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

Why is the Medicaid comparison limited to Delaware 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. Delaware (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 1366594699)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Nemours Foundation
Address	1600 Rockland Rd
City	Wilmington
State	DE
ZIP	19803
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	January 17, 2007

Payer Source	Total Paid
Medicaid	$172M
Medicare	$0

The NEMOURS FOUNDATION is effectively a Medicaid-focused provider with no Medicare billing on file; its entire reported lifetime revenue is $172M from Medicaid, making it functionally single-payer in the available dataset and indicating its operations are heavily dependent on state Medicaid volume. Its NPI was enumerated in 2007-01-17 (~19 years ago), so the entity has an established presence over nearly two decades to build that Medicaid patient base.

Medicaid revenue is concentrated in ambulatory evaluation-and-management and pediatric/preventive services: the top three Medicaid codes by revenue (precomputed) account for 29.6% of the provider’s total Medicaid revenue. That concentration suggests a service model anchored in high-volume outpatient visits and follow-up care rather than specialty procedural revenue dominance.

99213 is the single largest Medicaid revenue driver with $13.7M (11.7% of Medicaid revenue) across 274.9K claims and ranks #1 of 543 in-state (100th percentile); this extreme outlier status indicates the provider is the statewide leader for routine established outpatient visits and likely operates large primary care or pediatric ambulatory clinics.

High-acuity inpatient and neonatal critical care codes also contribute materially: 99472 generated $11.5M (9.8%) across 16.9K claims and 99233 generated $6.4M (5.4%) across 42K claims, with 99472 ranking #1 of 2 in-state and 99233 ranking #1 of 53 in-state (both 100th percentile where noted). These placements reflect substantial inpatient and critical-care activity for infants/young children and complex subsequent inpatient management, consistent with a multi-specialty clinic/center that includes pediatric inpatient services.

Emergency department and higher-complexity outpatient codes appear at scale: 99283 and 99284 produced $9.4M (8.0%) and $7.3M (6.2%) respectively, with 99283 ranking #2 of 26 (96th percentile) and 99284 at #4 of 35 (91st percentile). This mix shows the provider manages a large emergency and urgent-care workload for Medicaid patients, spanning low- to moderate-complexity ED visits.

Preventive and well-child visit codes (99392, 99393, 99391, 99394) are prominent and often rank #1 in-state, collectively contributing multiple millions to Medicaid revenue. The dominance of these preventive pediatrics codes (many flagged as extreme outliers, 100th percentile) further supports an operational focus on pediatric primary care and routine preventive services.

The provider is a statewide dominant volume leader on many core outpatient, inpatient follow-up, and pediatric preventive codes (multiple #1 ranks and repeated 100th percentile placements), signaling competitive strength within Delaware Medicaid. For several technical cardiology and anesthesia codes (e.g., 93303, 93306, 01922) the provider also ranks at or near the top for a small number of in-state peers, suggesting it offers specialized diagnostic and perioperative support services alongside its high-volume general pediatric and ED care.

Given the top-code mix and rank patterns, strategic implications for payers and network planners include recognizing this entity as a high-capacity Medicaid pediatric and emergency provider with concentrated revenue in a handful of E/M and pediatric-critical-care codes (top 3 = 29.6% of Medicaid revenue). Contracting, utilization management, and care-continuity initiatives should account for its outsized role in delivering routine office visits (99213/99214/99215), well-child care, ED services, and neonatal/infant critical care within the state.

Medicaid: Complete Services Breakdown

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

395 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…	274,870	$50	$13.7M
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.	16,930	$680	$11.5M
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…	131,030	$70	$9.6M
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.	100,290	$90	$9.4M
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.	42,240	$170	$7.3M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	42,030	$150	$6.4M
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…	76,330	$80	$6.1M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	57,260	$90	$4.9M
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…	72,870	$60	$4.7M
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…	39,980	$110	$4.5M

Showing 1–10 of 395

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

The Nemours Foundation — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

395 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.	1	10	10,140	$620	$6.3M
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.	2	30	11,180	$110	$3.4M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	1	10	6,010	$460	$2.8M
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.	2	10	8,820	$300	$2.7M
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.	4	40	770	$110	$1.9M
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.	8	30	1,350	$110	$1.5M
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.	5	20	4,570	$120	$1.4M
93320	The provider performs a complete Doppler echocardiography, which uses high–frequency sound waves to create a two–dimensional image of the heart, while the use of Doppler technology allows…	1	10	6,120	$210	$1.3M
01922	The provider performs anesthesia services for a patient undergoing non–invasive imaging or radiation therapy.	1	10	3,400	$360	$1.2M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	10	5,940	$100	$856K

Showing 1–10 of 395

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Nemours Foundation	FL	Children's Hospital	$0	$104.9M
The Nemours Foundation	DE	Children's Hospital	$0	$104M
The Nemours Foundation	FL	Multi-Specialty Clinic/Center	$0	$46.2M
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
Jevs Human Services	DE	Adult Development & Aging Psychologist	$0	$84.4M
Christiana Care Home Health And Community Services, Inc.	DE	Home Health Agency	$0	$44.1M
Children's Dental Health Of Delaware - Wilmington, PA	DE	Pediatric Dentistry	$0	$8M
Medexpress, Inc - Delaware	DE	Family Medicine Physician	$0	$7.9M
Radnon Home Care LLC	DE	In Home Supportive Care Agency	$0	$6.5M
Delaware Cardiovascular Associates, P.A.	DE	Cardiovascular Disease Physician	$0	$5.4M
Concord Dental, LLC	DE	Dental Clinic/Center	$0	$4.2M
Christiana Care Health Services Inc	DE	Student Health Clinic/Center	$0	$3.9M
Dental Management Strategies LLC	DE	Dentist	$0	$2.9M
David Dieu Dmd, Md, PA	DE	Oral and Maxillofacial Surgery (Dentist)	$0	$2.9M

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