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

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

Norton Childrens Medical Group, LLC (NPI 1326695255)

Key Findings

Field	Value
Entity Type	Organization
Organization	Norton Childrens Medical Group, LLC
Address	4803 Olympia Park Plz Ste 1100
City	Louisville
State	KY
ZIP	40241
Taxonomy	Pediatrics Physician
NPI Enumerated	August 26, 2019

Payer Source	Total Paid
Medicaid	$107.3M
Medicare	$0

This provider is effectively single-payer at present: there is no Medicare billing on file while total Medicaid revenue is $107.3M. The absence of Medicare receipts and the concentration of material activity in Medicaid indicate the organization’s revenue and patient mix are overwhelmingly Medicaid-driven rather than split across traditional Medicare/Medicaid populations.

Revenue is highly concentrated in a small set of outpatient E/M and immunization codes: the precomputed top three Medicaid codes (99214, 99213, 90460) account for 44.3% of the provider’s Medicaid revenue. Specifically, 99214 accounts for $18.6M (20.3% of Medicaid revenue), 99213 for $13.4M (14.6%), and 90460 for $8.6M (9.4%), signaling these services are the primary revenue drivers.

The service-line profile is pediatric primary care and preventive services. High volumes and revenue for established office visits 99214 (321.1K claims, $58 avg paid/claim, $18.6M) and 99213 (352.6K claims, $38 avg paid/claim, $13.4M), combined with leading-state volumes for well-visits 99392 ($7.6M) and 99391 ($6.7M) and a large immunization code 90460 ($8.6M), point to a throughput model focused on routine pediatric E/M, well-child care, and vaccination delivery.

Competitive standing in-state is dominant for many pediatric preventive and office visit codes. The provider is an extreme outlier and ranks at the 100th percentile for multiple codes (for example, 99214 ranks #7 of 2462 but is described as an extreme outlier, while 90460 ranks #1 of 395, 99392 ranks #1 of 264, 99391 ranks #1 of 234, 99393 ranks #1 of 316, and 99215 ranks #1 of 407), indicating market-leading volume versus in-state peers for core pediatric services.

While primary care and preventive care dominate, the provider also reports substantial emergency and inpatient-related E/M activity. Emergency visit code 99283 shows 121.3K claims and $4.9M revenue (5.3% of Medicaid revenue) and ranks #4 of 284 (99th percentile, notably above typical state volume), and 99284 and 99285 also appear in the top codes, signaling a significant urgent/acute care footprint in addition to outpatient pediatrics.

Diagnostic and testing throughput is material and concentrated on pediatric-relevant assays. Multiplex respiratory testing 87636 has 40.4K claims with $5.2M revenue and ranks #2 of 68 (99th percentile, notably above typical state volume); Streptococcus testing 87651 has 45.1K claims with $1.4M revenue and ranks #3 of 197 (99th percentile). High-volume screening 96110 (35.8K claims, $1M) ranks #1 of 127 and underscores systematic developmental screening integration into visits.

The provider delivers a notable volume of pediatric cardiac imaging and newborn services, indicating specialty diagnostic capacity linked to its pediatric population. Transthoracic echo codes 93303 ($1.7M, ranks #1 of 19) and 93320 ($680.4K, ranks #1 of 30) are state-leading in volume, and newborn care codes such as 99460 ($797.1K, ranks #1 of 88) and NICU-related codes 99480/99479 also appear in the top 25, reflecting significant perinatal and pediatric imaging activity.

The NPI was enumerated on 2019-08-26 (~7 years ago), and the current Medicaid footprint of $107.3M suggests rapid scale or operation at substantial scale since enumeration. Taken together with repeated 100th-percentile and extreme outlier rankings across many pediatric E/M, preventive, and testing codes, the provider behaves like a large, high-throughput pediatric practice or system within Kentucky’s Medicaid market rather than a small independent office.

Medicaid: Complete Services Breakdown

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

313 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…	321,100	$60	$18.6M
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…	352,570	$40	$13.4M
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.	254,010	$30	$8.6M
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…	104,580	$70	$7.6M
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…	105,190	$60	$6.7M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	40,450	$130	$5.2M
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.	121,290	$40	$4.9M
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.	59,380	$70	$3.9M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	44,930	$70	$3.2M
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…	40,040	$80	$3.1M

Showing 1–10 of 313

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Norton Childrens Medical Group, LLC — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

313 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	14	280	7,150	$150	$3M
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.	41	240	4,710	$150	$2.6M
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.	4	280	5,700	$120	$2M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	117	180	1,870	$280	$1.5M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	5	10	600	$260	$1.1M
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.	2	10	120	$250	$878.8K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	46	180	2,960	$110	$672.4K
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.	13	160	2,900	$110	$610.8K
36512	Apheresis (also known as pheresis or therapeutic pheresis) is a medical procedure utilizing specialized equipment to remove selected blood constituents (plasma, leukocytes, platelets, or cells) from…	3	10	1,080	$560	$585.4K
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…	23	210	1,340	$160	$568K

Showing 1–10 of 313

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Robert Baker	AR	Pediatric Anesthesiology Physician	$330.8K	$0
Thomas Higgins	KY	Otolaryngology Physician	$207K	$0
Paul Tennant	KY	Otolaryngology Physician	$135.9K	$0
Sin Min Yeoh	KY	Oral & Maxillofacial Surgery (D.M.D.)	$10K	$108.7K
Steven Glassman	KY	Orthopaedic Surgery of the Spine Physician	$88.2K	$0
Sean Miller	KY	Otolaryngology Physician	$83.1K	$0
Mark Severtson	KY	Otolaryngology Physician	$75.6K	$0
Paul Celestre	KY	Orthopaedic Surgery of the Spine Physician	$59.8K	$0
Anurag Arora	DE	Pediatric Radiology Physician	$56.2K	$0
Kevin Klayman	NY	Diagnostic Radiology Physician	$40.1K	$70

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Medical Associates, Inc.	KY	Internal Medicine Physician	$0	$135.1M
Community Medical Associates, Inc.	KY	Multi-Specialty Clinic/Center	$0	$49M
Motc - Louisville LLC	KY	Prosthetic/Orthotic Supplier	$0	$5.4M
Gml Pain Md Psc	KY	Durable Medical Equipment & Medical Supplies	$0	$3.9M
Jacob Yunker	KY	Ophthalmology Physician	$3.8M	$0
Thomas Harper	KY	Ophthalmology Physician	$3.3M	$0
Aspire Case Management LLC	KY	Case Management Agency	$0	$3.2M
Victor Neamtu	KY	Ophthalmology Physician	$1.5M	$980
Michael Mccall	KY	Dermatology Physician	$938.6K	$0
Timothy Brown	KY	Dermatology Physician	$874.6K	$0

Norton Childrens Medical Group, LLC — 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