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

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

University Pediatric Associates, Inc. (NPI 1457396541)

Key Findings

Field	Value
Entity Type	Organization
Organization	University Pediatric Associates, Inc.
Address	705 Riley Hospital Dr
City	Indianapolis
State	IN
ZIP	46202
Taxonomy	Pediatrics Physician
NPI Enumerated	June 20, 2006

Payer Source	Total Paid
Medicaid	$98.3M
Medicare	$0

This provider is effectively single‑payer in the available dataset: there is no Medicare billing on file and all reported federal program revenue is Medicaid‑based, totaling $98.3M. Analysts should treat Medicaid as the primary commercial/payer exposure for this entity when assessing revenue risk and access to care for vulnerable populations.

Revenue is highly concentrated in a small set of services: the top 3 Medicaid codes account for 43.2% of total Medicaid revenue, led by 99472 ($17.9M, 19.1%), 99214 ($12.5M, 13.4%), and 99469 ($10M, 10.7%). This concentration means changes in reimbursement or utilization for neonatal critical care and higher‑level pediatric E/M visits could materially affect overall revenue.

The code mix indicates a pediatric practice heavily oriented toward neonatal and inpatient critical care as well as high‑complexity outpatient evaluation and management. High‑revenue neonatal/ICU codes (99472, 99469, 99468) and recovering low birth weight management codes (99480, 99479) appear alongside substantial volumes of advanced E/M codes (99214, 99215, 99204, 99205) and inpatient subsequent care (99232, 99233), which together suggest integrated inpatient NICU services plus a large ambulatory/consultative pediatric operation.

Operational volume is large and measurable in raw claim counts for top drivers: 99472 has 48.3K claims, 99214 has 115.7K claims, and 99469 has 29.3K claims. Those claim totals, paired with the dollar amounts reported, point to sustained, high throughput across both inpatient critical‑care encounters and frequent higher‑level outpatient visits.

Competitive standing within Indiana is strong and in many cases dominant: the provider ranks #1 in‑state for multiple high‑revenue pediatric codes (for example 99469, 99215, 99233, 99480, 99479, 93303 and others) and appears in the 100th percentile for several of those lines. Where the provider is #1 it is described as an extreme outlier or notably above typical state volume for many specialty pediatric services, indicating market leadership in neonatal critical care, complex inpatient E/M and pediatric cardiology imaging.

Several individual codes are flagged as statistical outliers compared with in‑state peers: 99214 is an "extreme outlier" at the 99th percentile, 99469 is an "extreme outlier" at the 100th percentile, and a cluster including 99215, 99233, 99480, 99479, 93303, 99204 and 99205 are also labeled as "extreme outlier" or notably above typical state volume. These labels signal utilization that is far above typical state peers for multiple complex pediatric services and should be a focus for network contracting and utilization review.

The provider shows breadth across specialty pediatric diagnostics and support services in addition to NICU and E/M work: high ranked echocardiography codes (93306, 93303, 93320) and sleep/respiratory testing codes (95782, 95810, 94375) appear among the top Medicaid revenue contributors. This mix suggests on‑site or closely affiliated pediatric cardiology and sleep/respiratory testing capabilities that complement inpatient and outpatient neonatal/pediatric care.

The provider has an established tenure: NPI enumeration is dated 2006-06-20 (~20 years ago). That longevity, together with sustained high volumes and multiple #1 in‑state rankings, indicates an entrenched pediatric service line that has been operating at scale in Indiana for many years.

Medicaid: Complete Services Breakdown

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

116 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	48,260	$370	$17.9M
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…	115,690	$110	$12.5M
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.	29,300	$340	$10M
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…	52,420	$140	$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…	71,980	$100	$6.8M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	56,040	$110	$5.9M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	42,970	$110	$4.8M
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…	29,620	$150	$4.4M
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	8,280	$400	$3.3M
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…	48,560	$70	$3.2M

Showing 1–10 of 116

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Indiana Distribution

University Pediatric Associates, Inc. — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

116 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	1,710	$370	$6.1M
31622	In this procedure, the provider performs diagnostic rigid or flexible bronchoscopy, a test to view airways and diagnose lung disease. He may or may not use fluoroscopic guidance to perform this test.…	3	10	970	$1,160	$1.6M
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.	320	380	2,470	$100	$1.5M
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.	280	360	3,490	$110	$1.5M
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.	1	10	340	$320	$899.7K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	1	10	520	$320	$716.5K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	498	580	710	$60	$582.9K
64642	The provider injects a chemical, such as Botox®, into one to four muscles of one extremity to relieve a patient's pain and spasms.	1	10	1,080	$470	$495.6K
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…	20	2,120	870	$60	$450.6K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	556	690	1,070	$80	$422.3K

Showing 1–10 of 116

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
University Physicians & Surgeons, Inc	WV	Internal Medicine Physician	$0	$58.3M
University Physicians & Surgeons, Inc.	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$9.4M
William Myer	WV	Oral and Maxillofacial Surgery (Dentist)	$0	$774.1K
Vishal Verma	WV	Ophthalmology Physician	$419.8K	$0
Robin Arora	WV	Nephrology Physician	$392.5K	$0
Jonathan Cuda	TN	Anatomic Pathology Physician	$326.7K	$0
Rabah Boukhemis	WV	Physical Medicine & Rehabilitation Physician	$210.6K	$0
Matthew Bullock	WV	Adult Reconstructive Orthopaedic Surgery Physician	$207.9K	$0
Cynthia Pinson	WV	Family Medicine Physician	$206.4K	$0
Alexander Caughran	WV	Orthopaedic Surgery Physician	$175.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Health And Hospital Corporation Of Marion County	IN	General Acute Care Hospital	$0	$231.6M
Indiana University Health Care Associates, Inc	IN	General Practice Physician	$0	$125.4M
Indiana University Health Inc	IN	General Acute Care Hospital	$0	$111.5M
Indiana University Health Inc	IN	Children's Hospital	$0	$75.6M
University Family Physicians, Inc.	IN	Family Medicine Physician	$0	$65.3M
Indiana University Radiology Associates, Inc.	IN	Diagnostic Radiology Physician	$0	$47.8M
The Health And Hospital Corporation Of Marion County	IN	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$46.9M
Icem-wishard LLC	IN	Emergency Medicine Physician	$0	$34.6M
The Health And Hospital Corporation Of Marion County	IN	Nurse Practitioner	$0	$30.1M
University Medical Diagnostic Associates, Inc.	IN	Internal Medicine Physician	$0	$28.3M

University Pediatric Associates, Inc. — Billing Profile & Reimbursement Data

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University Pediatric Associates, Inc. — 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