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

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

The Nemours Foundation (NPI 1467505073)

Field	Value
Entity Type	Organization
Organization	The Nemours Foundation
Address	1600 Rockland Rd
City	Wilmington
State	DE
ZIP	19803
Taxonomy	Children's Hospital
NPI Enumerated	January 18, 2007

Payer Source	Total Paid
Medicaid	$104M
Medicare	$0

Key Findings

THE NEMOURS FOUNDATION’s billing footprint in the dataset is effectively single‑payer: there is no Medicare billing on file and all recorded inpatient/outpatient activity in this view is Medicaid‑paid with total Medicaid revenue of $104M. This means analysts should treat the provider as operating primarily within the Medicaid population for these payer‑level comparisons rather than as a mixed Medicare/Medicaid provider.

Revenue is highly concentrated in emergency department evaluation & management codes: the top three Medicaid revenue drivers are 99283 (32.5%), 99284 (11.6%), and 99285 (7.7%), and those three codes together account for 51.8% of the provider’s Medicaid revenue. That concentration signals that a majority of Medicaid dollars flow through ED E/M activity rather than dispersed outpatient clinic or physician office codes.

Code‑level volumes confirm an ED‑centric operational model: 99283 shows 92.7K claims with $277 avg paid/claim and $25.7M revenue, 99284 has 22.9K claims with $401 avg paid/claim and $9.2M revenue, 99285 totals 11.5K claims with $527 avg paid/claim and $6.1M revenue, and 99282 contributes 35.3K claims and $4.3M. Presence of G0378 (6.6K claims, $452 avg, $3M revenue) further suggests use of an observation service tied to ED throughput rather than only short ambulatory visits.

Beyond emergency care, the provider maintains sizable pediatric specialty and procedural services: multiple echocardiography codes (93306, 93303, 93325, 93320) and MRI brain (70551) together generate multimillion‑dollar Medicaid revenue lines, while ENT and surgical pediatric procedures appear in the top list (69436 tympanostomy $2.1M; 42820 tonsil/adenoid $667.6K). A relatively large dental/operative code 41899 (365 claims, $5807 avg, $2.1M revenue) and endoscopy code 43239 ($1M revenue) indicate operating room and specialty procedure capacity beyond routine ED care.

Therapies and developmental services are a material component of activity: 97530 (39.2K claims, $2.8M revenue) and 97110 (26.9K claims, $1.8M revenue) are both high‑volume therapy codes with state percentiles at or near the top (#4 of 79, 96th percentile and #5 of 92, 96th percentile respectively). Audiology and speech/swallowing services are also concentrated—92507 (22.4K claims, $2.1M, ranks #3 of 27, 92th percentile) and 92526 (8.2K claims, $741.8K, ranks #1 of 9, 100th percentile)—pointing to substantial outpatient rehabilitative and developmental programs.

Several individual codes stand out for above‑typical state volume or top in‑state rank: 92526 is ranked #1 of 9 (100th percentile) and 0241U ranks #2 of 12 (91th percentile) and 94640 ranks #2 of 24 (96th percentile), each described as notably above typical state volume. Conversely, some large revenue items are described as typical or unremarkable in state context (for example, 99283 is ranked #4 of 26, 88th percentile, and J1745 is #1 of 3, 100th percentile but noted as typical), indicating high absolute volume without clear monopoly positioning statewide.

Per‑claim dollar outliers concentrate non‑ED revenue into a few high‑cost services: 41899 averages $5807 paid/claim, J1745 averages $1467 paid/claim, and 95810 averages $1457 paid/claim. These high per‑claim payments mean smaller claim counts can still generate multi‑million dollar revenue lines, so surgical, infusion/biologic, and sleep study services materially influence the provider’s Medicaid revenue mix.

The provider has long tenure in the available enrollment data, with NPI enumeration recorded as 2007-01-18 (~19 years ago), indicating an established pediatric hospital presence. Coupled with the Medicaid‑only revenue footprint here and the code mix (ED, observation, specialty imaging, surgery, and high‑volume therapy services), the profile is consistent with a longstanding children’s hospital that serves a large Medicaid pediatric population in Delaware and maintains broad specialty and rehabilitative programing rather than a Medicare‑focused or adult specialty business model.

Medicaid: Complete Services Breakdown

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

388 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	92,750	$280	$25.7M
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.	22,850	$400	$9.2M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	11,540	$530	$6.1M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	35,290	$120	$4.3M
G0378	Hospital observation service, per hour	6,600	$450	$3M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	39,190	$70	$2.8M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	3,120	$760	$2.4M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	3,730	$590	$2.2M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2,640	$800	$2.1M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	370	$5,810	$2.1M

Showing 1–10 of 388

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

The Nemours Foundation — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

388 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	4	30	11,180	$110	$3.4M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	2	10	6,010	$460	$2.8M
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.	11	40	770	$110	$1.9M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1	10	580	$2,340	$1.6M
G0378	Hospital observation service, per hour	4	10	6,600	$190	$1.5M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	11	30	1,350	$110	$1.5M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	2	20	4,570	$120	$1.4M
93320	The provider performs a complete Doppler echocardiography, which uses high–frequency sound waves to create a two–dimensional image of the heart, while the use of Doppler technology allows…	2	10	6,120	$210	$1.3M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	4	10	350	$2,060	$1.2M
99281	The provider sees a patient for the lowest level emergency department visit.	10	10	110	$130	$1M

Showing 1–10 of 388

Related Providers

Other providers that share a Tax Identification Number (TIN) with The Nemours Foundation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Nemours Foundation	DE	Multi-Specialty Clinic/Center	$0	$172M
The Nemours Foundation	FL	Children's Hospital	$0	$104.9M
The Nemours Foundation	FL	Multi-Specialty Clinic/Center	$0	$46.2M
Nemours Children's Health, Downtown Orlando, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$44.4M
Nemours Children's Health, Jacksonville, Specialty Care	FL	Multi-Specialty Clinic/Center	$0	$23.6M
Sedigheh Ebadi	FL	Pediatrics Physician	$0	$10.1M
Children's Health Alliance, LLC	FL	Pediatrics Physician	$0	$9.6M
Michael Klufas	PA	Ophthalmology Physician	$7M	$0
Richard Kaiser	PA	Ophthalmology Physician	$6.6M	$0
Carl Regillo	PA	Ophthalmology Physician	$6.5M	$0

Nearby Providers

Other providers in the same ZIP code as The Nemours Foundation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jevs Human Services	DE	Adult Development & Aging Psychologist	$0	$84.4M
Christiana Care Home Health And Community Services, Inc.	DE	Home Health Agency	$0	$44.1M
Children's Dental Health Of Delaware - Wilmington, PA	DE	Pediatric Dentistry	$0	$8M
Medexpress, Inc - Delaware	DE	Family Medicine Physician	$0	$7.9M
Radnon Home Care LLC	DE	In Home Supportive Care Agency	$0	$6.5M
Delaware Cardiovascular Associates, P.A.	DE	Cardiovascular Disease Physician	$0	$5.4M
Concord Dental, LLC	DE	Dental Clinic/Center	$0	$4.2M
Christiana Care Health Services Inc	DE	Student Health Clinic/Center	$0	$3.9M
Dental Management Strategies LLC	DE	Dentist	$0	$2.9M
David Dieu Dmd, Md, PA	DE	Oral and Maxillofacial Surgery (Dentist)	$0	$2.9M

The Nemours Foundation — 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