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

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

Knoxville Pediatric Associates, P.C. (NPI 1407946312)

Knoxville Pediatric Associates, P.C. is a pediatrics physician provider located in Knoxville, Tennessee. This profile covers 0 Medicare and 48 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Knoxville Pediatric Associates, P.C.
Address	2201 W Clinch Ave
City	Knoxville
State	TN
ZIP	37916
Taxonomy	Pediatrics Physician
NPI Enumerated	October 13, 2006

Payer Source	Total Paid
Medicaid	$6.1M
Medicare	$0

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

48 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…	80,620	$50	$3.6M
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.	16,500	$50	$792K
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…	7,520	$70	$534.1K
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…	5,580	$80	$423.7K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	2,630	$40	$110.5K
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…	1,620	$70	$108.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,170	$70	$85.4K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	2,320	$30	$67.3K
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…	830	$80	$63.2K
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.	5,180	$10	$57K

Showing 1–10 of 48

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Knoxville Pediatric Associates, P.C. — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

48 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	52	610	1,220	$40	$206K
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…	1,228	3,760	610	$40	$202.3K
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…	66	520	470	$70	$187K
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	4,050	620	$30	$183.9K
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…	50	480	580	$60	$174.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	136	510	240	$70	$133.7K
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…	70	200	300	$60	$106K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	193	620	740	$20	$88.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	251	420	150	$80	$81.8K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	48	200	380	$30	$80.6K

Showing 1–10 of 48

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Summit Medical Group, PLLC	TN	Internal Medicine Physician	$0	$44.5M
Michael Watterson	NC	Rheumatology Physician	$669.3K	$2.6K
Nila Alsheik	IL	Diagnostic Radiology Physician	$332.8K	$300.3K
Jeffrey Summers	TN	Internal Medicine Physician	$624.1K	$0
David Szczesniak	OH	Diagnostic Radiology Physician	$588.2K	$0
Joshua Kellerman	NJ	Diagnostic Radiology Physician	$525K	$0
Matthew Lowrance	TN	Retina Specialist (Ophthalmology) Physician	$502.4K	$0
John D'souza	OH	Diagnostic Radiology Physician	$470.9K	$0
Nzeadibenma Uzochukwu	IL	Diagnostic Radiology Physician	$84K	$360.8K
Fred Sammons	TN	Internal Medicine Physician	$415.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
East Tennessee Children's Hospital Association, Inc.	TN	Children's Hospital	$0	$88.6M
Fort Sanders Perinatal Center	TN	Maternal & Fetal Medicine Physician	$0	$46.5M
East Tennessee Children's Primary Care Center, Inc.	TN	Pediatrics Physician	$0	$31.4M
Fort Sanders Regional Medical Center	TN	General Acute Care Hospital	$0	$26.8M
Vista Radiology, PC.	TN	Diagnostic Radiology Physician	$0	$10.7M
Allergy & Asthma Affiliates, PC	TN	Allergy & Immunology Physician	$0	$7M
American Anesthesiology Of Tennessee, P.C.	TN	Certified Registered Nurse Anesthetist	$0	$4.9M
Dba: Dolly Parton Children's Hospital Cardiology	TN	Pediatric Cardiology Physician	$0	$3.5M
Knoxville Pediatric Ophthalmology, PLLC	TN	Ophthalmology Physician	$0	$3.3M
East Tennessee Children's Hospital Association, Inc.	TN	Pediatric Pulmonology Physician	$0	$2.6M

Knoxville Pediatric Associates, P.C. — Billing Profile & Reimbursement Data

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Knoxville Pediatric Associates, P.C. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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