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

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

Premier Care Pediatrics, LLC (NPI 1215361761)

Premier Care Pediatrics, LLC is a pediatrics physician provider located in Great Falls, Montana. This profile covers 0 Medicare and 39 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	Premier Care Pediatrics, LLC
Address	926 13th Ave S
City	Great Falls
State	MT
ZIP	59405
Taxonomy	Pediatrics Physician
NPI Enumerated	September 1, 2013

Payer Source	Total Paid
Medicaid	$2M
Medicare	$0

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

39 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…	6,580	$90	$598.7K
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…	2,060	$120	$253.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2,070	$120	$253K
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.	4,700	$50	$230.3K
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…	1,590	$120	$182.6K
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…	1,280	$130	$164K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	730	$130	$97.8K
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,…	960	$50	$50.9K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	1,370	$20	$32.9K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	830	$20	$18.2K

Showing 1–10 of 39

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Premier Care Pediatrics, LLC — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

39 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	183	530	580	$70	$224.6K
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…	73	520	730	$40	$196.4K
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…	16	70	420	$80	$111.7K
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…	13	70	310	$90	$107.1K
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.	7	50	620	$40	$101K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	239	260	340	$20	$54.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7	80	130	$80	$43.2K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	72	190	390	$10	$19.6K
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…	25	30	600	$10	$16.7K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	10	50	80	$20	$16.4K

Showing 1–10 of 39

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Benefis Hospitals Inc	MT	Multi-Specialty Clinic/Center	$0	$38.2M
Great Falls Public Schools	MT	Local Education Agency (LEA)	$0	$15M
Great Falls Pediatric Dentistry, LLC	MT	Pediatric Dentistry	$0	$14.9M
Benefis Community Care, Inc.	MT	Case Management Agency	$0	$13.2M
Great Falls Clinic LLC	MT	Multi-Specialty Clinic/Center	$0	$11.2M
Easterseals-goodwill Northern Rocky Mountain, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$7.4M
Levi C Maltby Dmd P.C.	MT	Dentist	$0	$6M
Great Falls Emergency Services Inc	MT	Land Ambulance	$842.6K	$4.4M
Benefis Hospitals, Inc.	MT	Air Ambulance	$0	$5.2M
Easterseals Goodwill N. Rocky Mtn	MT	Developmentally Disabled Services Day Training Agency	$0	$3.7M

Premier Care Pediatrics, LLC — Billing Profile & Reimbursement Data

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Premier Care Pediatrics, LLC — 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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References