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

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

Pioneer Pediatrics, PLLC (NPI 1184816720)

Pioneer Pediatrics, PLLC is a pediatrics physician provider located in Mcminnville, Tennessee. This profile covers 0 Medicare and 51 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	Organization
Organization	Pioneer Pediatrics, PLLC
Address	236 E Main St
City	Mcminnville
State	TN
ZIP	37110
Taxonomy	Pediatrics Physician
NPI Enumerated	August 17, 2007

Payer Source	Total Paid
Medicaid	$6.3M
Medicare	$0

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

51 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…	30,860	$40	$1.2M
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…	18,280	$60	$1M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	15,690	$50	$721.8K
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…	12,270	$60	$711.5K
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…	9,370	$70	$618.5K
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…	22,830	$20	$547.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,590	$60	$293.7K
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,…	7,840	$30	$258.9K
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,…	7,940	$30	$198.6K
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.	17,160	$10	$188.8K

Showing 1–10 of 51

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Pioneer Pediatrics, PLLC — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

51 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	59	610	1,220	$40	$206K
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…	176	3,760	610	$40	$202.3K
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…	40	520	470	$70	$187K
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…	136	4,050	620	$30	$183.9K
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…	35	130	370	$50	$183.3K
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…	28	480	580	$60	$174.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	52	510	240	$70	$133.7K
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…	31	620	740	$20	$88.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	62	420	150	$80	$81.8K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	199	200	380	$30	$80.6K

Showing 1–10 of 51

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Thomas River Park Hospital, LLC	TN	General Acute Care Hospital	$0	$8.4M
Warren County Ttee	TN	Land Ambulance	$731.3K	$1.8M
Bryan Chastain	TN	Family Medicine Physician	$302.3K	$0
Linda Foster	TN	Family Medicine Physician	$150.6K	$0
Graves Family Pharmacy	TN	Community/Retail Pharmacy	$149.7K	$0
Kimberly Tabor	TN	Family Medicine Physician	$144.9K	$130
Coe Mcgrath	TN	Medical Physician Assistant	$141.9K	$0
Susan Harlow	TN	Internal Medicine Physician	$119.6K	$700
Judy Cole	TN	Family Medicine Physician	$112.1K	$0
Ashley Thurman	TN	Nurse Practitioner	$97.4K	$7.9K

Pioneer Pediatrics, PLLC — Billing Profile & Reimbursement Data

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Pioneer Pediatrics, PLLC — 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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