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

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

The Nemours Foundation (NPI 1245520386)

Field	Value
Entity Type	Organization
Organization	The Nemours Foundation
Address	6535 Nemours Pkwy
City	Orlando
State	FL
ZIP	32827
Taxonomy	Children's Hospital
NPI Enumerated	April 11, 2011

Payer Source	Total Paid
Medicaid	$104.9M
Medicare	$0

Key Findings

THE NEMOURS FOUNDATION reports no Medicare billing on file and $104.9M in lifetime Medicaid revenue, making it effectively a Medicaid-focused provider with the state Medicaid program as its primary public-payer source. This payer concentration means Medicaid policy and rate changes will disproportionately affect its revenue base.

Revenue is highly concentrated in a small set of Medicaid codes: the top three codes (99283, J3010, 99282) together account for 47.4% of the provider’s total Medicaid revenue. Those three codes individually account for $17M (19.9%), $14.1M (16.5%), and $9.3M (10.9%) respectively, signaling dependence on a narrow set of high-yield services.

The code mix indicates a large pediatric emergency and observation operation: 99283 has 58.5K claims ($17M), 99282 has 33.8K claims ($9.3M), and 99284/99285 are also billed (9.4K and 3.7K claims respectively), while hospital observation G0378 shows 13.3K claims ($3.1M). Together these volumes point to substantial ED throughput and short-term inpatient observation capacity in a pediatric setting rather than a Medicare-focused inpatient profile.

Drug administration and supply codes are outsized relative to peers: J3010 (injection, fentanyl citrate) has 18.4K claims and $14.1M revenue and is labeled an “extreme outlier” in-state (rank #4 of 178, 98th percentile). Complementary drug/supply codes like J3490 ($5.3M, 52.4K claims, rank #1 of 127, 100th percentile), A9150 ($6.3M, rank #1 of 11, 100th percentile), and J8499 ($1.7M, rank #1 of 24, 100th percentile) reinforce that medication administration and unclassified drug billing are a dominant component of its Medicaid profile.

Surgical and anesthesia activity for pediatric procedures is visible in the top codes: tympanostomy 69436 (2.8K claims, $2.9M), tonsil/adenoid procedures 42820 (1.4K claims, $2.2M) and 42830 (566 claims, $1.2M), and anesthetic agent J2704 (17.6K claims, $2M). These data indicate steady OR and ambulatory surgical throughput consistent with a children’s hospital performing routine ENT and minor surgical care.

Rehabilitation and specialty imaging are meaningful secondary service lines: therapeutic exercise 97110 (10.1K claims, $2M) and activity-based therapy 97530 (11.4K claims, $1.5M) indicate substantial outpatient therapy volume, while echocardiography codes 93306 and 93303 (combined ~$2.5M) point to pediatric cardiology imaging capacity. This mix suggests integrated ambulatory therapy and subspecialty imaging alongside ED and surgical services.

Competitive standing is mixed by service line: the provider is a major statewide outlier for several drug and supply codes (multiple #1 ranks and 100th-percentile labels, plus the J3010 98th-percentile extreme outlier), indicating dominance in medication administration and dispensing. By contrast, its emergency E/M ranks are varied — 99282 is notably above typical state volume (98th percentile, #8 of 315) while 99285 and 99284 sit nearer the median statewide distribution — suggesting strong pediatric ED volume overall but with code-level variability versus peers.

The NPI was enumerated 2011-04-11 (~15 years ago), so this provider has an established operating history; paired with $104.9M in Medicaid revenue and the concentrated top-code profile, that tenure supports the interpretation of a sustained, Medicaid-centered children’s hospital with high-volume ED, drug administration, and pediatric surgical services.

Medicaid: Complete Services Breakdown

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

303 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	58,510	$290	$17M
J3010	Injection, fentanyl citrate, 0.1 mg	18,400	$770	$14.1M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	33,780	$280	$9.3M
A9150	Non-prescription drugs	10,920	$580	$6.3M
J3490	Unclassified drugs	52,430	$100	$5.3M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	14,380	$250	$3.5M
G0378	Hospital observation service, per hour	13,250	$230	$3.1M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2,760	$1,040	$2.9M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	9,360	$270	$2.5M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	1,430	$1,550	$2.2M

Showing 1–10 of 303

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Florida Distribution

The Nemours Foundation — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Florida

Full comparison — all codes billed, vs. Florida median

303 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	43	700	2,400	$80	$1.2M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	238	740	2,180	$70	$1.1M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	9	10	710	$850	$915.3K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	270	660	1,900	$70	$743.6K
A9150	Non-prescription drugs	1	10	40	$320	$577.2K
J3262	Injection, tocilizumab, 1 mg	3	10	170	$1,470	$480.8K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	8	320	1,970	$90	$463.1K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	25	40	400	$460	$395.7K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	7	60	100	$710	$379K
44970	Laparoscopy, surgical, appendectomy	14	10	60	$1,820	$372.9K

Showing 1–10 of 303

Related Providers

Other providers that share a Tax Identification Number (TIN) with The Nemours Foundation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Nemours Foundation	DE	Multi-Specialty Clinic/Center	$0	$172M
The Nemours Foundation	DE	Children's Hospital	$0	$104M
The Nemours Foundation	FL	Multi-Specialty Clinic/Center	$0	$46.2M
Nemours Children's Health, Downtown Orlando, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$44.4M
Nemours Children's Health, Jacksonville, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$23.6M
Sedigheh Ebadi	FL	Pediatrics Physician	$0	$10.1M
Children's Health Alliance, LLC	FL	Pediatrics Physician	$0	$9.6M
Michael Klufas	PA	Ophthalmology Physician	$7M	$0
Richard Kaiser	PA	Ophthalmology Physician	$6.6M	$0
Carl Regillo	PA	Ophthalmology Physician	$6.5M	$0

Nearby Providers

Other providers in the same ZIP code as The Nemours Foundation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kellie Slimick	FL	Nurse Practitioner	$851.3K	$0
David Weinstein	FL	MOHS-Micrographic Surgery Physician	$246.3K	$0
Rachel Ergle	FL	Speech-Language Pathologist	$76K	$0
Protean Biodiagnostics Inc	FL	Clinical Medical Laboratory	$65.3K	$0
Kelsey Calamaro	FL	Physician Assistant	$59.2K	$0
Brian Gurr	FL	Certified Registered Nurse Anesthetist	$45.2K	$0
Sujit Routray	FL	Internal Medicine Physician	$26.2K	$0

The Nemours Foundation — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References