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

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

Tri-county Pediatrics, Inc (NPI 1235176397)

Tri-county Pediatrics, Inc is a pediatrics physician provider located in Elkins Park, Pennsylvania. This profile covers 0 Medicare and 60 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	Tri-county Pediatrics, Inc
Address	1939 W Cheltenham Ave
City	Elkins Park
State	PA
ZIP	19027
Taxonomy	Pediatrics Physician
NPI Enumerated	May 31, 2006

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

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
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…	16,580	$100	$1.6M
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…	13,010	$90	$1.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	12,450	$90	$1.1M
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…	36,920	$30	$959.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	7,350	$90	$646.8K
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.	26,640	$20	$612.8K
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…	8,730	$40	$323.1K
92551	The provider delivers a limited series of tones or sounds to a patient to determine if the patient’s hearing is in an acceptable range to detect hearing problems.	17,890	$10	$214.7K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	12,260	$20	$183.9K
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	4,960	$30	$148.9K

Showing 1–10 of 60

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Tri-county Pediatrics, Inc — 24 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

60 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	6	820	230	$80	$71.7K
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…	185	8,160	210	$60	$68.4K
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…	8	660	180	$70	$63.7K
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…	40	8,870	240	$40	$56.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6	870	160	$70	$48.2K
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…	996	1,210	100	$90	$45K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4	730	90	$70	$31.5K
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,…	566	1,630	90	$30	$22K
99051	The provider sees a patient during regular office hours that occur outside of traditional office hours, i.e., in the evening, on a weekend, or on a holiday.	38	320	130	$20	$17.2K
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.	2	540	130	$10	$15.3K

Showing 1–10 of 60

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bluebird Aba LLC	PA	Community/Behavioral Health Agency	$0	$19M
James Lewis	PA	Ophthalmology Physician	$530.8K	$0
Delaware Valley Nephrology And Hypertension Assoc PC	PA	Ambulatory Surgical Clinic/Center	$404K	$0
Daniel Moon	PA	Physical Medicine & Rehabilitation Physician	$329.6K	$3.5K
Lowell Meyerson	PA	Colon & Rectal Surgery Physician	$329.1K	$0
John Telegadis	PA	Internal Medicine Physician	$188.3K	$54.7K
Bohdan Doberczak	PA	Geriatric Psychiatry Physician	$110.3K	$101.5K
Chong Kim	PA	Internal Medicine Physician	$24.8K	$154.8K
Melissa Schwartz	PA	Otolaryngology/Facial Plastic Surgery Physician	$120.8K	$440
Rachel Rosen	PA	Family Medicine Physician	$91.6K	$0

Tri-county Pediatrics, Inc — Billing Profile & Reimbursement Data

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Tri-county Pediatrics, Inc — 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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