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

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

Memphis Children's Clinic, PLLC (NPI 1255411294)

Key Findings

Field	Value
Entity Type	Organization
Organization	Memphis Children's Clinic, PLLC
Address	1129 Hale Rd
City	Memphis
State	TN
ZIP	38116
Taxonomy	Pediatrics Physician
NPI Enumerated	October 16, 2006

Payer Source	Total Paid
Medicaid	$27.7M
Medicare	$0

This provider is effectively single‑payer Medicaid: there is no Medicare billing on file while Medicaid revenue totals $27.7M. The absence of Medicare activity combined with substantial Medicaid volume suggests the practice’s patient panel and reimbursement exposure are concentrated in pediatric Medicaid populations rather than dual-eligible or Medicare-aged patients.

Revenue concentration is high: the precomputed top 3 Medicaid codes by revenue account for 56.4% of the provider’s Medicaid revenue, driven by 99213 ($7.2M, 26.0%), 90460 ($4.5M, 16.2%), and 99214 ($3.9M, 14.2%). This level of concentration indicates that routine established-patient office visits and vaccine administration are the primary revenue drivers for the practice.

The CPT/HCPCS mix and volumes point to a high-throughput pediatric primary care operation that emphasizes immunizations and well-child care. Large claim counts for preventive and well-visit codes (99392 $2.9M, 99393 $2.4M, 99391 $2M, 99394 $1.3M) together with the top vaccine code 90460 ($4.5M) indicate a steady stream of routine preventive visits with in-office immunization delivery.

Competitive standing in-state is dominant for several core pediatric services. 90460 ranks #1 of 613 providers in-state (100th percentile; extreme outlier) and 99213 ranks #20 of 4050 providers (100th percentile; extreme outlier), signaling the provider bills far above typical state volumes for both vaccine administration and low-complexity established visits.

For higher-complexity established visits, the provider also reports notable volume: 99214 produced $3.9M in revenue and ranks #62 of 3759 providers in-state (98th percentile; notably above typical state volume). This mix (both high-volume 99213 and materially present 99214) suggests the clinic manages a spectrum of pediatric problems from routine follow-up to moderate-complexity outpatient care.

The practice shows broad ancillary testing and screening activity that complements pediatric primary care: COVID testing 87635 ($714K, ranks #11 of 377, 97th percentile), influenza multiplex 87502 ($626.6K, ranks #4 of 195, 98th percentile), hearing screens 92551 ($405K, ranks #2 of 415, 100th percentile), and vision screen 99173 ($131.6K, ranks #2 of 570, 100th percentile). These volumes indicate in-office diagnostic and preventive screening are routine parts of visits and revenue capture.

Several codes are flagged as statistical outliers in-state for this provider, reinforcing its role as a high-volume pediatric clinic: 90460 and multiple well-visit codes (99392, 99393, 99394) are described as extreme outliers, while 99214, 87635, and others are noted as notably above typical state volume. These descriptors suggest the clinic consistently bills at the upper end of peer distributions for child-focused preventive and testing services.

The NPI tenure is long-standing, enumerated 2006-10-16 (~20 years ago), which aligns with the large, steady Medicaid footprint and the high cumulative claim volumes reported for routine pediatric services. Long tenure plus concentrated Medicaid revenue and repeated top-rank placements imply an established pediatric practice embedded in the state Medicaid market.

Medicaid: Complete Services Breakdown

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

83 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…	143,150	$50	$7.2M
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.	97,120	$50	$4.5M
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…	51,390	$80	$3.9M
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…	36,770	$80	$2.9M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	31,000	$80	$2.4M
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…	26,440	$70	$2M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	15,530	$80	$1.3M
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…	15,190	$50	$714K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	14,570	$40	$626.6K
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.	45,000	$10	$405K

Showing 1–10 of 83

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Memphis Children's Clinic, PLLC — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

83 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	1	610	1,220	$40	$206K
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…	62	3,760	610	$40	$202.3K
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…	3	520	470	$70	$187K
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…	20	4,050	620	$30	$183.9K
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	480	580	$60	$174.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3	510	240	$70	$133.7K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	4	200	300	$60	$106K
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…	32	620	740	$20	$88.8K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	15	260	300	$30	$84.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3	420	150	$80	$81.8K

Showing 1–10 of 83

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Memphis & Shelby County Ped. Group	TN	Pediatrics Physician	$0	$9.2M
Tri-state Orthopaedics, LLC	TN	Orthopaedic Surgery Physician	$0	$6.9M
Satellite Healthcare Of Pace Road LLC	TN	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4M
Ob Gyn Centers Of Memphis,mpllc	TN	Obstetrics & Gynecology Physician	$0	$3M
Center For Oral And Facial Surgery	TN	Oral and Maxillofacial Surgery (Dentist)	$0	$2.9M
Isd Renal Inc	TN	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.5M
Ricky Robinson	TN	Podiatrist	$162.3K	$322.4K
Perisco Wofford	TN	Internal Medicine Physician	$117.8K	$75.5K
Ahsan Kathawala	TN	Internal Medicine Physician	$104.8K	$0
Dwight Dishmon	TN	Interventional Cardiology Physician	$92.2K	$0

Memphis Children's Clinic, PLLC — Billing Profile & Reimbursement Data

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Memphis Children's Clinic, 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