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 1265585806)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Nemours Foundation
Address	807 Childrens Way
City	Jacksonville
State	FL
ZIP	32207
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	January 18, 2007

Payer Source	Total Paid
Medicaid	$46.2M
Medicare	$0

This entity is effectively single‑payer in the current claims record: Total Medicare revenue is listed as none (no Medicare billing on file) while Total Medicaid revenue is $46.2M, indicating Medicaid is the sole documented revenue source in the dataset and the primary focus of its billing activity. Analysts should treat comparative Medicare benchmarks as inapplicable for this provider.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management and consultation codes: the top three Medicaid codes (99214, 99244, 99213) together account for 40.3% of the provider’s Medicaid revenue, with 99214 contributing $6.2M (16.6%), 99244 $5.1M (13.5%), and 99213 $3.8M (10.2%). This concentration signals reliance on a handful of high-volume E/M and consult services for a large share of Medicaid receipts.

Operational mix implied by the code portfolio points to a multi‑specialty ambulatory center with embedded specialty diagnostics and procedural capacity: high volumes of office/consult codes (99214, 99213, 99244, 99243) are complemented by emergency visit codes (99283, 99284, 99285), cardiac imaging (93306, 93303), sleep testing (95782, 95810), EEG (95819), MRI brain (), pathology (), and tympanostomy (). The breadth of codes suggests integrated outpatient care with on‑site imaging, sleep and procedural services rather than a narrow single‑service clinic.

Competitive standing in‑state is strong and in some areas dominant: 99244 ranks #1 of 224 providers in‑state (100th percentile; extreme outlier), 99214 ranks #34 of 6379 (99th percentile; extreme outlier), and 99213 ranks #70 of 5934 (99th percentile; notably above typical state volume). These rankings indicate the provider is a major regional hub for consultation and higher‑complexity office visits relative to peers.

Several individual codes are statistical outliers or notably above typical state volume, reinforcing the provider’s specialty positioning: 99244 is an extreme outlier (rank #1 of 224), 99214 is characterized as an extreme outlier (rank #34 of 6379), and 99215 also appears as an extreme outlier (11.6K claims, $1.8M; rank #13 of 979, 99th percentile). These labels point to unusually large state market share for higher‑complexity outpatient encounters.

The raw volume metrics show very high outpatient throughput on Medicaid: 99214 has 53K claims at $117 avg paid/claim generating $6.2M, and 99213 has 50.2K claims at $76 avg paid/claim generating $3.8M. Such claim counts, paired with elevated average paid/claim on consult codes (e.g., 99244 $282 avg paid/claim across 18K claims), indicate both scale and a payer mix within Medicaid that yields meaningful per‑claim reimbursement for consult-level services.

The presence and ranking of consult series codes beyond routine office visits (99243: 17.9K claims, $3.2M, rank #2 of 145; 99245: rank #4 of 65) suggest this provider functions as a referral destination for higher‑complexity consults and specialty evaluations. High ranks for consultation codes are consistent with a center receiving referred cases rather than solely managing routine primary care encounters.

The practice has longstanding presence in claims data: the NPI was enumerated on 2007-01-18 (~19 years ago), indicating nearly two decades of billing history. That tenure, combined with high state ranking on multiple codes, supports interpretation of the provider as an established multi‑specialty center with durable Medicaid relationships and referral patterns.

Medicaid: Complete Services Breakdown

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

209 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…	53,040	$120	$6.2M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	17,980	$280	$5.1M
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…	50,230	$80	$3.8M
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	17,930	$180	$3.2M
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.	22,960	$90	$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.	12,000	$150	$1.8M
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…	11,570	$160	$1.8M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	5,310	$310	$1.6M
99203	The provider sees a new 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 provider…	8,000	$170	$1.3M
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.	1,010	$1,300	$1.3M

Showing 1–10 of 209

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 — 7 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

209 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.	24	30	2,220	$350	$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.	130	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.	202	740	2,180	$70	$1.1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	29	50	570	$100	$1.1M
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.	289	660	1,900	$70	$743.6K
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.	5	30	310	$720	$616.3K
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.	207	320	1,970	$90	$463.1K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	19	60	100	$710	$379K
44970	Laparoscopy, surgical, appendectomy	11	10	60	$1,820	$372.9K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	28	40	120	$610	$357.5K

Showing 1–10 of 209

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Nemours Foundation	DE	Multi-Specialty Clinic/Center	$0	$172M
The Nemours Foundation	FL	Children's Hospital	$0	$104.9M
The Nemours Foundation	DE	Children's Hospital	$0	$104M
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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southern Baptist Hospital Of Florida Inc	FL	General Acute Care Hospital	$0	$88M
One Call Government Solutions, LLC	FL	Transportation Broker	$0	$48.5M
Emergency Physicians Inc	FL	Emergency Medicine Physician	$0	$34.2M
Southern Baptist Hospital Of Florida, Inc	FL	Children's Hospital	$0	$29.1M
Child Guidance Center, Inc.	FL	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8M
Metro Treatment Of Florida, LP	FL	Methadone Clinic	$168.7K	$4.4M
Swl Services LLC	FL	Clinical Medical Laboratory	$4.1M	$2.5K
Gary Gabor	FL	Rheumatology Physician	$2.7M	$0
Bernhardt Laboratories Inc	FL	Clinical Medical Laboratory	$1.8M	$620.2K
Nicole Anderson	FL	Radiation Oncology Physician	$719.5K	$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