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

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

Topcare Medical Group Inc (NPI 1285016758)

Key Findings

Field	Value
Entity Type	Organization
Organization	Topcare Medical Group Inc
Address	12377 Merit Dr Ste 300
City	Dallas
State	TX
ZIP	75251
Taxonomy	Pediatrics Physician
NPI Enumerated	June 22, 2015

Payer Source	Total Paid
Medicaid	$160.4M
Medicare	$0

TOPCARE MEDICAL GROUP INC is effectively a single-payer Medicaid operator: there is no Medicare billing on file and the provider reports $160.4M in Medicaid revenue, indicating its billed volume and revenue are concentrated entirely in Medicaid for the periods on file. This payer concentration shapes both the service mix and competitive positioning described below.

The provider’s Medicaid revenue is highly concentrated in a few codes: the top three Medicaid codes (99214, 99213, 87426) account for 45.6% of its total Medicaid revenue. Those individual contributions are 99214 = $31.4M (19.8%), 99213 = $23M (14.6%), and 87426 = $17.7M (11.2%), showing a strong revenue dependence on established E/M visits and high-volume SARS‑CoV‑2 testing.

The code mix indicates a pediatric primary-care, high-throughput model: extremely large volumes for established patient office visits (99214: 848.5K claims; 99213: 853.6K claims) combined with high volumes of well-child/preventive codes (99393, 99392, 99394, 99391) and vaccine administration (90460 = 1.3M claims). This pattern—heavy E/M plus preventive visits and mass immunization codes—is consistent with a pediatric-focused practice serving large numbers of children for routine care and vaccinations.

Infectious disease testing and point-of-care diagnostics are a major service line for this provider: 87426 (SARS–CoV–2 immunoassay) generated $17.7M on 535.6K claims and ranks #1 in-state; additional high volumes for influenza and rapid assays (87400 = 655.5K claims, 87804 = 310.8K claims, 87807 = 106.9K claims, 87880 = 318.6K claims, U0002 = 17.4K claims) show integrated, high-throughput diagnostic activity. These testing revenues and claim counts indicate operational capacity to process large numbers of acute respiratory and COVID-related tests alongside routine pediatric care.

Preventive pediatric services and immunizations are prominent revenue contributors beyond the top three: 99393 = $15.3M (9.7%), 99392 = $13.8M (8.7%), 90460 = $11.5M (7.2%), 99394 = $10.8M (6.9%), and 99391 = $9.9M (6.2%). The combination of well-child visit codes and very high vaccine administration claims (90460: 1.3M claims) underscores that well-child visits and immunization programs are central to the practice’s Medicaid revenue mix.

TOPCARE is a dominant statewide volume leader for many pediatric and testing codes: 99214, 99213, 87426, 99393, 99392, 90460 and numerous others rank #1 in Texas and are described as 100th percentile "extreme outlier, far above typical state volume for this code." These rank and percentile signals indicate the provider is a major in-state participant for pediatric E/M, immunizations, and infectious disease testing, far exceeding typical peers in volume.

The practice operates at very large scale as evidenced by raw claim volumes that are atypical for an individual office (examples: 90460 = 1.3M claims, 99214 = 848.5K claims, 99213 = 853.6K claims, 87426 = 535.6K claims). Such claim volumes are consistent with either a multi-site clinic network or a single highly centralized, high-throughput pediatric operation and imply significant patient throughput and administrative capacity.

The provider has an established billing history with its NPI enumerated on 2015-06-22 (~11 years ago), which suggests the current scale and payer positioning were built over multiple years. Combined with its Medicaid concentration and statewide dominant ranks on core pediatric and testing codes, the tenure supports a sustained, Medicaid-focused business model that could influence contracting and network negotiations within Texas.

Medicaid: Complete Services Breakdown

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

187 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…	848,510	$40	$31.4M
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…	853,620	$30	$23M
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	535,600	$30	$17.7M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	235,400	$70	$15.3M
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…	226,620	$60	$13.8M
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.	1,274,860	$10	$11.5M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	159,520	$70	$10.8M
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…	161,580	$60	$9.9M
87400	The lab analyst performs the technical lab test to detect antigens of influenza A or B using an immunoassay technique, such as EIA. This analysis will distinguish if a patient has influenza A or B.	655,520	$10	$4.6M
99429	Use 99429 to report a preventive medicine service that does not have a specific code.	162,100	$30	$4.1M

Showing 1–10 of 187

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Topcare Medical Group Inc — 25 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

187 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…	1	6,040	710	$40	$232.8K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	51	140	180	$60	$215.9K
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…	1	1,500	880	$80	$185.8K
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…	1	1,360	800	$80	$185.6K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	190	220	130	$80	$180.8K
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…	1	5,810	540	$50	$155.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1	1,540	650	$80	$150.4K
83013	The lab analyst tests multiple breath samples for the presence of an isotope that indicates the presence of the H. pylori bacteria. This organism can cause irritation and ulcers of the stomach lining.	12	20	110	$30	$129.3K
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…	59	350	230	$70	$120.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1	1,540	360	$80	$110.6K

Showing 1–10 of 187

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Topcare Medical Group Inc	TX	Specialist	$0	$42.5M
Almouie Pediatrics	TX	Pediatrics Physician	$0	$23.1M
Ngozi Ladokun	TX	Family Nurse Practitioner	$2.9M	$0
George Valdez	TX	Family Medicine Physician	$835.7K	$0
Alex Su	TX	Family Medicine Physician	$227.8K	$0
Ma Cristina Manaloto	GU	Pediatrics Physician	$0	$93.9K
Chelsea Van Rooy	KY	Psychiatric/Mental Health Nurse Practitioner	$67K	$0
Naila Kabani	TX	Family Nurse Practitioner	$12.4K	$0
Robert Murphy	TX	Family Nurse Practitioner	$4.6K	$0
Jahvel Thompson	TX	Physician Assistant	$3.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Oci Acquisition LLC	TX	Home Health Agency	$0	$17.7M
Park Central Surgical Center, Ltd	TX	Ambulatory Surgical Clinic/Center	$622.3K	$352.8K
Prasanna Sinkre	TX	Anatomic Pathology & Clinical Pathology Physician	$662.5K	$0
William Posten	TX	MOHS-Micrographic Surgery Physician	$651K	$0
Chandra Davenport	TX	Physician Assistant	$376.9K	$0
Baylor Surgicare At North Dallas, LLC	TX	Ambulatory Surgical Clinic/Center	$372.2K	$0
Claire Chu	TX	Ophthalmology Physician	$354.9K	$0
Chima Asikaiwe	TX	Psychiatry Physician	$281.6K	$25K
Nadear Elmahi	TX	Internal Medicine Physician	$272.4K	$0
Shalini Katikaneni	TX	Internal Medicine Physician	$242.7K	$0

Topcare Medical Group Inc — 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