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

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

Kids 1st Pediatrics, LLC (NPI 1376090357)

Key Findings

Field	Value
Entity Type	Organization
Organization	Kids 1st Pediatrics, LLC
Address	23800 John T Reid Pkwy
City	Scottsboro
State	AL
ZIP	35768
Taxonomy	Pediatrics Physician
NPI Enumerated	September 7, 2016

Payer Source	Total Paid
Medicaid	$14.6M
Medicare	$0

KIDS 1ST PEDIATRICS, LLC reports no Medicare revenue on file and $14.6M in lifetime Medicaid revenue, making its observed billing effectively single-payer Medicaid in scope. The absence of Medicare activity suggests this entity’s reported practice focuses on pediatric Medicaid populations rather than dual Medicare/Medicaid caseloads.

Revenue is highly concentrated: the precomputed top three Medicaid codes together account for 93.0% of this provider’s total Medicaid revenue, with a single code, T1015, representing the lion’s share at $13M (89.1% of Medicaid revenue). This concentration indicates that a bundled clinic-encounter code is the principal revenue driver for the organization.

The code mix centered on T1015 (Clinic visit/encounter, all-inclusive) plus an array of diagnostic test codes (87633, 87804, 87880, 87811) and routine vaccine codes is consistent with a high-throughput pediatric primary care clinic that performs office visits alongside on-site infectious disease testing and immunization services. The heavy use of bundled clinic visit coding implies most services are billed as comprehensive encounters rather than a large number of high-reimbursement procedure codes.

Testing volume is a distinctive operational feature: 87880 (strep immunoassay) shows 16.9K claims and $219.2K revenue while ranking #24 of 680 providers in-state (97th percentile; notably above typical state volume), and 87804 (influenza immunoassay) has 12K claims with a 95th percentile rank (typical, unremarkable volume). These high claim counts and top-state percentiles for common respiratory tests indicate sizable on-site diagnostic throughput relative to peers.

COVID and molecular respiratory testing are also material to activity: 87811 (COVID immunoassay) reports 7.5K claims and $194.3K revenue, ranking #13 of 303 providers in-state (96th percentile; typical, unremarkable volume), while 87633 (multiplex viral nucleic acid testing) contributes $311.1K and ranks #30 of 98 (70th percentile; typical, unremarkable volume). Together these codes show the practice provides both point-of-care immunoassays and higher-complexity molecular testing services.

Visit-level E/M patterns show very large claim volume at low average payment per claim: 99213 appears with 45.3K claims ($2 avg paid/claim, $90.7K revenue) and ranks #32 of 1988 providers in-state (98th percentile; notably above typical state volume). This suggests the clinic logs substantial numbers of standard established-patient office visits, contributing significant clinical throughput though only modest revenue per encounter.

Immunization services are a consistent secondary revenue stream, aligned with pediatrics: DTaP 90700 (5.1K claims, $40.4K revenue) ranks #6 of 132 providers in-state (96th percentile; typical, unremarkable volume), and multiple other vaccine codes (90670, 90648, 90713, 90680, 90686, 90744, 90633, 90707, 90716, 90651) appear across the list at modest revenues and generally high state percentile ranks. These vaccine volumes reinforce that preventive pediatric care and routine childhood immunizations are core parts of the service mix.

Competitive standing is mixed: while T1015 drives almost all Medicaid revenue, the provider ranks #19 of 243 in-state for that code (93th percentile; typical, unremarkable volume), indicating it is a solid regional participant for clinic encounters but not a statewide dominant for that service. Conversely, the provider is a clear high-volume outlier for certain point-of-care tests (e.g., 87880 at the 97th percentile and 99213 at the 98th percentile), highlighting pockets of above-typical operational intensity within an otherwise typical pediatric Medicaid billing profile.

The provider’s NPI was enumerated on 2016-09-07 (~10 years ago), indicating an established presence in the market for roughly a decade; combined with the billing mix, this tenure aligns with a mature pediatric clinic model focused on Medicaid-covered preventive care, vaccinations, and respiratory testing services.

Medicaid: Complete Services Breakdown

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

52 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	75,900	$170	$13M
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	1,690	$180	$311.1K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	12,030	$20	$252.7K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	16,860	$10	$219.2K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	7,470	$30	$194.3K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	760	$170	$126K
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.	1,520	$60	$95.4K
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…	45,340	$1	$90.7K
90700	This code represents a DTaP vaccine product administered into the muscle to protect against diphtheria, tetanus, and pertussis (whooping cough). It is used for children younger than 7 years of age.	5,050	$10	$40.4K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	3,430	$10	$37.7K

Showing 1–10 of 52

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

Kids 1st Pediatrics, LLC — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

52 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	19	240	6,820	$120	$2.9M
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	30	100	470	$130	$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…	367	1,990	680	$60	$201.7K
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…	32	1,990	560	$40	$185.6K
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…	52	270	1,360	$60	$159.7K
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…	57	300	1,160	$50	$147.8K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	62	80	220	$70	$103.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	78	320	640	$50	$98.1K
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…	162	200	170	$50	$60.5K
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.	54	230	410	$40	$59.2K

Showing 1–10 of 52

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sunny Horizons, LLC	AL	Speech-Language Pathologist	$0	$7.3M
New Beacon Healthcare Group, LLC	AL	Community Based Hospice Care Agency	$0	$6.2M
American Drug Testing Lab LLC	AL	Clinical Medical Laboratory	$0	$5.4M
Scottsboro Pediatrics PC	AL	Primary Care Clinic/Center	$0	$4M
Northeast Alabama Health Services, Inc	AL	Federally Qualified Health Center (FQHC)	$0	$3.7M
Premier Medical Clinic LLC	AL	Multi-Specialty Clinic/Center	$0	$3.6M
Valley Medical Clinic LLC	AL	Rural Health Clinic/Center	$0	$1.6M
Hh Health System - Jackson LLC	AL	Land Ambulance	$934.4K	$406K
Scottsboro Ent, PC	AL	Otolaryngology Physician	$0	$1.2M
Adl Occupational Therapy, LLC	AL	Occupational Therapist	$0	$1.1M

Kids 1st Pediatrics, LLC — Billing Profile & Reimbursement Data

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Kids 1st Pediatrics, 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

Nearby Providers

Frequently Asked Questions

References