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.

East Tennessee Children's Hospital Association, Inc. (NPI 1427134691)

Field	Value
Entity Type	Organization
Organization	East Tennessee Children's Hospital Association, Inc.
Address	2018 Clinch Ave
City	Knoxville
State	TN
ZIP	37916
Taxonomy	Pediatric Anesthesiology Physician
NPI Enumerated	October 31, 2006

Payer Source	Total Paid
Medicaid	$2.5M
Medicare	$0

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	15,660	$150	$2.4M
00126	The provider performs anesthesia services for a patient undergoing procedures on the external, middle, and inner ear including biopsy and tympanotomy.	700	$90	$61.9K
00813	The anesthesia provider performs anesthesia services for a patient undergoing both upper and lower intestinal endoscopy where the surgical provider introduces an endoscope into the intestines above…	440	$120	$54.8K
00731	The anesthesia provider performs anesthesia services for an unspecified type of upper gastrointestinal endoscopic procedure during which another provider introduces the endoscope to but not beyond…	190	$120	$23.6K
00920	The provider performs anesthesia services for a patient undergoing a procedure on male genitalia that is not specified by any other anesthesia code. As part of the procedure, the provider may incise…	30	$160	$5.4K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	80	$50	$3.6K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	30	$20	$780
99140	This code, describing emergency conditions, is a qualifying circumstance CPT code. This add–on code, used along with a primary anesthesia procedure code, is applied only in cases when application of…	20	$20	$400
99100	This code, depicting the "age criteria", is a qualifying circumstance CPT. This is an add–on code, used along with a primary anesthesia procedure code, and is applied only in cases when the patient's…	30	$10	$360

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

East Tennessee Children's Hospital Association, Inc. — 1 of 9 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

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	2	60	110	$130	$236.7K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	648	840	440	$20	$73K
00920	The provider performs anesthesia services for a patient undergoing a procedure on male genitalia that is not specified by any other anesthesia code. As part of the procedure, the provider may incise…	4	10	60	$90	$48.4K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	225	260	280	$20	$35.4K
00731	The anesthesia provider performs anesthesia services for an unspecified type of upper gastrointestinal endoscopic procedure during which another provider introduces the endoscope to but not beyond…	30	60	170	$60	$31.8K
00126	The provider performs anesthesia services for a patient undergoing procedures on the external, middle, and inner ear including biopsy and tympanotomy.	3	20	70	$70	$21.1K
00813	The anesthesia provider performs anesthesia services for a patient undergoing both upper and lower intestinal endoscopy where the surgical provider introduces an endoscope into the intestines above…	2	20	30	$140	$17.4K
99100	This code, depicting the "age criteria", is a qualifying circumstance CPT. This is an add–on code, used along with a primary anesthesia procedure code, and is applied only in cases when the patient's…	4	10	20	$20	$2.9K
99140	This code, describing emergency conditions, is a qualifying circumstance CPT code. This add–on code, used along with a primary anesthesia procedure code, is applied only in cases when application of…	5	10	30	$40	$1.3K

Related Providers

Other providers that share a Tax Identification Number (TIN) with East Tennessee Children's Hospital Association, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
East Tennessee Children's Hospital Association, Inc.	TN	Children's Hospital	$0	$88.6M
East Tennessee Children's Hospital Association, Inc	TN	Durable Medical Equipment & Medical Supplies	$0	$20.3M
Dba: Dolly Parton Children's Hospital Cardiology	TN	Pediatric Cardiology Physician	$0	$3.5M
East Tennessee Children's Hospital Association, Inc.	TN	Pediatric Pulmonology Physician	$0	$2.6M
Larry Patterson	TN	Ophthalmology Physician	$929.6K	$0
Michael Moore	TN	Certified Registered Nurse Anesthetist	$22.4K	$0
Catherine Ramsey	MS	Certified Registered Nurse Anesthetist	$17.1K	$0

Nearby Providers

Other providers in the same ZIP code as East Tennessee Children's Hospital Association, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
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
Knoxville Pediatric Associates, P.C.	TN	Pediatrics Physician	$0	$6.1M
American Anesthesiology Of Tennessee, P.C.	TN	Certified Registered Nurse Anesthetist	$0	$4.9M
Knoxville Pediatric Ophthalmology, PLLC	TN	Ophthalmology Physician	$0	$3.3M
Innovative Pathology Services PLLC	TN	Anatomic Pathology & Clinical Pathology Physician	$0	$2.5M
East Tennessee Pediatric Cardiology, P.C.	TN	Pediatric Cardiology Physician	$0	$2.5M

East Tennessee Children's Hospital Association, Inc. — Billing Profile & Reimbursement Data

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East Tennessee Children's Hospital Association, Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References