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

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

Coeur D'alene Pediatrics PA (NPI 1255496980)

Key Findings

Field	Value
Entity Type	Organization
Organization	Coeur D'alene Pediatrics PA
Address	700 W Ironwood Dr
City	Coeur D Alene
State	ID
ZIP	83814
Taxonomy	Pediatrics Physician
NPI Enumerated	December 22, 2006

Payer Source	Total Paid
Medicaid	$11.6M
Medicare	$0

Payer mix and scale: this practice reports none (no Medicare billing on file) and Total Medicaid revenue: $11.6M, indicating it operates effectively as a Medicaid-focused pediatric practice rather than a mixed Medicare/Medicaid provider. The absence of Medicare billing makes Medicaid the dominant — and effectively sole — revenue stream captured in these records.

Revenue concentration: the provider’s Medicaid revenue is highly concentrated in three codes, with the top 3 Medicaid codes by revenue accounting for 69.9% of total Medicaid revenue. Those top contributors are 99213 ($3.8M, 32.5%), 99214 ($3.2M, 27.6%), and 90460 ($1.1M, 9.9%), signaling a dependence on routine evaluation/management visits and vaccine administration for most of its Medicaid dollars.

Business/service-line implications: the code mix — led by 99213 and 99214 (high-volume established-patient office E/M) alongside 90460/90461 (vaccine administration) and multiple preventive visit codes (99392/99393/99391/99394) — is characteristic of a high-throughput pediatric primary care practice providing routine sick and well visits plus immunization services. The prominence of both E/M and immunization codes suggests operations organized around frequent office encounters and scheduled vaccine clinics for children.

Competitive standing for core E/M and immunization services: the provider ranks at or near the top statewide for its highest-volume codes, with 99213 ranked #9 of 669 providers in-state (99th percentile; extreme outlier), 99214 ranked #9 of 618 (99th percentile; notably above typical state volume), and 90460 ranked #1 of 78 (100th percentile; extreme outlier). These ranks indicate a dominant statewide presence for pediatric office visits and vaccine administration relative to peers.

Preventive care and well-visit profile: substantial revenue and volume in preventive codes supports a strong emphasis on routine well-child care — examples include 99392 ($893.6K, 7.7%, rank #5 of 79, 95th percentile), 99393 ($747.1K, 6.4%, rank #4 of 78, 96th percentile), 99391 ($473.2K, 4.1%, rank #9 of 84, 90th percentile), and 99394 ($311.5K, 2.7%, rank #3 of 61, 97th percentile). This pattern reinforces the interpretation that the practice delivers comprehensive preventive pediatric services across age groups.

High-volume screening and point-of-care testing: the provider is a statewide leader in several screening and quick-test codes that support pediatric workflows — for example, 99173 (vision screening) shows 19.1K claims and $95.6K revenue, rank #1 of 20 (100th percentile), and 92552 (audiometry) shows 5K claims and $109.1K revenue, rank #1 of 8 (100th percentile). While these services are individually smaller revenue contributors compared with E/M and vaccines, their extreme ranks indicate systematic incorporation of on-site screenings into routine visits.

Operational scale signal: claim volumes such as 99213 at 60.9K claims and 90460 at 60.3K claims point to very high visit throughput and repeated vaccine administration, consistent with a busy pediatric clinic or multi-provider practice model serving a large pediatric Medicaid population. These volumes, paired with the concentration in a few codes, imply standardized visit types and workflows optimized for repeat office-based encounters.

Tenure and market presence: the NPI was enumerated on 2006-12-22 (~20 years ago), indicating long-term registration in the provider directory. Combined with persistent high statewide ranks and the Medicaid revenue base noted above, the data are consistent with a stable, well-established pediatric practice with significant local market share for routine pediatric services.

Medicaid: Complete Services Breakdown

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

63 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…	60,870	$60	$3.8M
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…	35,580	$90	$3.2M
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.	60,340	$20	$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…	10,150	$90	$893.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8,890	$80	$747.1K
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…	5,770	$80	$473.2K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	13,940	$30	$418.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3,310	$90	$311.5K
92552	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the lowest threshold at which the patient can hear.	4,960	$20	$109.1K
99173	The provider checks the eyesight in both eyes of a pediatric patient by asking him to read letters of varying sizes on a standard chart, such as a Snellen’s chart, which he keeps 20 feet away from…	19,110	$10	$95.6K

Showing 1–10 of 63

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Coeur D'alene Pediatrics PA — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

63 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	9	670	740	$40	$193.6K
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…	9	620	560	$60	$191.8K
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…	5	80	450	$80	$171.3K
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…	9	80	380	$70	$151.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4	80	130	$80	$91.4K
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	80	460	$30	$77.7K
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…	74	140	100	$90	$54.4K
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	50	210	$80	$51.4K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	2	60	290	$30	$48.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3	60	50	$70	$35.5K

Showing 1–10 of 63

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Res-care Washington, Inc	ID	In Home Supportive Care Agency	$0	$31.9M
Dirne Health Centers, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$13.6M
Coeur D'alene School District #271	ID	Local Education Agency (LEA)	$0	$9.8M
Ambitions Of Idaho, Inc	ID	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$7.6M
Dirne Health Centers, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$7.1M
Kootenai Health, Inc.	ID	General Acute Care Hospital	$0	$7M
Family Support Services Of North Idaho	ID	Mental Health Counselor	$0	$6.9M
Dirne Health Centers, Inc	ID	Federally Qualified Health Center (FQHC)	$0	$6.7M
Kootenai Health, Inc.	ID	Psychiatry Physician	$0	$6.7M
Collaborative Behavior Solutions, LLC	ID	Community/Behavioral Health Agency	$0	$5.9M

Coeur D'alene Pediatrics PA — Billing Profile & Reimbursement Data

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Coeur D'alene Pediatrics PA — 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

Nearby Providers

Frequently Asked Questions

References