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

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

Scottish Rite Children's Medical Center (NPI 1184779332)

Key Findings

Field	Value
Entity Type	Organization
Organization	Scottish Rite Children's Medical Center
Address	1001 Johnson Ferry Rd Ne
City	Atlanta
State	GA
ZIP	30342
Taxonomy	Pediatric Hematology & Oncology Physician
NPI Enumerated	January 25, 2007

Payer Source	Total Paid
Medicaid	$493.4M
Medicare	$0

SCOTTISH RITE CHILDREN'S MEDICAL CENTER appears to operate overwhelmingly as a Medicaid-focused pediatric specialty center with no Medicare billing on file; its total Medicaid revenue is $493.4M and there is explicitly no Medicare revenue reported, indicating the provider is effectively single-payer (Medicaid) in scale. The NPI was enumerated on 2007-01-25 (~19 years ago), so this billing profile reflects an operation with nearly two decades of enrollment and likely established referral and service lines in the market.

Revenue concentration is high: the top three Medicaid codes (99285, 99284, 99283) together account for 57.5% of total Medicaid revenue, signaling that emergency department evaluation and management services are the dominant revenue drivers for this provider. Those three ED E/M codes — 99285 ($88.1M, 26.0%), 99284 ($56.3M, 16.6%), and 99283 ($50.6M, 14.9%) — form the core of the center's Medicaid revenue base, which implies heavy ED volume and a service model centered on urgent and emergent pediatric care.

The code mix beyond ED E/M amplifies a broad pediatric acute-care and procedural footprint: high-volume imaging codes (70551, 70553, 70450), sleep and polysomnography codes (95810, 95782), surgical codes (44970 appendectomy; 42820 tonsil/adenoid removal; 69436 tympanostomy), and extensive PT/therapy codes (97110, 97150, 97161) indicate the facility delivers both emergency/inpatient-focused interventions and a range of diagnostic and rehabilitative services under Medicaid. Together these codes suggest an integrated pediatric hospital or medical center providing acute ED care, operative procedures, imaging-heavy diagnostics, sleep studies, and therapy services.

Competitive standing in-state is dominant for many of its highest-revenue codes: this provider ranks #1 of in-state peers for 99285, 99284, 99283, 97110, 70551, 70553, 95810, 42820, 76770 and numerous others, frequently at the 100th percentile and described as an "extreme outlier, far above typical state volume for this code." These rankings indicate the center is a major statewide hub for pediatric emergency visits, imaging, surgical procedures, and specialized studies, not a modest or routine contributor in those lines.

Some high-revenue items show more typical peer volumes: G0378 (hospital observation) is ranked #3 of 21 (90th percentile), 70450 (CT head) ranks #9 of 77 (89th percentile), and 99291 (critical care) ranks #6 of 46 (89th percentile), indicating while the center is dominant for many services, certain adjacent acute-care codes have strong but not singular statewide presence. This nuance suggests the provider shares some inpatient/critical care and imaging workloads with other larger hospitals rather than monopolizing every acute-service line.

The payer-service implications are operationally meaningful: depending on Medicaid reimbursement dynamics, the heavy reliance on high-acuity ED codes (99285–99283) and resource-intensive imaging/surgery codes (e.g., 70551, 70553, 44970) concentrates financial risk and operational demand on emergency, radiology, and surgical capacity. Payer negotiations or changes to ED/acute reimbursement policies would materially affect the provider’s revenue given that the top three ED codes alone represent 57.5% of Medicaid revenue.

Several specialty procedures and high-unit services are flagged as notable outlier volumes in-state — for example, MRI brain studies 70551 and 70553, polysomnography 95810/95782, and pediatric ENT procedures 42820 and 69436 all rank at or near the top of state provider lists. These outlier labels and the absolute revenue associated with these codes (many in the multi-million-dollar range) support the interpretation that the center functions as a referral destination for advanced pediatric imaging, sleep diagnostics, and pediatric surgical care across Georgia.

Medicaid: Complete Services Breakdown

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

731 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	108,410	$810	$88.1M
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.	134,480	$420	$56.3M
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.	218,120	$230	$50.6M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	123,270	$120	$14.3M
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	13,380	$1,000	$13.3M
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…	6,770	$1,820	$12.3M
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	6,350	$1,740	$11M
44970	Laparoscopy, surgical, appendectomy	2,420	$4,120	$10M
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.	5,640	$1,740	$9.8M
97150	In this procedure, the provider supervises and directs therapeutic procedures like exercise therapy for a group of patients.	77,240	$100	$7.5M

Showing 1–10 of 731

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Scottish Rite Children's Medical Center — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

731 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	1	10	1,420	$1,740	$4.4M
44970	Laparoscopy, surgical, appendectomy	1	10	20	$4,080	$2.5M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	3	10	650	$2,620	$2.5M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	1	140	200	$280	$1.9M
V5261	Hearing aid, digital, binaural, bte	1	10	920	$1,860	$1.7M
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	1	10	360	$1,510	$1.6M
V5247	Hearing aid, digitally programmable analog, monaural, bte (behind the ear)	1	10	1,670	$960	$1.6M
97150	In this procedure, the provider supervises and directs therapeutic procedures like exercise therapy for a group of patients.	1	10	840	$90	$1.5M
70543	The provider obtains multi–sequence and multi–planar images of the orbits, face, and/or neck initially without the use of contrast and then injects contrast to see additional images and diagnose…	1	10	470	$1,970	$1.5M
95812	Electroencephalogram or EEG is a diagnostic test that uses small electrodes attached to the scalp to measure the electrical activity of the brain. Extended monitoring is a routine…	1	10	380	$460	$1.3M

Showing 1–10 of 731

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Arthur M. Blank Hospital, Inc.	GA	Children's Hospital	$0	$116.5M
John Millichap	IL	Neurology with Special Qualifications in Child Neurology Physician	$49.3K	$239.6K
Ronald Parsons	PA	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$99K	$0
Idelberto Badell	GA	Surgery Physician	$53.1K	$0
Bryce Gillespie	GA	Orthopaedic Hand Surgery Physician	$34.4K	$0
Paul Tso	GA	Transplant Surgery Physician	$34.3K	$0
Nancy Hammond	KS	Neurology Physician	$20.2K	$0
Field Willingham	GA	Gastroenterology Physician	$15.7K	$0
Olujimi Adefisan	GA	Child & Adolescent Psychiatry Physician	$4K	$0
Jennifer Zurosky	CO	Clinical Neurophysiology Physician	$2.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Life Hope Labs LLC	GA	Clinical Medical Laboratory	$8.3M	$7.3K
The Childrens Center For Digestive Health Care LLC	GA	Pediatric Gastroenterology Physician	$0	$8.1M
Northside Emergency Associates, LLC	GA	Emergency Medicine Physician	$0	$6.1M
Atlanta Perinatal Consultants, LP	GA	Neonatal-Perinatal Medicine Physician	$0	$4.8M
Stephanie Vanderveldt	GA	Ophthalmology Physician	$4.1M	$0
David Chin Yee	GA	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Children's Orthopaedics Of Atlanta P.C.	GA	Orthopaedic Surgery Physician	$0	$2.5M
Hyung Cho	GA	Ophthalmology Physician	$2.5M	$0
Sean Koh	GA	Ophthalmology Physician	$2.5M	$0
Paul Sutej	GA	Rheumatology Physician	$2.4M	$0

Scottish Rite Children's Medical Center — Billing Profile & Reimbursement Data

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Scottish Rite Children's Medical Center — 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