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

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

Nemours Children's Health, Downtown Orlando, Specialty Care (NPI 1215505508)

Key Findings

Field	Value
Entity Type	Organization
Organization	Nemours Children's Health, Downtown Orlando, Specialty Care
Address	1717 S Orange Ave
City	Orlando
State	FL
ZIP	32806
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	June 14, 2021

Payer Source	Total Paid
Medicaid	$44.4M
Medicare	$0

This provider has no Medicare billing on file and reports $44.4M in lifetime Medicaid revenue, making its public payer footprint effectively single‑payer and highly Medicaid‑centric. That absence of Medicare activity should frame any payer mix or competitive analysis: comparisons to Medicare peers are not possible for this NPI.

Revenue is concentrated in a small set of outpatient evaluation & management and ED codes: 99214 ($5.6M, 15.6%), 99204 ($4.4M, 12.3%), and 99283 ($2.7M, 7.6%) together account for 35.5% of the provider’s Medicaid revenue. This top‑3 concentration signals that a large share of Medicaid dollars flow through a few high‑volume visit types rather than a broad spread of low‑revenue procedures.

The code mix points to a high‑volume multi‑specialty outpatient and acute‑care practice model: heavy billing for established and new patient office visits (99214, 99204, 99213, 99215) combined with substantial emergency department E/M (99283, 99284) suggests integrated ambulatory and ED throughput rather than a narrow subspecialty clinic. Concurrent high volumes of echocardiography (93306, 93303) and sleep testing (95782, 95810) indicate embedded diagnostic services supporting complex pediatric cardiology and sleep programs.

On statewide competitive standing the provider is a dominant outlier for several key E/M and diagnostic codes: 99214 ranks #32 of 6379 in‑state (100th percentile; extreme outlier) and 99204 ranks #5 of 1853 (100th percentile; extreme outlier), while 99215 is #9 of 979 (99th percentile; extreme outlier). These ranks indicate the provider operates at volumes far above typical Florida peers for core clinic visit codes, consistent with a major regional role in pediatric ambulatory care.

Cardiac and sleep diagnostic services are also strong relative to state peers: 93306 is #25 of 681 (96th percentile; notably above typical state volume) and 95782 is #2 of 26 (96th percentile; labeled typical in the source but numerically near the top), supporting the view that the site provides specialized pediatric echo and attended sleep study capacity that few other Medicaid providers match in Florida. This suggests referral or centralized diagnostic functions within the local pediatric network.

Procedure and specialty mix shows breadth across pediatrics: tympanostomy (69436, 1.3K claims, $557.1K revenue, rank #16 of 84, 82th percentile) and pediatric urologic work (54300, 303 claims, $317.5K revenue, rank #2 of 12, 91th percentile) appear alongside allergy testing (95004) and high ECG volume (93000, 17K claims, $374.8K revenue, rank #5 of 701, 99th percentile; extreme outlier). The presence of both high-frequency office E/M and discrete procedural codes signals a multi‑service pediatric center capable of delivering both clinic visits and operating/procedural care.

Operational throughput is evident in raw claim counts and payment mix: 99214 shows 53.9K claims at $104 avg paid/claim while 99204 shows 21K claims at $211 avg paid/claim, and 99213 records 35.3K claims at $67 avg paid/claim. These volumes plus differences in avg paid/claim between new and established visits imply substantial daily visit demand and a reimbursement profile where visit type materially affects per‑claim revenue.

The provider’s NPI was enumerated on 2021-06-14 (~5 years ago); achieving $44.4M in Medicaid revenue and extreme statewide ranks on several codes within this window suggests rapid scale‑up to a large pediatric outpatient and diagnostic operation. Analysts should treat the entity as a relatively recent entrant that has quickly become a high‑volume Medicaid provider in Florida.

Medicaid: Complete Services Breakdown

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

167 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…	53,900	$100	$5.6M
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…	21,020	$210	$4.4M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	29,880	$90	$2.7M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	19,920	$130	$2.5M
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…	35,310	$70	$2.4M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	7,430	$310	$2.3M
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	1,420	$1,520	$2.2M
99215	The provider sees an established 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…	15,670	$140	$2.1M
99203	The provider sees a new 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 provider…	13,250	$150	$1.9M
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	1,910	$990	$1.9M

Showing 1–10 of 167

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Florida Distribution

Nemours Children's Health, Downtown Orlando, Specialty Care — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Florida

Full comparison — all codes billed, vs. Florida median

167 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	107	700	2,400	$80	$1.2M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	138	740	2,180	$70	$1.1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	27	50	570	$100	$1.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	319	660	1,900	$70	$743.6K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	2	30	310	$720	$616.3K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	289	320	1,970	$90	$463.1K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	17	60	100	$710	$379K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	17	40	120	$610	$357.5K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	16	80	230	$400	$331.4K
54161	The provider excises the foreskin of a patient older than 28 days; the provider uses a technique other than a clamp, other devices, or dorsal slit.	26	40	260	$580	$315.8K

Showing 1–10 of 167

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Nemours Foundation	DE	Multi-Specialty Clinic/Center	$0	$172M
The Nemours Foundation	FL	Children's Hospital	$0	$104.9M
The Nemours Foundation	DE	Children's Hospital	$0	$104M
The Nemours Foundation	FL	Multi-Specialty Clinic/Center	$0	$46.2M
Nemours Children's Health, Jacksonville, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$23.6M
Sedigheh Ebadi	FL	Pediatrics Physician	$0	$10.1M
Children's Health Alliance, LLC	FL	Pediatrics Physician	$0	$9.6M
Michael Klufas	PA	Ophthalmology Physician	$7M	$0
Richard Kaiser	PA	Ophthalmology Physician	$6.6M	$0
Carl Regillo	PA	Ophthalmology Physician	$6.5M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Orlando Health, Inc.	FL	General Acute Care Hospital	$0	$105.5M
Orlando Health Medical Group Inc	FL	Internal Medicine Physician	$0	$57.6M
Emergency Physicians Of Central Florida LLP	FL	Emergency Medicine Physician	$0	$50M
Dva Renal Healthcare Inc	FL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$14.5M
Orlando Physicians Network Inc	FL	Internal Medicine Physician	$0	$9.4M
Elia Mavrofrides	FL	Ophthalmology Physician	$6.2M	$240
Samuel Houston	FL	Ophthalmology Physician	$4.2M	$39.3K
Matthew Cunningham	FL	Ophthalmology Physician	$4M	$1.8K
Eric Feinstein	FL	Ophthalmology Physician	$3.4M	$1.5K
Jaya Kumar	FL	Ophthalmology Physician	$3.4M	$3K

Nemours Children's Health, Downtown Orlando, Specialty Care — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References