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

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

Sanjay Kandoth Md PC (NPI 1487824223)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sanjay Kandoth Md PC
Address	3061 S Maryland Pkwy Ste 101
City	Las Vegas
State	NV
ZIP	89109
Taxonomy	Pediatrics Physician
NPI Enumerated	March 7, 2008

Payer Source	Total Paid
Medicaid	$14.6M
Medicare	$0

SANJAY KANDOTH MD PC is effectively a Medicaid-focused pediatric practice: there is no Medicare billing on file and total Medicaid revenue reported is $14.6M, which makes Medicaid the sole payer of record for the data provided. This profile should be treated as a single-payer (Medicaid) operation for competitive and utilization analysis in Nevada.

Revenue is heavily concentrated in a small set of pediatric primary-care services: the top three Medicaid codes — 99213 ($4.1M, 28.5%), 90460 ($2.3M, 15.7%), and 99391 ($2.1M, 14.5%) — together account for 58.7% of the provider's total Medicaid revenue. This concentration indicates that a majority of the practice’s revenue is driven by routine office visits, vaccine administrations, and preventive well-child care.

The code mix and volumes describe a high-volume pediatric primary care model: 99213 shows 70K claims with a $59 avg paid/claim, 90460 shows 46.5K claims with a $49 avg paid/claim, and 99391 shows 24.4K claims with an $86 avg paid/claim. These figures point to a throughput-oriented clinic that delivers frequent low-to-moderate–complexity E/M visits, routine immunizations, and comprehensive preventive visits as core services.

Competitive standing within Nevada is dominant for many pediatric services: 99213 ranks #4 of 2476 providers in-state (100th percentile; extreme outlier), 90460 ranks #2 of 310 (100th percentile; extreme outlier), and 99391 ranks #2 of 296 (100th percentile; extreme outlier). Across multiple top codes the provider sits at or near the top percentile, indicating statewide leadership in billed volume for key pediatric visit and immunization services.

Operational economics appear driven by high visit volumes with modest per-claim payments: major codes show relatively low avg paid/claim amounts (for example, 99213 $59 and 99212 $33) combined with very large claim counts (70K and 22.2K respectively). That mix is consistent with a business model that relies on scale—large patient panels and frequent preventive or problem-focused visits—rather than high-acuity or high-reimbursement procedures.

The provider also offers significant newborn and minor-procedure services, expanding beyond outpatient office care: 99460 (newborn evaluation) shows 4.8K claims and $407.9K revenue and ranks #1 of 71 in-state (100th percentile; extreme outlier), while 54150 (circumcision) shows 1K claims and $110.6K revenue and ranks #1 of 13 (100th percentile; extreme outlier). These entries indicate an active role in perinatal and newborn hospital care as well as in-office procedural services that add to Medicaid revenue diversity.

Multiple ancillary testing and prevention codes also register exceptionally high volumes for the state: 87804 (influenza test) 26.2K claims $235.4K revenue (rank #3, 99th percentile; extreme outlier), 87880 (strep test) 16.1K claims $128.6K revenue (rank #3, 99th percentile; extreme outlier), and 99188 (fluoride) 4.5K claims $54.4K revenue (91st percentile; typical, unremarkable). This pattern reinforces a broad service mix that includes point-of-care diagnostics and preventive interventions tied to pediatric office workflows.

The NPI was enumerated on 2008-03-07 (~18 years ago), signaling an established presence in the market; when combined with the provider’s high percentile ranks across many codes, this tenure suggests entrenched referral patterns and a sustained Medicaid patient base. For payers and network planners, the provider represents a longstanding, high-capacity pediatric practice with concentrated Medicaid exposure and leading statewide volumes for core pediatric services.

Medicaid: Complete Services Breakdown

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

69 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…	70,040	$60	$4.1M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	46,470	$50	$2.3M
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	24,370	$90	$2.1M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	17,490	$90	$1.5M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10,940	$90	$940.5K
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,…	22,170	$30	$731.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,590	$90	$431.2K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	4,800	$90	$407.9K
99058	The provider renders emergency services to a patient in the provider’s office during regular office hours without an appointment and ahead of other scheduled patients.	21,650	$20	$368K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	4,800	$70	$312.2K

Showing 1–10 of 69

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nevada Distribution

Sanjay Kandoth Md PC — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nevada

Full comparison — all codes billed, vs. Nevada median

69 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	261	430	500	$40	$214.4K
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…	542	2,250	290	$60	$138K
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…	4	2,480	330	$50	$107.6K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	2	300	280	$80	$103.8K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3	300	240	$80	$97.1K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	2	310	410	$40	$95K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4	270	170	$80	$70.6K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	20	30	320	$30	$67.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	9	220	130	$80	$57K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	8	90	290	$20	$51.8K

Showing 1–10 of 69

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sunrise Hospital And Medical Center, LLC	NV	General Acute Care Hospital	$0	$85.9M
Fremont Emergency Services Scherr Ltd	NV	Emergency Medicine Physician	$0	$20.9M
Sunrise Hospital And Medical Center, LLC	NV	General Acute Care Hospital	$0	$17.1M
Sdmi, LLC	NV	Diagnostic Radiology Physician	$0	$14.3M
Harold Zilberman M D Chtd	NV	Pediatrics Physician	$0	$14.3M
Radiology Specialists Ltd Marasso-miller	NV	Diagnostic Radiology Physician	$0	$13.9M
1st Love & Life Caregivers, LLC	NV	In Home Supportive Care Agency	$0	$10.8M
Childrens Lung Specialists	NV	Pediatric Pulmonology Physician	$0	$8.6M
Jlk Home Care, Inc	NV	In Home Supportive Care Agency	$0	$5.1M
Elsa Home Care Inc	NV	In Home Supportive Care Agency	$0	$4.8M

Sanjay Kandoth Md PC — Billing Profile & Reimbursement Data

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Sanjay Kandoth Md PC — 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