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NPI 1235350901 · Knoxville, TN · Pediatrics Physician
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East Tennessee Children's Primary Care Center, Inc. is a pediatrics physician provider located in Knoxville, Tennessee. This profile covers 0 Medicare and 91 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | East Tennessee Children's Primary Care Center, Inc. |
| Address | 2018 Clinch Ave |
| City | Knoxville |
| State | TN |
| ZIP | 37916 |
| Taxonomy | Pediatrics Physician |
| NPI Enumerated | May 1, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $31.4M |
| Medicare | $0 |
This entity is effectively a Medicaid-focused pediatric practice: it reports $31.4M in lifetime Medicaid revenue and has no Medicare billing on file, so all measurable fee-for-service activity in our dataset is concentrated in Medicaid. The provider’s NPI has been enumerated since 2007-05-01 (~19 years ago) under the Pediatrics Physician taxonomy, consistent with a sustained pediatric outpatient operation.
Revenue is highly concentrated in a small set of outpatient pediatrics codes: the precomputed top three Medicaid codes (99213, 90460, 99392) account for 56.7% of this provider’s total Medicaid revenue. Individually, 99213 alone represents $11M (35.1% of Medicaid revenue), 90460 contributes $3.7M (11.9%), and 99392 contributes $3M (9.7%), highlighting a reliance on routine E/M and preventive/immunization services.
The code mix indicates a high-volume primary pediatric care model with heavy emphasis on established office visits and preventive care. Large counts and revenues for 99213 ($11M, 214.8K claims) and preventive visit codes 99392 and 99391 (together contributing $5.8M) plus vaccine administration 90460 ($3.7M) point to workflows organized around well-child checks, routine sick visits, and immunization delivery.
Competitive standing within Tennessee is dominant for core pediatric outpatient and immunization services: 99213 ranks #10 of 4050 providers in-state (100th percentile; extreme outlier), 90460 ranks #3 of 613 (100th percentile; extreme outlier), and 99392 ranks #2 of 519 (100th percentile; extreme outlier). These ranks indicate the provider operates at volumes far above typical state peers for these codes, positioning it as a major pediatric access point in the market.
Beyond E/M and vaccines, the practice shows unusually high volumes in developmental and behavioral screening services and school-entry screenings, suggesting integrated preventive screening workflows. For example, 96110 generated $1.8M (63.4K claims) and ranks #5 of 622 providers in-state (99th percentile; extreme outlier), while 96161 ($420.5K) ranks #2 of 230 (100th percentile; extreme outlier); vision and hearing codes 99177 ($289.7K, rank #3) and 92551 ($324.1K, rank #3) also rank as extreme outliers.
The practice also provides substantial in-office infectious disease testing for acute pediatric respiratory illness, which supports both clinical throughput and episodic-care revenue. High-volume lab/testing codes include influenza multiplex testing 87502 ($1.1M, rank #5; 12.7K claims), Group A Strep testing 87651 ($986.5K, rank #4; 29.9K claims), and SARS–CoV–2 testing 87635 ($469.8K, rank #15; 12.4K claims), marking a meaningful ancillary testing footprint.
Operationally, the revenue profile shows concentration risk tied to outpatient E/M and vaccine administration: 99213 alone is 35.1% of Medicaid revenue and the top three codes total 56.7%. Payers and network planners should note that changes to outpatient E/M valuation, vaccine administration reimbursement, or preventive-visit utilization would disproportionately affect this provider’s Medicaid revenue base.
Taken together—long-tenured pediatric specialty, Medicaid-only billing in the file, dominant in-state ranks for core pediatric visit and preventive codes, and high ancillary screening/testing volumes—the provider appears to operate as a high-throughput pediatric primary care center with deep Medicaid exposure. These characteristics make it a key Medicaid pediatric access node in Knoxville and Tennessee more broadly, particularly for well-child services, immunizations, screenings, and same-day sick-child testing.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
91 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… | 214,780 | $50 | $11M |
| 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. | 82,570 | $50 | $3.7M |
| 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… | 38,340 | $80 | $3M |
| 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… | 38,330 | $70 | $2.8M |
| 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… | 34,990 | $70 | $2.5M |
| 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… | 63,370 | $30 | $1.8M |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 18,070 | $80 | $1.4M |
| 87502 | The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly… | 12,740 | $80 | $1.1M |
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 29,890 | $30 | $986.5K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 12,360 | $40 | $469.8K |
Showing 1–10 of 91
How this provider's Medicaid billing volume and revenue compare to other Tennessee providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Tennessee median
91 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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 | 610 | 1,220 | $40 | $206K |
| 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… | 91 | 3,760 | 610 | $40 | $202.3K |
| 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 | 520 | 470 | $70 | $187K |
| 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… | 10 | 4,050 | 620 | $30 | $183.9K |
| 90847 | A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the… | 103 | 110 | 450 | $50 | $182.5K |
| 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 | 480 | 580 | $60 | $174.8K |
| 90791 | In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. | 139 | 310 | 110 | $70 | $142.8K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 9 | 510 | 240 | $70 | $133.7K |
| E0445 | Oximeter device for measuring blood oxygen levels non-invasively | 12 | 10 | 1,240 | $70 | $120K |
| 87502 | The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly… | 5 | 200 | 300 | $60 | $106K |
Showing 1–10 of 91
Other providers in the same ZIP code as East Tennessee Children's Primary Care Center, Inc., ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.