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

Why is the Medicaid comparison limited to Montana 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. Montana (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 Childrens Clinic Of Billings, PC (NPI 1295837250)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Childrens Clinic Of Billings, PC
Address	3401 Avenue E
City	Billings
State	MT
ZIP	59102
Taxonomy	Pediatrics Physician
NPI Enumerated	September 1, 2006

Payer Source	Total Paid
Medicaid	$10.9M
Medicare	$0

This provider is effectively a single‑payer Medicaid practice: there is no Medicare billing on file while reported Medicaid revenue totals $10.9M, indicating Medicaid is the dominant — and for available data the sole — federal payer contribution to this entity’s revenue mix. The absence of Medicare billing suggests the clinic’s patient panel and services are focused on populations and payers covered under state Medicaid rather than Medicare-age beneficiaries.

Revenue is highly concentrated in a narrow set of outpatient pediatric codes: the top three Medicaid codes (99213, 99391, 99392) together account for 68.2% of this provider’s Medicaid revenue. Those three codes individually represent $4.4M (99213, 40.9%), $1.7M (99391, 16.1%), and $1.2M (99392, 11.3%) of the $10.9M total, highlighting reliance on routine established visits and preventive well‑child care as the primary revenue drivers.

The code mix clearly signals a pediatric primary care and preventive services operation: very high volumes of 99213 (established office visits), 99391/99392 (preventive medicine/well‑child visits), and large vaccine administration codes 90471/90472. Vaccination administration counts (90471: 30.1K claims, $632.4K; 90472: 17.3K claims, $502K) and multiple vaccine product codes (90670, 90681, 90651) show immunization delivery is a substantial and consistent service line supporting the practice’s Medicaid revenue.

The provider is a state‑level volume leader for several pediatric/preventive codes: 99391 ranks #1 of 68 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), 99392 ranks #2 of 72 (99th percentile; extreme outlier, far above typical state volume for this code), and 99213 ranks #8 of 523 (99th percentile; extreme outlier, far above typical state volume for this code). These rankings indicate market dominance in well‑child and routine established visit capacity within Montana’s Medicaid network.

While lower‑ and moderate‑complexity E/M codes dominate revenue, higher‑complexity visits are present but occupy a much smaller share of billing: 99214 accounts for $712.6K (6.6% of Medicaid revenue) and ranks at an 86th percentile statewide (typical, unremarkable volume), and 99215 contributes $152.4K (1.4%) and ranks in the mid‑percentile (typical, unremarkable volume). This pattern suggests the clinic’s case mix is concentrated on routine and preventive ambulatory pediatric care, with a modest tail of higher‑complexity outpatient visits.

The practice also operates notable point‑of‑care and screening services alongside visits: high volumes of brief behavioral/developmental screening (96127: 10K claims, $69.7K; ranks #1 of 72 providers in-state, 100th percentile; extreme outlier) and developmental screening (96110: 4.1K claims) imply standardized screening is embedded in workflows. In‑office diagnostic testing is present as well — e.g., multiplex respiratory testing 87637 (1.7K claims, $181.9K; ranks #2 of 21, 95th percentile) — supporting acute respiratory and infection management tied to ambulatory visits.

Vaccination delivery and pediatric preventive protocols are a distinct competency: pneumococcal vaccination 90670 (7.5K claims, $142.2K) and rotavirus 90681 (1.8K claims, $19.7K) both rank at or near the top of in‑state volumes (90670 rank #1 of 54, 100th percentile; 90681 rank #1 of 5, 100th percentile). Coupled with the very large counts for administration codes 90471/90472, this pattern signals a high‑throughput immunization program that materially contributes to Medicaid revenue.

The provider has a long tenure in the NPI registry (enumerated 2006-09-01, approximately 20 years), which combined with the high Medicaid volumes and top‑percentile ranks suggests an established pediatric primary care presence in Billings. The longevity plus concentrated preventive and vaccination services point to a stable, community‑anchored pediatric practice focused on routine ambulatory and well‑child care for Medicaid populations.

Medicaid: Complete Services Breakdown

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

68 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…	47,220	$90	$4.4M
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…	14,890	$120	$1.7M
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…	9,760	$120	$1.2M
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…	5,050	$140	$712.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	30,110	$20	$632.4K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	17,310	$30	$502K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2,320	$120	$288.1K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	1,750	$100	$181.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,360	$130	$181.1K
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…	840	$180	$152.4K

Showing 1–10 of 68

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

The Childrens Clinic Of Billings, PC — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

68 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	74	530	580	$70	$224.6K
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…	8	520	730	$40	$196.4K
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	70	420	$80	$111.7K
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…	2	70	310	$90	$107.1K
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…	43	160	250	$110	$85.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5	80	130	$80	$43.2K
99205	The provider sees a new 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 provider…	33	70	70	$180	$40.4K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	2	10	200	$100	$27.6K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	5	20	60	$70	$26K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	2	20	100	$40	$21.6K

Showing 1–10 of 68

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Youth Dynamics, Inc.	MT	Mental Illness Community Based Residential Treatment Facility	$0	$65.4M
New Day, Inc.	MT	Mental Illness Community Based Residential Treatment Facility	$0	$27.7M
Youth Dynamics, Inc.	MT	Professional Counselor	$0	$24.6M
Resource, Support, & Development, Inc.	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$21.3M
Brittany Curl	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$17.5M
Rimrock Pediatric Dentistry	MT	Pediatric Dentistry	$0	$15.2M
Bridges Of Montana	MT	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$12.7M
Community Option Resource Enterprises, Inc.	MT	Developmentally Disabled Services Day Training Agency	$0	$9.8M
Ryan K. Larsen Dmd & Associates	MT	Dental Anesthesiology	$0	$8.3M
Brewer Dental Center PLLC	MT	General Practice Dentistry	$0	$8.3M

The Childrens Clinic Of Billings, PC — Billing Profile & Reimbursement Data

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The Childrens Clinic Of Billings, PC — 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