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

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

Childrens Specialty Group PLLC (NPI 1255354130)

Field	Value
Entity Type	Organization
Organization	Childrens Specialty Group PLLC
Address	601 Childrens Ln
City	Norfolk
State	VA
ZIP	23507
Taxonomy	Pediatrics Physician
NPI Enumerated	July 25, 2006

Payer Source	Total Paid
Medicaid	$87.7M
Medicare	$0

Key Findings

CHILDRENS SPECIALTY GROUP PLLC is effectively a Medicaid-centered practice: there is no Medicare billing on file while lifetime Medicaid revenue totals $87.7M, indicating the provider operates as a single-payer (Medicaid) revenue base in the available data. The provider’s NPI has been enumerated since 2006-07-25 (~20 years ago), supporting a long-tenured presence in the market.

Revenue is concentrated in a small set of high-volume E/M and neonatal codes: the precomputed top three Medicaid codes (99214, 99284, 99472) together account for 39.6% of the provider’s total Medicaid revenue. Those three codes individually generated $15M (99214, 18.5%), $8.7M (99284, 10.7%), and $8.4M (99472, 10.3%), underscoring a heavy dependence on a handful of service lines for a large portion of revenue.

The code mix signals a blended service model spanning outpatient pediatrics, emergency care, and intensive neonatal inpatient care: high revenues and volumes for 99214 (171.9K claims) and 99204/99205 as new-patient E/Ms point to substantial ambulatory activity, while dominant neonatal critical-care codes (99472, 99469, 99479, 99480, 99460, 99462) indicate significant NICU and newborn inpatient services. This combination suggests a multi-site or vertically integrated pediatric specialty operation that manages both ambulatory and inpatient newborn populations.

CHILDRENS SPECIALTY GROUP is a statewide leader on multiple neonatal and inpatient metrics: codes 99472 and 99469 each rank #1 in-state (100th percentile) and are described as notably above typical or extreme outliers, and several other inpatient/discharge codes (99479, 99480, 99460) also rank at the 100th percentile. Those top ranks and percentile labels indicate the provider is a dominant participant in neonatal and related inpatient pediatric care within Virginia.

The provider also shows unusually high ED and higher-complexity outpatient volumes for a pediatric practice: 99284 has 97.5K claims and $8.7M revenue (rank #10 of 620 providers, 99th percentile; notably above typical state volume), and ED-level codes 99283 and 99285 appear among the top revenue drivers. These patterns suggest a significant role in emergency pediatric care in addition to its inpatient newborn focus.

There is notable procedural and ancillary revenue beyond E/M and neonatal codes: J0585 (onabotulinumtoxina) contributes $6.8M (8.4% of Medicaid revenue) and ranks #3 in-state (90th percentile), while 95004 (allergy testing) ranks #1 in-state (100th percentile) and 95810 (polysomnography) ranks as an extreme outlier (98th percentile). These items point to diversified service lines—procedural injectables, allergy diagnostics, and sleep studies—that augment the practice’s core pediatric and neonatal volumes.

Many high-revenue codes are extreme outliers or in the top percentiles statewide, especially for common pediatric E/M codes: 99214 ranks #11 of 3523 (100th percentile; extreme outlier) and 99204 ranks #2 of 968 (100th percentile; extreme outlier). This consistent pattern of top rankings across both outpatient and inpatient pediatric services signals substantial scale and a competitive advantage relative to in-state peers for those service categories.

Despite diversification across outpatient, emergency, inpatient neonatal, and procedural codes, the provider remains revenue-concentrated: the reliance on a few high-revenue codes (the top three comprising 39.6% of Medicaid revenue) means shifts in utilization or reimbursement for those specific services could materially affect overall revenue. Analysts should treat this as a large, Medicaid-dependent pediatric specialty practice with deep statewide market penetration in newborn and higher-acuity pediatric care, rather than a broadly balanced payer mix operation.

Medicaid: Complete Services Breakdown

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

147 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	171,890	$90	$15M
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.	97,500	$90	$8.7M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	30,860	$270	$8.4M
J0585	Injection, onabotulinumtoxina, 1 unit	3,550	$1,920	$6.8M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	25,840	$260	$6.7M
99204	The provider sees a new 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 provider…	37,390	$130	$4.8M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	48,010	$90	$4.2M
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.	81,380	$50	$4.1M
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.	28,580	$130	$3.7M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	36,810	$80	$3.1M

Showing 1–10 of 147

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Childrens Specialty Group PLLC — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

147 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	1	10	1,430	$260	$1.7M
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.	32	340	160	$130	$1.3M
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.	15	630	90	$140	$1.1M
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.	109	140	3,240	$160	$1M
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.	10	620	70	$120	$1M
J0585	Injection, onabotulinumtoxina, 1 unit	3	20	750	$540	$871.7K
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	1	10	50	$250	$835.5K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	2	10	190	$710	$431.3K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	20	140	$80	$415K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	19	30	50	$1,670	$401.7K

Showing 1–10 of 147

Related Providers

Other providers that share a Tax Identification Number (TIN) with Childrens Specialty Group PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mary Immaculate Hospital LLC	VA	General Acute Care Hospital	$0	$24.5M
Masood Ahmed	VA	Interventional Cardiology Physician	$393.1K	$3.4K
Ryan Seutter	VA	Cardiovascular Disease Physician	$292.9K	$580
Anil Patel	VA	Pulmonary Disease Physician	$221.4K	$0
Saumil Patel	VA	Cardiovascular Disease Physician	$206.4K	$0
Fredrick Southern	VA	Vascular Surgery Physician	$187.3K	$0
Amit Patel	VA	Pulmonary Disease Physician	$180.3K	$0
Benjamin Rubinstein	VA	Otolaryngology Physician	$98.2K	$0
Kent Lam	VA	Otolaryngology Physician	$87.1K	$0
Joseph Han	VA	Otolaryngology Physician	$78.6K	$0

Nearby Providers

Other providers in the same ZIP code as Childrens Specialty Group PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Childrens Hospital Of The Kings Daughters Inc	VA	Children's Hospital	$0	$288.2M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$88M
Sentara Reference Lab Solutions, LLC	VA	Clinical Medical Laboratory	$12.9M	$4.7M
Medical Center Radiologists Inc	VA	Diagnostic Radiology Physician	$0	$13.7M
Childrens Hospital Of The Kings Daughters Inc	VA	Adolescent and Children Mental Health Clinic/Center	$0	$10.2M
Childrens Hospital Of The Kings Daughters Inc	VA	Pediatrics Physician	$0	$8.4M
Jonathan Wiesen	VA	Internal Medicine Physician	$2.4M	$0
Deepak Deshmukh	VA	Vascular Surgery Physician	$1.4M	$0
Sentara Hospitals	VA	Air Ambulance	$977.3K	$170.6K
Edwin Crandley	VA	Radiation Oncology Physician	$315.3K	$0

Childrens Specialty Group PLLC — Billing Profile & Reimbursement Data

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Childrens Specialty Group PLLC — 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