Findings

Field	Value
Entity Type	Organization
Organization	Northeast Wyoming Pediatric Associates, P.C.
Address	916 Jackson Ave
City	Sheridan
State	WY
ZIP	82801
Taxonomy	Pediatrics Physician
NPI Enumerated	January 27, 2006

Payer Source	Total Paid
Medicaid	$3.2M
Medicare	$0

NORTHEAST WYOMING PEDIATRIC ASSOCIATES, P.C. is effectively a Medicaid-only biller: there is no Medicare billing on file while lifetime Medicaid revenue is reported as $3.2M. This payer mix indicates the practice’s patient population and reimbursement exposure are concentrated in Medicaid, not Medicare, which has implications for network contracting and revenue sensitivity to state Medicaid policy changes.

Revenue concentration is high: the precomputed top 3 Medicaid codes (99214, 99213, and 90460) account for 72.8% of the provider’s total Medicaid revenue. Those three codes are dominated by office E/M visits and vaccine administration, signaling that a small set of ambulatory pediatric services drive the bulk of the practice’s Medicaid dollars.

The code mix points to a primary-care pediatric practice with strong preventive and vaccination activity. High-revenue E/M codes 99214 ($1.2M, 39.0%) and 99213 ($763.7K, 23.9%) reflect frequent established-patient visits, while 90460 ($315.5K, 9.9%) and multiple vaccine product codes (e.g., 90686, 90670) show substantial immunization throughput, consistent with a full-scope pediatric office offering well-child care and routine vaccine delivery.

Competitive standing in-state is strong for core outpatient pediatric services: 99214 ranks #5 of 223 providers in Wyoming (98th percentile; extreme outlier), and 99213 ranks #10 of 257 (96th percentile; notably above typical). The practice is a major statewide participant for high-acuity established visits compared with peers, suggesting a large ambulatory panel or high visit frequency relative to other Wyoming pediatricians.

Preventive care metrics are also elevated: 99391 ($228.5K) and 99392 ($221.2K) both rank #2 in-state (98th percentile) and 99393/99394 rank in the upper percentiles as well, indicating consistently high volumes of well-child and preventive visits across age groups. This pattern reinforces the interpretation that continuity preventive care and scheduled well visits are a central service line for the practice.

The practice shows notable on-site diagnostic and screening capacity for pediatric respiratory and developmental needs. Codes for SARS-CoV-2/influenza testing (87428 ranks #1 of 13, 100th percentile) and rapid strep/RSV testing (87880, 87807, 87804) appear in the top 25, and developmental screening codes 96110 (typical volume) and 96127 (rank #1 of 27, 100th percentile; extreme outlier) indicate routine use of standardized developmental and behavioral assessments.

Several codes indicate unusually high claim volumes even when payment per claim is low: for example, 94760 shows 8.2K claims at $3 avg paid/claim totaling $24.5K and ranks #1 of 5 providers in-state (100th percentile; notably above typical). These high-claim, low-dollar services (oxygen saturation checks, brief assessments) suggest scale in routine point-of-care procedures that support high patient throughput and operational efficiency in a busy pediatric clinic.

Tenure and stability: the provider’s NPI was enumerated on 2006-01-27 (~20 years ago), indicating long-standing presence in the local market. Combined with the practice’s concentrated Medicaid revenue base and elevated in-state ranks on core pediatric and preventive codes, this tenure supports the view of an established pediatric primary-care provider with dominant Medicaid-facing volumes in Sheridan, WY.

Medicaid: Complete Services Breakdown

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

48 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…	14,140	$90	$1.2M
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…	13,170	$60	$763.7K
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.	7,890	$40	$315.5K
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…	3,010	$80	$228.5K
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…	2,630	$80	$221.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,160	$80	$96.6K
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…	1,520	$50	$69.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	550	$90	$51.8K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	1,790	$20	$42.9K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	760	$40	$27.5K

Showing 1–10 of 48

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wyoming Distribution

Northeast Wyoming Pediatric Associates, P.C. — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wyoming

Full comparison — all codes billed, vs. Wyoming median

48 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…	5	220	400	$50	$79.3K
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	260	420	$30	$67.2K
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	50	280	$70	$43.2K
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.	2	70	490	$40	$42.9K
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…	2	40	170	$70	$34.1K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	3	10	270	$30	$18.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2	30	100	$60	$17.8K
99336	N/A	3	10	20	$110	$16.9K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	5	20	330	$30	$16.8K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	5	30	260	$20	$15.8K

Showing 1–10 of 48

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Erica Rinker	WY	Family Medicine Physician	$78.8K	$0
Emily Denney	WY	Family Medicine Physician	$73.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Normative Services, Inc.	WY	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$8.5M
Lgbtq Telepsychiatry	WY	Psychiatric/Mental Health Nurse Practitioner	$0	$3.9M
Rehabilitation Enterprises Of Northeastern Wyoming	WY	Clinical Psychologist	$0	$3.5M
Gillette Pediatric Dentistry LLC	WY	Pediatric Dentistry	$0	$2.9M
Eagle Ridge Rehabilitative Services	WY	Case Management Agency	$0	$2.6M
David Bailey	WY	Pediatric Dentistry	$0	$2.6M
Sensational Kids, LLC	WY	Pediatric Occupational Therapist	$0	$2.1M
Memorial Hospital Of Sheridan County	WY	General Acute Care Hospital	$0	$989.7K
Linda Garretson	WY	Developmentally Disabled Services Day Training Agency	$0	$989.3K
Senior Citizens Council	WY	Home Health Agency	$0	$959.7K

Northeast Wyoming Pediatric Associates, P.C. — Billing Profile & Reimbursement Data

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Northeast Wyoming Pediatric Associates, P.C. — 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