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NPI 1205859691 · Rockville, MD · Maternal & Fetal Medicine Physician
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Pediatrix Medical Group Of The Mid-atlantic PC is a maternal & fetal medicine physician provider located in Rockville, Maryland. This profile covers 0 Medicare and 40 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Pediatrix Medical Group Of The Mid-atlantic PC |
| Address | 9901 Medical Center Dr |
| City | Rockville |
| State | MD |
| ZIP | 20850 |
| Taxonomy | Maternal & Fetal Medicine Physician |
| NPI Enumerated | July 26, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $28.4M |
| Medicare | $0 |
This provider has no Medicare billing on file and is effectively a Medicaid-focused operation, with total Medicaid revenue of $28.4M reported. The absence of Medicare activity combined with substantial Medicaid receipts indicates the provider’s patient mix and revenue base are concentrated almost entirely in the Medicaid program.
Revenue is highly concentrated in a small set of services: the precomputed top 3 Medicaid codes (99213, 76819, 76805) account for 47.3% of the provider’s total Medicaid revenue. Individually these codes generate $5.8M (99213, 20.5%), $4.2M (76819, 15.0%), and $3.3M (76805, 11.8%), making them the primary drivers of the $28.4M Medicaid footprint.
The code mix signals a core business in maternal–fetal diagnostic imaging and high-volume prenatal ambulatory care: dominant codes include ultrasound and fetal surveillance procedures such as 76819, 76805, 76820, 76815, 76817, 76811 and repeated E/M visits (99213, 99202). This pattern is consistent with a maternal & fetal medicine practice that conducts frequent prenatal imaging and monitoring in outpatient settings rather than inpatient or broad multispecialty services.
On statewide competitive standing the provider is a clear leader for many obstetric imaging codes: 76819 ranks #1 of 43 providers in-state (100th percentile; extreme outlier), 76805 ranks #1 of 56 (100th percentile; extreme outlier), and several other ultrasound codes (76815, 76817, 76801, 76813) also rank #1 in-state at the 100th percentile. These ranks and percentile labels indicate volumes far above typical state levels and identify the entity as a dominant facility for prenatal ultrasound services in Maryland.
Outpatient evaluation-and-management activity is also unusually high: 99213 shows 72.5K claims at $80 avg paid/claim producing $5.8M and ranks #20 of 3275 providers in-state (99th percentile; extreme outlier), while 99202 contributes 11.4K claims and $773.8K (ranks #2 of 192, 99th percentile; extreme outlier). The combination of very high E/M claim counts with high-volume imaging suggests a high-throughput ambulatory care model where frequent prenatal visits are paired with on-site diagnostic testing.
The provider offers secondary diagnostic services that contribute material but smaller shares of revenue, including vascular imaging (93976: $2.3M, ranks #3 of 20, 89th percentile) and echocardiography entries such as 93303 ($328K) and related cardiac codes. These lines appear complementary to the dominant obstetric imaging footprint, indicating some diversification into vascular and cardiac diagnostic testing without matching the scale of prenatal services.
Several codes are explicitly flagged as unusually concentrated relative to peers: multiple services are described as “extreme outlier” or at the 100th percentile (for example, 76819, 76805, 76815, 76817, 76801, 76813 and 99213), while other imaging codes are “notably above typical” (76811, 76816). These labels reinforce that the provider’s operational model produces volumes far above typical state providers for obstetric ultrasound and related prenatal services.
The provider’s NPI was enumerated on 2006-07-26 (~20 years ago), indicating long tenure in the market. Combined with sustained Medicaid revenue of $28.4M and repeated top-state rankings for prenatal imaging, the data point to an established, high-volume maternal–fetal medicine practice with deep Medicaid exposure and a specialized service-line focus.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
40 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… | 72,500 | $80 | $5.8M |
| 76819 | The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test. | 58,180 | $70 | $4.2M |
| 76805 | In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks… | 32,960 | $100 | $3.3M |
| 76820 | The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when… | 59,860 | $50 | $2.8M |
| 93976 | The provider performs a duplex scan of a single organ or a limited area of the abdominal, pelvic, scrotal, or retroperitoneal organs. He performs the procedure to examine the vascular supply to the… | 15,780 | $140 | $2.3M |
| 76811 | The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic… | 10,540 | $150 | $1.6M |
| 76816 | The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound. | 17,730 | $90 | $1.6M |
| 76815 | The provider performs a limited examination of the fetus using ultrasound. The provider performs the examination of certain parameters for one or more fetuses. | 23,370 | $60 | $1.5M |
| 76817 | The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach. | 14,710 | $70 | $985.8K |
| 99202 | The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider… | 11,380 | $70 | $773.8K |
Showing 1–10 of 40
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
40 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… | 5 | 10 | 2,880 | $100 | $358.7K |
| 92586 | N/A | 1 | 10 | 5,440 | $60 | $313.9K |
| 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… | 2,650 | 3,670 | 680 | $90 | $310K |
| 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… | 20 | 3,280 | 610 | $80 | $296.1K |
| 76811 | The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic… | 2 | 30 | 670 | $130 | $291.4K |
| 93976 | The provider performs a duplex scan of a single organ or a limited area of the abdominal, pelvic, scrotal, or retroperitoneal organs. He performs the procedure to examine the vascular supply to the… | 3 | 20 | 280 | $70 | $290.8K |
| 59409 | In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery… | 13 | 20 | 60 | $810 | $256.6K |
| 76821 | The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the middle cerebral artery. This test determines the timing of labor induction and… | 3 | 10 | 1,680 | $50 | $242.7K |
| 76816 | The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound. | 3 | 60 | 370 | $70 | $195.6K |
| 76820 | The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when… | 1 | 40 | 250 | $40 | $190.6K |
Showing 1–10 of 40
Other providers in the same ZIP code as Pediatrix Medical Group Of The Mid-atlantic PC, ranked by combined Medicare and Medicaid revenue.
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