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.

Children's Urgent Care, LLC (NPI 1124541438)

Key Findings

Field	Value
Entity Type	Organization
Organization	Children's Urgent Care, LLC
Address	500 Cahaba Park Cir
City	Birmingham
State	AL
ZIP	35242
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	July 18, 2017

Payer Source	Total Paid
Medicaid	$16.2M
Medicare	$0

CHILDREN'S URGENT CARE, LLC presents as an urgent-care–style pediatric clinic: the top revenue drivers are evaluation-and-management visit codes for new and established patients (99214: 78K claims, $4.8M revenue; 99204: 53K claims, $4.4M revenue; 99213: 39K claims, $1.7M revenue). These high volumes of 99204 and 99214 indicate the practice handles large throughput of both new-patient and moderate-complexity established-patient visits consistent with walk-in or scheduled urgent-care workflows focused on children.

The provider’s Medicaid revenue is highly concentrated: the precomputed top 3 Medicaid codes (99214, 99204, 99213) account for 67.2% of this provider's total Medicaid revenue. With total Medicaid revenue of $16.2M, this concentration means a substantial share of reimbursement depends on a narrow set of E/M visit codes.

CHILDREN'S URGENT CARE has no Medicare billing on file and $16.2M in Medicaid revenue, so it is effectively a Medicaid-focused operation rather than a dual-payer practice. The absence of Medicare activity makes payer mix simple but also exposes the organization to policy or rate changes that disproportionately affect Medicaid.

On statewide competitiveness, the practice is a major outlier for several top codes: 99204 ranks #2 of 632 providers in-state (100th percentile), 99214 ranks #10 of 1990 (100th percentile), and 99213 ranks #44 of 1988 (98th percentile). These rankings indicate dominant in-state market share for core urgent-care E/M services and place the provider well above typical state volumes for these visit codes.

Point-of-care infectious disease testing is a material secondary service line: 87426 (COVID immunoassay) shows 50.6K claims and $1.1M revenue (6.9% of Medicaid revenue) and ranks #1 of 406 providers in-state (100th percentile); 87804 (influenza rapid) shows 109.8K claims and $987.8K revenue (6.1%) and ranks #2 of 793 (100th percentile). Multiple other rapid-test codes (87811, 87880, 87807) also appear in the top list at high ranks, signaling testing throughput is a consistent revenue contributor alongside E/M visits.

Operational patterns support high access and throughput: the provider reports 15K claims for 99051 (after-hours visits) with $195K revenue (1.2% of Medicaid revenue) and ranks #5 of 81 in-state (95th percentile), suggesting frequent evening/weekend service delivery. High claim counts for specimen-collection and rapid-test codes (for example, 99000: 6.8K claims, $13.7K revenue, rank #5 of 113) are consistent with an integrated on-site testing workflow that supports quick diagnosis for acute pediatric complaints.

The NPI was enumerated 2017-07-18 (~9 years ago), giving the entity several years to scale operations to the current reported Medicaid footprint. Given that tenure plus the $16.2M in Medicaid revenue and 100th-percentile rankings on multiple codes, the organization appears to have established a substantial in-state urgent-care presence focused on pediatric acute visits and high-volume point-of-care testing.

The revenue profile creates both strength and vulnerability: dominance on a small set of E/M codes and large volumes of rapid diagnostic testing create bargaining leverage with payers and operational efficiency for high-throughput care, but they also concentrate reimbursement exposure—changes to Medicaid E/M valuation or coverage of specific rapid-test codes could materially affect topline results.

Medicaid: Complete Services Breakdown

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

36 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…	78,040	$60	$4.8M
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…	53,040	$80	$4.4M
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…	38,990	$40	$1.7M
99203	The provider sees a new 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 provider…	22,230	$60	$1.3M
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,…	50,620	$20	$1.1M
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	109,760	$10	$987.8K
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…	29,570	$30	$768.8K
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.	54,050	$10	$594.6K
99051	The provider sees a patient during regular office hours that occur outside of traditional office hours, i.e., in the evening, on a weekend, or on a holiday.	15,000	$10	$195K
87807	The lab analyst performs the technical lab test to analyze for the presence of respiratory syncytial virus (RSV) in a specimen by immunoassay using direct optical, meaning visual, observation.	16,950	$10	$152.5K

Showing 1–10 of 36

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

Children's Urgent Care, LLC — 11 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

36 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…	10	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…	93	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…	44	1,990	560	$40	$185.6K
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…	2	630	60	$80	$45.8K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	172	500	120	$60	$42.2K
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…	20	170	210	$40	$39.3K
99205	The provider sees a new 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 provider…	47	160	70	$200	$39K
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	300	140	$20	$34K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	2	790	390	$10	$33K
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.	2	680	400	$10	$29.2K

Showing 1–10 of 36

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prohealth Hospice-alabama, LLC	AL	Community Based Hospice Care Agency	$0	$3.8M
Jonathan Curtis	AL	Pediatric Dentistry	$0	$3.4M
Birmingham Internal Medicine Associates, LLC	AL	Internal Medicine Physician	$0	$2.7M
Southeast Diabetes, Inc.	AL	Durable Medical Equipment & Medical Supplies	$0	$1.9M
Children's Dentistry Of Alabama	AL	Pediatric Dentistry	$0	$1.6M
Glenwood Inc	AL	Speech-Language Pathologist	$0	$1.2M
Christopher Harmon	AL	MOHS-Micrographic Surgery Physician	$1.1M	$0
Brian King	AL	MOHS-Micrographic Surgery Physician	$998.5K	$0
Growing Up Pediatrics, P.C.	AL	Pediatrics Physician	$0	$992.3K
Evans Bailey	AL	MOHS-Micrographic Surgery Physician	$780.1K	$0

Children's Urgent Care, LLC — Billing Profile & Reimbursement Data

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Children's Urgent Care, 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

Nearby Providers

Frequently Asked Questions

References