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

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

Night Lite Pediatric Center, LLC (NPI 1407974579)

Key Findings

Field	Value
Entity Type	Organization
Organization	Night Lite Pediatric Center, LLC
Address	620 S Hunt Club Blvd
City	Apopka
State	FL
ZIP	32703
Taxonomy	Pediatrics Physician
NPI Enumerated	March 27, 2007

Payer Source	Total Paid
Medicaid	$38.8M
Medicare	$0

This provider is effectively a single-payer Medicaid operation: there is no Medicare billing on file and lifetime Medicaid revenue is $38.8M, indicating the practice’s scale and reimbursement exposure are tied to Medicaid. The absence of Medicare activity means analyses should focus on Medicaid payer dynamics and state-level competition rather than national Medicare benchmarking.

Revenue is heavily concentrated in a small set of outpatient evaluation-and-management codes: the top 3 Medicaid codes (99213, 99203, 99214) account for 76.0% of this provider's total Medicaid revenue, with 99213 alone generating $15.5M (39.9%), 99203 producing $8.4M (21.5%), and 99214 contributing $5.7M (14.6%). This concentration signals that a few visit types drive most clinical revenue and that changes in utilization or reimbursement for those codes would materially affect total revenue.

The clinical mix implies a high-volume pediatric ambulatory and urgent-care model: the leading codes are 99213, 99203, and 99214 — all office/outpatient E/M visits for new and established patients — which suggests routine primary care and same-day urgent visits are the core services delivered. Complementary codes such as S9083 (global fee urgent care centers) and 99050 (after-hours office services) further support an operational model oriented to walk-in or extended-hours pediatric care.

This provider is a dominant statewide performer for several high-volume E/M codes: 99213 ranks #8 of 5934 providers in-state (100th percentile; extreme outlier) and 99203 ranks #2 of 1673 providers in-state (100th percentile; extreme outlier), indicating unusually large volumes compared with peers. 99214 ranks #41 of 6379 (99th percentile; notably above typical), which places the practice well above typical state volume across both new- and established-patient visits.

Operational patterns show heavy after-hours and urgent-care utilization: 99050 has 126.9K claims and $888.4K revenue (2.3%) and ranks #1 of 106 providers in-state (100th percentile; extreme outlier), while S9083 accounts for 20.3K claims and $2.7M revenue (6.9%) and ranks #10 of 133 providers (93th percentile; typical, unremarkable). Together these codes indicate substantial delivery of care outside standard office hours and a meaningful urgent-care component within the practice.

High-throughput diagnostic testing is present but contributes modestly to revenue: influenza and SARS-CoV-2 related codes such as 87804 (60.4K claims, $362.3K, 0.9%), U0002 (22.4K claims, $223.8K, 0.6%), 87426 (53.2K claims, $106.5K, 0.3%), and 87880 (55.8K claims, $55.8K, 0.1%) are all state-level extreme outliers in claim volume. The combination of very high claim counts and low average paid/claim suggests a throughput-heavy testing workflow that supports the high E/M visit volume but does not materially shift overall revenue distribution.

Tenure and scale: the NPI was enumerated 2007-03-27 (~19 years ago), indicating an established presence in the market that has grown to large Medicaid volumes over time. The long enumeration combined with extreme state-level ranks on core E/M codes is consistent with a stable, mature ambulatory pediatric center rather than a newly formed clinic.

Analyst implications: because Medicaid revenue is concentrated in a few E/M codes and the provider is an extreme outlier statewide on multiple high-volume codes, further investigation of market share drivers, visit mix, and coding consistency is warranted for competitive benchmarking and financial modeling. Reviewers should prioritize state-level comparisons for 99213, 99203, and 99214 and consider the operational impact of after-hours and high-throughput testing on capacity and cost structure.

Medicaid: Complete Services Breakdown

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

53 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…	135,730	$110	$15.5M
99203	The provider sees a new 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 provider…	67,380	$120	$8.4M
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…	48,000	$120	$5.7M
S9083	Global fee urgent care centers	20,290	$130	$2.7M
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	14,380	$140	$2M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	15,120	$130	$1.9M
99204	The provider sees a new 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 provider…	7,420	$130	$949.1K
99050	In this procedure, the provider renders services to a patient in his office at a time when that office would otherwise be closed.	126,910	$10	$888.4K
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.	60,390	$10	$362.3K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	22,380	$10	$223.8K

Showing 1–10 of 53

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Florida Distribution

Night Lite Pediatric Center, LLC — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Florida

Full comparison — all codes billed, vs. Florida median

53 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S9083	Global fee urgent care centers	10	130	680	$90	$517.2K
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	5,930	460	$40	$169.3K
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…	41	6,380	430	$50	$139.3K
99204	The provider sees a new 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 provider…	26	1,850	90	$110	$71.5K
99203	The provider sees a new 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 provider…	2	1,670	90	$80	$69.2K
S0119	Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code)	14	30	930	$50	$60.1K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,290	1,330	340	$10	$54.3K
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.	161	590	130	$40	$51.9K
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…	278	650	380	$20	$47.9K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	334	610	690	$10	$41K

Showing 1–10 of 53

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Total Renal Care Inc	FL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$9.6M
Huntclub Pediatric Associates, LLC	FL	Pediatrics Physician	$0	$9.1M
Athena Theodosatos	FL	Dermatology Physician	$728.2K	$5.3K
Paul Neuman	FL	Nurse Practitioner	$656.8K	$7.2K
Michael Gordon	FL	Internal Medicine Physician	$343.7K	$0
Pinida Toochinda	FL	Internal Medicine Physician	$296.9K	$0
Vishal Dahya	FL	Cardiovascular Disease Physician	$183.1K	$0
Cesar Bonilla Isaza	FL	Cardiovascular Disease Physician	$171.1K	$0
Emery Medical Solutions Inc	FL	Diagnostic Radiology Physician	$119.9K	$42.2K
Addam Masri	FL	Family Medicine Physician	$105.8K	$0

Night Lite Pediatric Center, 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