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

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

Nationwide Children's Hospital (NPI 1134152986)

Field	Value
Entity Type	Organization
Organization	Nationwide Children's Hospital
Address	700 Childrens Dr
City	Columbus
State	OH
ZIP	43205
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 7, 2006

Payer Source	Total Paid
Medicaid	$777.8M
Medicare	$0

Key Findings

NATIONWIDE CHILDREN'S HOSPITAL is effectively a single-payer Medicaid billing entity: there is no Medicare billing on file and the provider reports $777.8M in lifetime Medicaid revenue. This concentration means its financial performance and negotiating leverage are tightly linked to Medicaid volumes and reimbursement policies rather than a blended Medicare/Medicaid mix.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management and developmental-screening codes: the top three Medicaid codes (99213, 99214, 96110) account for 45.9% of total Medicaid revenue. The single largest driver is 99213 ($154.8M; 25.6% of Medicaid revenue), followed by 99214 ($75.8M; 12.5%) and 96110 ($46.5M; 7.7%).

The code mix indicates a core business built around high-volume pediatric ambulatory care and preventive medicine: very large claim counts for office visits (99213: 1.8M claims; 99214: 735.7K claims) alongside preventive visit codes such as 99392 (314.9K claims) and 99391 (301.6K claims). These patterns point to a system organized for routine well-child care, chronic-condition follow-up, and large-scale outpatient clinic throughput rather than elective adult inpatient services.

The provider is a major regional hub for developmental and behavioral pediatrics and associated family therapy: 96110 is an outlier with 186.7K claims and $46.5M revenue (ranks #1 in-state, 100th percentile, extreme outlier), and related codes such as 96127, 90791, 90847, 90837 and 90846 also appear among top revenue contributors. High paid/claim amounts on evaluation and psychotherapy-related codes (e.g., 90791: $309 avg paid/claim) reinforce the prominence of specialty behavioral and developmental services in the hospital’s Medicaid mix.

NATIONWIDE CHILDREN'S shows statewide dominance across many pediatric outpatient and therapy codes: it ranks #1 in-state for 99213 (1 of 5077 providers, 100th percentile, extreme outlier) and holds top statewide ranks for multiple other high-revenue codes (for example, 96110 and 90791 are both #1 in-state). Multiple top codes listed as “extreme outlier” indicate the hospital operates at volumes far above typical state providers for pediatric ambulatory, behavioral, and rehabilitative services.

The provider also delivers high-volume speech, hearing, and ENT-related services: 92551 (220.9K claims, $19.0M revenue) and 92507 (149.9K claims, $13.5M revenue) both rank at or near the top in-state, and 69436 (tympanostomy) generates $12.3M on 8.4K claims (rank #2 in-state). This mix is consistent with a comprehensive pediatric specialty center offering audiology, speech therapy, and procedural ENT care alongside outpatient clinics.

There is a meaningful emergency and urgent-care footprint alongside the outpatient focus: emergency visit codes 99283 (143.2K claims, $21.0M) and 99284 (65.5K claims, $9.8M) appear in the top 25, indicating substantial ED volume that likely serves the pediatric population in addition to scheduled ambulatory care. The presence of both ED and high-volume outpatient E/M codes suggests integrated care pathways from acute to follow-up outpatient management.

The organization has an established operational history (NPI enumerated 2006-07-07, ~20 years ago), which combined with its Medicaid concentration and numerous 100th-percentile, rank-1 code positions implies sustained scale in pediatric services. For payer/provider analysts, this profile signals material exposure to Medicaid payment changes but also market leverage as a dominant statewide provider for pediatric ambulatory, developmental/behavioral, and rehabilitative services.

Medicaid: Complete Services Breakdown

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

913 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…	1,821,210	$90	$154.8M
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…	735,690	$100	$75.8M
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…	186,710	$250	$46.5M
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	125,320	$220	$27.2M
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…	314,920	$80	$23.9M
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…	301,590	$80	$23.5M
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	185,280	$110	$21.1M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	143,180	$150	$21M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	130,610	$160	$20.2M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	63,200	$310	$19.5M

Showing 1–10 of 913

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Nationwide Children's Hospital — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

913 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	127	150	4,030	$100	$5.9M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	134	170	4,660	$300	$2.6M
A0431	Ambulance service, conventional air services, transport, one way (rotary wing)	5	20	530	$2,040	$2.6M
81479	Use 81479 to report a molecular pathology procedure that does not have a specific code.	4	10	760	$50	$2M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	11	480	4,510	$90	$1.8M
J0741	Injection, cabotegravir and rilpivirine, 2mg/3mg	7	10	230	$4,830	$1.7M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	4	10	890	$1,920	$1.7M
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	22	40	2,980	$230	$1.7M
H2020	Therapeutic behavioral services, per diem	100	310	1,190	$150	$1.5M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	41	660	460	$90	$1.5M

Showing 1–10 of 913

Related Providers

Other providers that share a Tax Identification Number (TIN) with Nationwide Children's Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ohiohealth Corporation	OH	Family Medicine Physician	$0	$89.1M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Adena Medical Group LLC	OH	Family Medicine Physician	$0	$39.9M
Pediatric Academic Association, Inc.	OH	Pediatrics Physician	$0	$37.2M
Nationwide Children's Hospital	OH	Home Infusion Agency	$0	$22.4M
Nationwide Children's Hospital Homecare	OH	Home Health Agency	$0	$17.5M
Nationwide Children's Hospital	OH	Multi-Specialty Clinic/Center	$0	$13M
Nationwide Children's Hospital	OH	Dental Clinic/Center	$0	$11.1M
Nationwide Children's Hospital	OH	Home Health Agency	$0	$6.7M
Cameron Nabavi	OH	Ophthalmology Physician	$264.2K	$0

Nearby Providers

Other providers in the same ZIP code as Nationwide Children's Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Vincent Family Centers	OH	Adolescent and Children Mental Health Clinic/Center	$0	$29.6M
River's Crossing Home Care LLC	OH	Home Health Agency	$0	$15.2M
Pediatric Ophthalmology Associates Inc.	OH	Ophthalmology Physician	$0	$9.5M
Columbus Neighborhood Health Center Inc	OH	Federally Qualified Health Center (FQHC)	$0	$8.7M
Manmohan Katapadi	OH	Cardiovascular Disease Physician	$183.2K	$25.3K
Thomas Keeling	OH	Infectious Disease Physician	$204.5K	$0
James Smith	OH	Infectious Disease Physician	$190.3K	$0
Matthew Robertson	OH	Diagnostic Radiology Physician	$108.7K	$0
Rodney Kusumi	OH	Infectious Disease Physician	$96.8K	$0
Thomas Murray	OH	Neurology with Special Qualifications in Child Neurology Physician	$38.9K	$0

Nationwide Children's Hospital — 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