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

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

Nebraska Pediatric Practice, Inc (NPI 1144556333)

Key Findings

Field	Value
Entity Type	Organization
Organization	Nebraska Pediatric Practice, Inc
Address	8200 Dodge St
City	Omaha
State	NE
ZIP	68114
Taxonomy	Pediatrics Physician
NPI Enumerated	October 23, 2009

Payer Source	Total Paid
Medicaid	$29M
Medicare	$0

NEBRASKA PEDIATRIC PRACTICE, INC is effectively a Medicaid-focused provider: there is no Medicare billing on file while lifetime Medicaid revenue is $29M, indicating the practice’s patient mix and reimbursement exposure are dominated by Medicaid. This makes the organization functionally single-payer in the available claims data and suggests strategy and operations are oriented toward pediatric Medicaid populations rather than Medicare beneficiaries.

Revenue concentration is meaningful: the top three Medicaid codes by revenue account for 43.7% of the provider’s total Medicaid revenue, signaling reliance on a relatively narrow set of services for nearly half of Medicaid receipts. That level of concentration implies that shifts in reimbursement, utilization, or policy affecting those codes could materially impact overall revenue.

Office-based pediatric E/M visits are the largest individual revenue drivers: 99214 ($4.7M, 19.1%) and 99213 ($4.5M, 18.0%) together represent a substantial share of Medicaid revenue and high claim volumes (70.8K and 87.4K claims respectively). These numbers indicate the practice manages a very large volume of established patient visits and operates as a high-throughput ambulatory pediatric clinic with strong longitudinal primary care activity.

The provider is a statewide outlier for multiple common pediatric visit codes: 99214 ranks #5 of 596 providers in-state (99th percentile; extreme outlier) and 99213 ranks #6 of 696 providers (99th percentile; extreme outlier). These rankings characterize the practice as a dominant volume center for pediatric office visits in Nebraska, far above typical state volumes for these codes.

Cardiac imaging and echo services are a distinct service line for the practice: 93306 ($1.7M, 6.7%), 93303 ($1.2M, 4.7%), 93325 ($1.1M, 4.4%), and related echo codes (93320, 93325, 93306) appear among top revenue codes and in several instances rank at the 100th percentile or as extreme outliers statewide. This mix suggests an integrated pediatric cardiology capability or high referral volume for transthoracic echocardiography within the practice.

Several high-acuity and neonatal follow-up codes appear at top revenue positions, including 99472 ($933.3K, 3.8%) and 99480 ($579K, 2.3%), with 99472 ranking #1 of 1 providers in-state. The presence of follow-up care for critically ill infants and low-birth-weight infant management indicates the practice provides or coordinates specialty inpatient-to-outpatient continuity care for complex pediatric patients.

The practice’s competitive standing across many procedures is extremely strong statewide: multiple codes rank #1 in Nebraska (e.g., 93306, 93303, 93325, 93320, 74018, 76770, 93306 ranks #1 of 37, etc.), and many top codes are labeled as extreme outliers or at the 100th percentile. This pattern denotes a leading market position in Nebraska for both ambulatory pediatric visits and several diagnostic services, likely reflecting scale, specialty offerings, or network position.

Tenure is long-standing: the NPI was enumerated on 2009-10-23 (~17 years ago), indicating an established operation with sustained presence in the market. That longevity combined with concentrated Medicaid volume and repeated top-state rankings suggests durable referral relationships and operational capacity to support high patient throughput and specialized pediatric services.

Medicaid: Complete Services Breakdown

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

196 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…	70,770	$70	$4.7M
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…	87,390	$50	$4.5M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	15,040	$110	$1.7M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	12,510	$90	$1.2M
93325	The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the…	20,070	$60	$1.1M
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…	12,420	$90	$1.1M
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…	11,090	$100	$1.1M
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…	10,740	$90	$1M
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…	10,440	$90	$960.3K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	3,150	$300	$933.3K

Showing 1–10 of 196

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Nebraska Pediatric Practice, Inc — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

196 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	1	10	4,350	$250	$1.5M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	1	10	3,150	$300	$932.4K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	2	10	730	$1,150	$838.5K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	4	10	1,940	$100	$498.7K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	5	20	240	$900	$448.5K
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	4	10	240	$1,540	$424.6K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	1	40	350	$170	$366.6K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	5	20	270	$260	$342.4K
93325	The provider performs Doppler echocardiography, a diagnostic procedure based on the Doppler effect of sound, color flow velocity mapping, a two–dimensional image representation of blood flow in the…	1	10	210	$90	$329.3K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	10	3,150	$100	$325.5K

Showing 1–10 of 196

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital & Medical Center	NE	Children's Hospital	$0	$89.8M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Children's Hospital & Medical Center	NE	Multi-Specialty Clinic/Center	$0	$10M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Children's Specialty Physician Billing - Behavioral Health	NE	Psychologist	$0	$1.9M
Children's Rehab - Occupational Therapy	NE	Pediatric Occupational Therapist	$0	$388.1K
Shane Tsai	NE	Clinical Cardiac Electrophysiology Physician	$95.1K	$0
Timothy Donovan	NE	Vascular & Interventional Radiology Physician	$84.8K	$0
Michael Moulton	NE	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$79.7K	$0
Eric Eidem	SD	Physician Assistant	$78.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Physicians	NE	Pediatrics Physician	$0	$39.4M
Physicians Clinic Inc	NE	Family Medicine Physician	$0	$20.5M
Nebraska Methodist Hospital	NE	General Acute Care Hospital	$0	$14.5M
Smiles 4 Kids PC	NE	General Practice Dentistry	$0	$11.5M
Nebraska Methodist Hospital	NE	Emergency Medicine Physician	$0	$5.3M
Unmc College Of Dentistry	NE	Dentist	$0	$4.8M
Stones Worth Stepping, P.C.	NE	Occupational Therapist	$0	$4.7M
Pacific Surgery Center, LLC	NE	Ambulatory Surgical Clinic/Center	$3.4M	$3.2K
Stefano Tarantolo	NE	Hematology & Oncology Physician	$3.2M	$0
Midwest Endoscopy Services LLC	NE	Ambulatory Surgical Clinic/Center	$1.9M	$874.4K

Nebraska Pediatric Practice, Inc — Billing Profile & Reimbursement Data

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Nebraska Pediatric Practice, Inc — 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