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

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

Utah Valley Pediatrics L.L.C. (NPI 1497812721)

Key Findings

Field	Value
Entity Type	Organization
Organization	Utah Valley Pediatrics L.L.C.
Address	1355 N University Ave
City	Provo
State	UT
ZIP	84604
Taxonomy	Pediatrics Physician
NPI Enumerated	January 3, 2007

Payer Source	Total Paid
Medicaid	$11.9M
Medicare	$0

This provider reports no Medicare billing on file and $11.9M in lifetime Medicaid revenue, making the practice effectively single‑payer (Medicaid) in scale; that concentration creates direct exposure to Medicaid policy and rate changes for pediatric services. The provider’s NPI was enumerated 2007-01-03 (~19 years ago), indicating long tenure in the market that aligns with the high cumulative Medicaid volume.

Revenue concentration is highly focused: the precomputed top 3 Medicaid codes account for 76.3% of this provider’s total Medicaid revenue, driven primarily by 99213 ($6.2M, 96.1K claims, $65 avg paid/claim; 53.0% of total), 99391 ($1.5M, 22.7K claims, $68 avg paid/claim; 13.1% of total), and 99214 ($1.2M, 14.8K claims, $81 avg paid/claim; 10.2% of total). This heavy reliance on a small set of E/M and preventive codes indicates that routine office visits and well-child care are the primary revenue engines.

The code mix signals a high-volume pediatric primary care and preventive practice: dominant codes include E/M visits 99213, 99214 and preventive medicine 99391, 99392, 99393, alongside very large vaccine administration volumes such as 90471 (47.4K claims) and 90472 (21.4K claims). These volumes, together with frequent developmental and behavioral screens (96110: 37.9K claims; 96127: 14.3K claims) and vision screening 99177 (18.3K claims), are consistent with a clinic workflow focused on routine well-child visits, immunization delivery, and standardized screening.

Competitive standing in-state is strong and concentrated: the provider ranks at or near the top for many pediatric codes—99213 ranks #2 of 1355 providers (100th percentile; extreme outlier), 99391 ranks #1 of 218 (100th percentile; extreme outlier), and 99392 ranks #1 of 194 (100th percentile; extreme outlier). Multiple other codes (99393, 90471, 90472, 90460, 90461, 96110, 96127, 99177) are also ranked in the 99–100th percentile, indicating the provider is a dominant volume leader for routine pediatric services statewide.

Beyond office-based E/M and preventive care, the provider bills for diagnostic testing and acute visit services: 87651 (Strep A) appears at 10.4K claims for $238.4K revenue (rank #2 of 47, 98th percentile) and 87635 (SARS‑CoV‑2 testing) at 2.9K claims for $49.6K revenue (rank #5 of 74, 95th percentile). These test volumes, together with relatively high counts for influenza multiplex testing 87502 and vaccine product codes (90686), show the practice routinely manages acute infectious presentations and on-site testing as part of its ambulatory pediatric care.

The practice also delivers newborn and inpatient-adjacent care at measurable volume: 99460 ($68.2K, 1K claims, rank #2 of 26, 96th percentile), 99463 ($20.6K, 261 claims, rank #1 of 4, 100th percentile), and 99238 ($54.8K, 996 claims) are present in the top code list. Inclusion of these codes indicates the group’s service scope extends beyond routine outpatient visits into newborn hospital encounters and discharge management, suggesting either close affiliation with local birth centers/hospitals or pediatricists who provide perinatal coverage.

Several lower-revenue procedure and minor surgery codes appear (17110, 99381) and 99203 new-patient visits (439 claims), which together with the very large established-patient volumes imply a mature panel of patients and occasional in-office procedures. The presence of 17110 (destruction of benign lesions) and sustained vaccine administration codes indicates operational capacity for basic procedures and immunization clinics within the ambulatory setting.

The pattern of many codes labeled as “extreme outlier” or “notably above typical” in-state suggests this is a multi-provider or high-throughput pediatric practice rather than a low-volume solo clinician. That interpretation is supported by absolute claim counts such as 96.1K claims for 99213 and tens of thousands of preventive and vaccine claims, which are atypical for single-provider operations and explain the provider’s top statewide ranks for standard pediatric services.

Medicaid: Complete Services Breakdown

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

114 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…	96,110	$70	$6.2M
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…	22,730	$70	$1.5M
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…	14,820	$80	$1.2M
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…	17,620	$70	$1.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8,270	$50	$388.6K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	10,360	$20	$238.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	47,360	$1	$142.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,030	$30	$108.7K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	37,890	$1	$75.8K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	1,790	$40	$73.3K

Showing 1–10 of 114

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Utah Valley Pediatrics L.L.C. — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

114 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	208	240	220	$50	$145.2K
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…	24	1,340	200	$80	$144K
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…	2	1,360	190	$70	$125K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	5	70	340	$50	$117.7K
J1100	Injection, dexamethasone sodium phosphate, 1 mg	13	70	410	$50	$93.9K
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…	157	200	240	$90	$85.8K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	49	160	250	$50	$76.9K
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…	1	220	200	$80	$74K
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…	1	190	150	$80	$58.1K
J8540	Dexamethasone, oral, 0.25 mg	8	20	60	$110	$45.6K

Showing 1–10 of 114

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Daniel Simmons	UT	Pediatrics Physician	$0	$333.5K
Aubrie Brooks	UT	Family Nurse Practitioner	$44.4K	$6.8K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ihc Health Services, Inc.	UT	General Acute Care Hospital	$0	$44.3M
Revere Health PC	UT	Multi-Specialty Clinic/Center	$0	$24M
Riverwoods Surgery Center, LLC	UT	Ambulatory Surgical Clinic/Center	$737.9K	$5M
Utah Valley Emergency Physicians Inc	UT	Emergency Medicine Physician	$0	$4.7M
Ryan Isom	UT	Retina Specialist (Ophthalmology) Physician	$3.7M	$0
Jack Stringham	UT	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
Ihc Health Services Inc	UT	Durable Medical Equipment & Medical Supplies	$0	$3.3M
Richard Corey	UT	Retina Specialist (Ophthalmology) Physician	$3M	$50.1K
Provo City Board Of Education	UT	Local Education Agency (LEA)	$0	$3M
Robert Welch	UT	Retina Specialist (Ophthalmology) Physician	$2.5M	$0

Utah Valley Pediatrics L.L.C. — Billing Profile & Reimbursement Data

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Utah Valley Pediatrics L.L.C. — 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