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

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

Macomb Pediatric Associatea P.C (NPI 1245453125)

Macomb Pediatric Associatea P.C is a pediatrics physician provider located in Warren, Michigan. This profile covers 0 Medicare and 67 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	Macomb Pediatric Associatea P.C
Address	29703 Hoover Rd
City	Warren
State	MI
ZIP	48093
Taxonomy	Pediatrics Physician
NPI Enumerated	April 10, 2007

Payer Source	Total Paid
Medicaid	$6M
Medicare	$0

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

67 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…	26,580	$60	$1.6M
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…	12,060	$90	$1.1M
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…	7,620	$80	$617.5K
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…	7,150	$70	$507.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,090	$80	$402.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,400	$80	$201.7K
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.	28,070	$10	$196.5K
99381	The provider performs a well–baby visit for a child under the age of one.	1,780	$90	$158.6K
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,…	3,910	$40	$148.5K
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…	1,100	$120	$133.5K

Showing 1–10 of 67

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Macomb Pediatric Associatea P.C — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

67 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…	311	4,380	1,000	$70	$289.9K
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…	204	4,770	1,060	$50	$247.8K
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…	47	670	730	$60	$140K
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…	50	590	850	$50	$134.5K
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…	236	1,170	170	$90	$107.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	54	720	420	$60	$93.9K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	817	860	260	$70	$71.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	77	720	220	$60	$60.1K
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.	5	540	650	$20	$57K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	92	470	300	$30	$48.6K

Showing 1–10 of 67

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Henry Ford Health Macomb Oakland Hospital	MI	General Acute Care Hospital	$0	$59.2M
Michigan Surgery Specialists, P.C.	MI	Surgery Physician	$0	$6.8M
Consortiums Laboratory Services LLC	MI	Clinical Medical Laboratory	$767.1K	$489.3K
Siraj Panchbhaiya	MI	Foot & Ankle Surgery Podiatrist	$1.2M	$0
Mylab Inc	MI	Clinical Medical Laboratory	$268.1K	$857K
Alan Parent	MI	Ophthalmology Physician	$968.9K	$0
Jessie Alperin	MI	Rheumatology Physician	$788.9K	$0
Anthony Baron	MI	Rheumatology Physician	$745.6K	$0
Harjot Grover	MI	Internal Medicine Physician	$467.6K	$0
Sudhir Lingnurkar	MI	Psychiatry Physician	$461.7K	$0

Macomb Pediatric Associatea P.C — Billing Profile & Reimbursement Data

Sign up for Macomb Pediatric Associatea P.C — Billing Profile & Reimbursement Data policy alerts

Macomb Pediatric Associatea P.C — Billing Profile & Reimbursement Data

Sign up for Macomb Pediatric Associatea P.C — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References