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

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

Hillsboro Pediatric Clinic LLC (NPI 1245312842)

Hillsboro Pediatric Clinic LLC is a pediatrics physician provider located in Hillsboro, Oregon. This profile covers 0 Medicare and 71 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	Hillsboro Pediatric Clinic LLC
Address	445 E Main St
City	Hillsboro
State	OR
ZIP	97123
Taxonomy	Pediatrics Physician
NPI Enumerated	October 20, 2006

Payer Source	Total Paid
Medicaid	$5.4M
Medicare	$0

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

71 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…	39,780	$50	$2.1M
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…	6,480	$80	$511.6K
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…	5,580	$80	$446K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,730	$70	$384.2K
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…	3,900	$90	$335.7K
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,…	6,340	$30	$215.6K
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	8,780	$20	$184.4K
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…	2,710	$50	$129.9K
96158	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of a patient’s physical health…	2,180	$60	$126.6K
96167	The provider, typically a psychologist, interviews the patient’s family in the presence of the patient and counsels them on strategies to change family dynamics and behaviors that adversely affect…	2,210	$60	$123.6K

Showing 1–10 of 71

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Hillsboro Pediatric Clinic LLC — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

71 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…	333	1,500	650	$70	$312.4K
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…	41	1,590	590	$50	$236.5K
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…	13	170	300	$80	$133.1K
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…	14	180	220	$90	$124.6K
41010	In this procedure, the provider makes an incision in the lingual frenum, a membranous ridge under the tongue, to allow greater movement of the tongue in patients with ankyloglossia.	2	10	700	$170	$121.3K
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…	548	600	120	$80	$83.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5	170	170	$90	$78.3K
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…	25	140	350	$30	$75.4K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	76	210	150	$60	$59.2K
96168	The provider, typically a psychologist, interviews the patient’s family in the presence of the patient and counsels them on strategies to change family dynamics and behaviors that adversely affect…	1	10	1,560	$20	$38.3K

Showing 1–10 of 71

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Neurotherapeutic Pediatric Therapies Inc	OR	Occupational Therapist	$0	$4.3M
Neurotherapeutic Pediatric Therapies Inc	OR	Occupational Therapist	$0	$1.6M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tuality Healthcare	OR	General Acute Care Hospital	$0	$27.8M
Tuality Medical Group LLC	OR	Internal Medicine Physician	$0	$11.5M
Tuality Medical Equipment And Supply	OR	Parenteral & Enteral Nutrition Supplies (DME)	$0	$5.2M
Bridgetown Physical Medicine	OR	Chiropractor	$0	$2.6M
Hillsboro Eye Clinic, PC	OR	Ophthalmology Physician	$0	$2.5M
Washington County Juvenile Shelter	OR	Case Management Agency	$0	$2.4M
Corazon Chiropractic Clinic, LLC	OR	Chiropractor	$0	$2.3M
Virginia Garcia Memorial Health Center	OR	Federally Qualified Health Center (FQHC)	$0	$1.9M
Acorn Dentistry For Kids - Hillsboro, LLC	OR	Dental Clinic/Center	$0	$1.3M
Nw Preventive And Primary Care	OR	Naturopath	$0	$1.1M

Hillsboro Pediatric Clinic LLC — Billing Profile & Reimbursement Data

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Hillsboro Pediatric Clinic 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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