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

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

Sweetwater Pediatrics P.C. (NPI 1215135025)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sweetwater Pediatrics P.C.
Address	1204 Hilltop Dr
City	Rock Springs
State	WY
ZIP	82901
Taxonomy	Primary Care Clinic/Center
NPI Enumerated	July 3, 2007

Payer Source	Total Paid
Medicaid	$2M
Medicare	$0

This practice is effectively a Medicaid-focused pediatric primary care clinic: there is no Medicare billing on file while it reports $2M in lifetime Medicaid revenue, so its commercial/Medicare exposure is minimal and operations are concentrated in the Medicaid program. The NPI shows the group has been enumerated since 2007-07-03 (~19 years ago), indicating long-tenured presence in its market.

Revenue concentration is high: the top 3 Medicaid codes (99213, S0281, and 90460) together account for 53.6% of this provider's total Medicaid revenue. 99213 alone represents $480.4K (24.2%), S0281 $323.1K (16.3%), and 90460 $259.1K (13.1%), which signals that a small set of visit and care-coordination codes drive the majority of dollars.

Service-line implications from the code mix point to a pediatric primary care model heavily weighted toward office visits, immunizations, and medical-home care coordination. High-volume E/M code 99213 alongside vaccineadministration 90460 and medical home program S0281 suggests routine well-child and established patient management with a sizable care-coordination component.

S0281 shows an unusually large claim volume (53.9K claims) at a low average paid/claim ($6) and accounts for $323.1K in revenue; its rank is #5 of 18 in-state (76th percentile). This pattern is consistent with a practice that bills frequent, low-dollar care-coordination or medical-home touches that together contribute materially to revenue.

The provider is a clear in-state leader on several preventive and pediatric-specific services: 90460 ranks #3 of 73 providers in-state (97th percentile) and 99392 ranks #3 of 43 providers in-state (95th percentile), both described as "notably above typical state volume." 99393 ranks #1 of 30 providers in-state (100th percentile), indicating state-level dominance for well visits for children ages 5–11. These ranks point to unusually strong performance on routine pediatric preventive services and immunization delivery.

Several codes show top-in-state positions for niche services: 90633 (Hep A pediatric dose) ranks #1 of 17 providers in-state (100th percentile) and 87632 ranks #1 of 1 providers in-state (0th percentile; no state peer volume comparison available). The presence of #1 ranks on vaccine and lab codes suggests the practice is a primary site for routine pediatric immunizations and some diagnostic testing in its market.

There are multiple codes with high percentile standing for screening and developmental assessment: 96110 ranks #2 of 25 providers in-state (96th percentile) and 96127 ranks #4 of 27 providers in-state (88th percentile). These figures indicate the practice performs developmental and behavioral screening at volumes well above typical peers, aligning with a comprehensive pediatric preventive-care model.

Concentration risk and competitive implications: because 53.6% of Medicaid revenue is tied to three codes, the practice’s revenue is sensitive to changes in reimbursement or utilization for 99213, S0281, and 90460. At the same time, top-percentile ranks on several preventive and vaccine codes (including multiple #1 ranks) reflect a strong competitive position within the state for core pediatric services, implying both vulnerability to coding/payment shifts and resilience from market leadership in well-child care and immunizations.

Medicaid: Complete Services Breakdown

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

60 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…	8,010	$60	$480.4K
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	53,850	$10	$323.1K
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.	5,760	$50	$259.1K
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…	2,370	$80	$199.1K
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…	2,590	$80	$194K
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…	1,420	$90	$123.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,370	$80	$115.1K
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,…	1,920	$40	$71.1K
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…	3,070	$20	$67.5K
87632	The lab analyst performs a test to identify a respiratory virus using an amplified nucleic acid probe technique. He may also use the multiplex reverse transcription technique. The provider does this…	140	$250	$33.7K

Showing 1–10 of 60

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wyoming Distribution

Sweetwater Pediatrics P.C. — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wyoming

Full comparison — all codes billed, vs. Wyoming median

60 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	5	20	13,160	$10	$190.1K
S0280	Medical home program, comprehensive care coordination and planning, initial plan	2	10	860	$10	$110.5K
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…	61	220	400	$50	$79.3K
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…	16	260	420	$30	$67.2K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	23	100	130	$30	$46.4K
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…	4	50	280	$70	$43.2K
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.	3	70	490	$40	$42.9K
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…	3	40	170	$70	$34.1K
87632	The lab analyst performs a test to identify a respiratory virus using an amplified nucleic acid probe technique. He may also use the multiplex reverse transcription technique. The provider does this…	1	10	140	$250	$33.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1	30	100	$60	$17.8K

Showing 1–10 of 60

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lsw, LLC	WY	Developmentally Disabled Services Day Training Agency	$0	$11.6M
Able Hands	WY	Developmentally Disabled Services Day Training Agency	$0	$9.6M
Pain Care Center, LLC	WY	Pain Medicine (Anesthesiology) Physician	$0	$1.6M
Southwest Counseling Service	WY	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$1.5M
Qrc LLC	WY	Case Management Agency	$0	$1.4M
University Of Utah Adult Services	WY	Emergency Medicine Physician	$0	$1.2M
Lcr Dental Rock Springs LLC	WY	Dentist	$0	$1.1M
Memorial Hospital Of Sweetwater County	WY	Internal Medicine Physician	$0	$1.1M
Aai Services LLC	WY	Case Management Agency	$0	$971.4K
Nicole Armstrong	WY	Case Manager/Care Coordinator	$0	$773.2K

Sweetwater Pediatrics P.C. — Billing Profile & Reimbursement Data

Sign up for Sweetwater Pediatrics P.C. — Billing Profile & Reimbursement Data policy alerts

Sweetwater Pediatrics P.C. — Billing Profile & Reimbursement Data

Sign up for Sweetwater Pediatrics P.C. — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References