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

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

First State Pediatrics, LLC (NPI 1235463548)

First State Pediatrics, LLC is a pediatrics physician provider located in Newark, Delaware. This profile covers 0 Medicare and 36 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	First State Pediatrics, LLC
Address	210 Christiana Medical Ctr
City	Newark
State	DE
ZIP	19702
Taxonomy	Pediatrics Physician
NPI Enumerated	September 21, 2009

Payer Source	Total Paid
Medicaid	$1.1M
Medicare	$0

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

36 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…	8,850	$40	$354K
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…	2,880	$70	$190.3K
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…	2,970	$50	$142.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,890	$70	$128.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,020	$80	$82.5K
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…	1,160	$70	$81.4K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	2,180	$10	$30.5K
90698	This code represents a combination vaccine product administered into the muscle to protect against five diseases: diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and polio.	1,910	$10	$21K
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…	1,820	$10	$20K
90680	This code represents a live pentavalent rotavirus vaccine given by mouth in a three–dose schedule to protect against rotavirus infection.	1,260	$10	$13.9K

Showing 1–10 of 36

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

First State Pediatrics, LLC — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

36 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…	251	500	1,130	$50	$235.1K
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…	12	50	1,070	$70	$226.6K
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…	11	50	1,050	$60	$191.3K
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…	64	540	1,100	$40	$185.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	15	50	800	$70	$170.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	18	50	470	$80	$126.7K
99381	The provider performs a well–baby visit for a child under the age of one.	8	10	50	$60	$83.3K
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.	22	30	1,850	$10	$50.9K
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…	18	40	1,180	$10	$50.3K
83655	The lab analyst performs a test to measure the amount of lead in the patient specimen. A typical aim of the test is to check for lead exposure.	24	30	230	$20	$31.1K

Showing 1–10 of 36

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mosaic	DE	Mental Illness Community Based Residential Treatment Facility	$0	$118.5M
Community Systems, Inc.	DE	Intellectual & Developmental Disabilities Psychologist	$0	$96.7M
Resources For Human Development Inc.	DE	Intellectual & Developmental Disabilities Psychologist	$0	$86M
Epic Health Services (de), LLC	DE	Home Health Agency	$0	$33.7M
Jay J Harris Dmd PC	DE	Dentist	$0	$16.7M
Elite Home Health Care Inc	DE	In Home Supportive Care Agency	$0	$14.8M
Accredo Health Group Inc	DE	Pharmacy	$0	$10.2M
Bear-glasgow Dental, LLC	DE	General Practice Dentistry	$0	$8.2M
Center For Child Development, Incorporated	DE	Psychologist	$0	$4.9M
Comfort Care At Home, Inc.	DE	Home Health Agency	$0	$4M

First State Pediatrics, LLC — Billing Profile & Reimbursement Data

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First State 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