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.

Gi For Kids, PLLC (NPI 1215392030)

Gi For Kids, PLLC is a pediatric gastroenterology physician provider located in Knoxville, Tennessee. This profile covers 0 Medicare and 72 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	Gi For Kids, PLLC
Address	1975 Town Center Blvd
City	Knoxville
State	TN
ZIP	37922
Taxonomy	Pediatric Gastroenterology Physician
NPI Enumerated	December 21, 2015

Payer Source	Total Paid
Medicaid	$18.9M
Medicare	$0

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

72 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	65,860	$70	$4.9M
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	8,080	$260	$2.1M
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	13,320	$140	$1.8M
99204	The provider sees a new 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 provider…	14,480	$120	$1.7M
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	5,730	$240	$1.4M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	700	$1,860	$1.3M
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…	20,870	$50	$1M
J3380	Injection, vedolizumab, intravenous, 1 mg	180	$4,050	$709.5K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	2,670	$140	$379.7K
78268	The provider analyzes breath samples using a scintillation counter. The samples are from a patient who underwent a test involving administration of a radioactive isotope C–14 labeled solution of urea…	5,810	$60	$371.8K

Showing 1–10 of 72

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

Gi For Kids, PLLC — 11 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

72 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1	10	460	$2,200	$896.4K
J3380	Injection, vedolizumab, intravenous, 1 mg	1	10	120	$3,620	$423.7K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	14	40	1,860	$70	$294.9K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	23	40	200	$20	$234.7K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	1	170	340	$190	$206.8K
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…	42	3,760	610	$40	$202.3K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	7	70	130	$140	$193.9K
78268	The provider analyzes breath samples using a scintillation counter. The samples are from a patient who underwent a test involving administration of a radioactive isotope C–14 labeled solution of urea…	1	10	2,920	$60	$187.8K
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…	205	4,050	620	$30	$183.9K
49452	Under fluoroscopic guidance, the provider replaces the existing gastrojejunostomy tube through the skin. Providers may exchange the tube when the existing tube becomes dislodged or no longer…	2	10	310	$530	$178.6K

Showing 1–10 of 72

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's West Surgery Center	TN	Ambulatory Surgical Clinic/Center	$0	$10M
C A H Managment Company, LLC	TN	Urgent Care Clinic/Center	$0	$9.8M
Orthotennessee, PC	TN	Orthopaedic Surgery Physician	$0	$7.2M
Rocky Top Pediatric Dentistry, LLC	TN	Pediatric Dentistry	$0	$4.6M
Knoxville Eye Surgery Center LLC	TN	Ambulatory Surgical Clinic/Center	$4.1M	$180
Knoxville Orthopaedic Surgery Center LLC	TN	Ambulatory Surgical Clinic/Center	$3.1M	$19.1K
Knoxville Dermatology Group PC	TN	Dermatology Physician	$0	$3.1M
Recovery Strategies LLC	TN	Substance Use Disorder Rehabilitation Clinic/Center	$0	$2.8M
Fort Sanders West Op Surgery Center	TN	Ambulatory Surgical Clinic/Center	$2.1M	$10
Kimberly Grande	TN	Specialist	$963.5K	$0

Gi For Kids, PLLC — Billing Profile & Reimbursement Data

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Gi For Kids, 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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