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

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

Specialty Care Pediatrics, Inc. (NPI 1477034395)

Field	Value
Entity Type	Organization
Organization	Specialty Care Pediatrics, Inc.
Address	2256 Nw 164th Street
City	Edmond
State	OK
ZIP	73013
Taxonomy	Home Health Agency
NPI Enumerated	August 28, 2018

Payer Source	Total Paid
Medicaid	$44.8M
Medicare	$0

Key Findings

SPECIALTY CARE PEDIATRICS, INC. is registered as a Home Health Agency in Edmond, OK and its NPI was enumerated on 2018-08-28 (~8 years ago), indicating roughly eight years of enrollment in federal programs and time to establish payer relationships and operational workflows. This tenure supports the observed high cumulative Medicaid billing over multiple years rather than a short-term spike in activity.

This provider has no Medicare billing on file and reports Total Medicare revenue: none, while Total Medicaid revenue is $44.8M; operationally and financially it is effectively single-payer (Medicaid) from the claims data available. Analysts should treat Medicaid policy and contract changes as the primary drivers of the provider’s revenue performance.

Revenue concentration is extreme: the precomputed top-3 Medicaid codes account for 100.0% of the provider’s Medicaid revenue, and the single listed code T1000 itself is reported as accounting for $44.8M (100.0% of this provider's total Medicaid revenue). This level of single-code dependency indicates that nearly all billing is tied to one service line and creates exposure to coding, rate, or utilization-management changes specific to that code.

The dominant billing code is T1000 (Private duty / independent nursing service(s) - licensed, up to 15 minutes), with 111.7K claims and a $401 avg paid/claim. That mix is consistent with a high-frequency, short-visit private duty nursing model—likely home-based pediatric skilled nursing given the provider name—and suggests staffing and scheduling optimized around many brief visits rather than fewer extended encounters.

In-state competitive standing for T1000 is solid but not monopolistic: this provider ranks #2 of 9 providers in-state (88th percentile), which positions it as a leading regional participant for this service line. Notably, the dataset characterizes its volume for this code as a "typical, unremarkable volume for this code," so while the provider is near the top of the local ranked list, its activity falls within the common range for the code across peers.

Operational scale and unit economics are visible in the claims-level metrics: 111.7K claims at a $401 avg paid/claim generate the reported $44.8M in Medicaid revenue, pointing to a high-transaction model where aggregate revenue is driven by claim count rather than high per-encounter payments. This pattern has implications for workforce planning, routing, and billing operations that must reliably handle large volumes of short encounters.

From a payer risk and contracting perspective, the provider’s dependence on a single Medicaid code (T1000) concentrates utilization risk: any reimbursement changes, medical necessity policies, or prior authorization rules targeting private duty nursing could materially affect the provider’s revenue. Analysts should prioritize monitoring policy changes for T1000 and assessing whether the provider has alternative service lines or diversification strategies, since the current dataset shows no Medicare activity and no other Medicaid revenue streams on file.

Medicaid: Complete Services Breakdown

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

1 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1000	Private duty / independent nursing service(s) - licensed, up to 15 minutes	111,680	$400	$44.8M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oklahoma Distribution

Specialty Care Pediatrics, Inc. — 0 of 1 code billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oklahoma

Full comparison — all codes billed, vs. Oklahoma median

1 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1000	Private duty / independent nursing service(s) - licensed, up to 15 minutes	2	10	25,530	$350	$24.3M

Nearby Providers

Other providers in the same ZIP code as Specialty Care Pediatrics, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Medical Resource Management, LLC	OK	Urgent Care Clinic/Center	$0	$14.9M
Oklahoma Arthritis Center, P.C.	OK	Rheumatology Physician	$0	$10.1M
Craig Carson	OK	Rheumatology Physician	$9.7M	$0
Sand Lily Healthcare, Inc.	OK	In Home Supportive Care Agency	$0	$8.9M
Christopher Fisher	OK	Internal Medicine Physician	$7.6M	$0
Summit Medical Center	OK	General Acute Care Hospital	$0	$7.1M
Brian Phelps	OK	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Ana Kumar	OK	Rheumatology Physician	$4.1M	$0
Sandeep Shah	OK	Retina Specialist (Ophthalmology) Physician	$3.9M	$0
Ryan Ridges	OK	Retina Specialist (Ophthalmology) Physician	$3.6M	$0

Specialty Care Pediatrics, Inc. — Billing Profile & Reimbursement Data

Sign up for Specialty Care Pediatrics, Inc. — Billing Profile & Reimbursement Data policy alerts

Specialty Care Pediatrics, Inc. — Billing Profile & Reimbursement Data

Sign up for Specialty Care Pediatrics, Inc. — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References