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

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

Daniel Simmons (NPI 1134196900)

Daniel Simmons is a pediatrics physician provider located in Orem, Utah. This profile covers 0 Medicare and 22 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Individual
Organization	Daniel Simmons
Address	171 N 400 W
City	Orem
State	UT
ZIP	84057
Taxonomy	Pediatrics Physician
NPI Enumerated	March 1, 2006

Payer Source	Total Paid
Medicaid	$333.5K
Medicare	$0

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

22 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…	2,220	$70	$152.8K
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…	630	$100	$65.7K
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…	490	$100	$50.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	440	$90	$37.2K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	1,800	$10	$9K
99177	The provider uses instruments to conduct a vision screening exam to analyze both eyes to diagnose ocular or eye–related diseases. Both the screening and analysis take place on–site.	1,060	$10	$7.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	60	$90	$5.4K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	910	$1	$1.8K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	650	$1	$1.3K
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.	110	$10	$640

Showing 1–10 of 22

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Daniel Simmons — 1 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

22 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	178	1,360	190	$70	$125K
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…	69	70	340	$50	$117.7K
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…	73	220	200	$80	$74K
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…	45	190	150	$80	$58.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	36	150	60	$70	$32.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	52	90	90	$60	$22.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	75	610	140	$10	$13.8K
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.	104	200	150	$10	$5.7K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	73	320	140	$1	$5K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	55	500	70	$10	$3.8K

Showing 1–10 of 22

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Utah Valley Pediatrics L.L.C.	UT	Pediatrics Physician	$0	$11.9M
Aubrie Brooks	UT	Family Nurse Practitioner	$44.4K	$6.8K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Home Health Specialists, LLC	UT	Home Health Agency	$0	$16.1M
Timpanogos Regional Medical Services, Inc.	UT	General Acute Care Hospital	$0	$7.8M
Kids On The Move, Inc.	UT	Developmentally Disabled Services Day Training Agency	$0	$6.7M
Papilion Integrated Recovery Centers	UT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$6.2M
Chrysalis Utah, LLC	UT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$4.6M
Kids On The Move, Inc	UT	Developmentally Disabled Services Day Training Agency	$0	$4.4M
Ihc Health Services, Inc.	UT	General Acute Care Hospital	$0	$4.2M
City Of Orem Corporation	UT	Land Ambulance	$235.5K	$3.1M
Central Utah Surgicenter, LLC	UT	Ambulatory Surgical Clinic/Center	$2.1M	$28K
Hautoa Enterprises LLC	UT	Substance Abuse Rehabilitation Facility	$49.8K	$1.9M

Daniel Simmons — Billing Profile & Reimbursement Data

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Daniel Simmons — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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