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.

Marion Pediatrics LLC (NPI 1497836340)

Field	Value
Entity Type	Organization
Organization	Marion Pediatrics LLC
Address	1411 W Bella Dr
City	Marion
State	IN
ZIP	46953
Taxonomy	Specialist
NPI Enumerated	October 18, 2006

Payer Source	Total Paid
Medicaid	$6M
Medicare	$0

Medicaid: Complete Services Breakdown

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

56 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…	36,790	$70	$2.4M
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…	7,290	$100	$699.7K
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…	6,540	$100	$621.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,820	$100	$558.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,430	$100	$430K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	8,660	$20	$207.7K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	13,850	$10	$180K
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.	4,370	$30	$144.2K
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…	1,480	$90	$131.4K
99381	The provider performs a well–baby visit for a child under the age of one.	1,190	$80	$94K

Showing 1–10 of 56

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

Marion Pediatrics LLC — 4 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

56 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	870	2,120	870	$60	$450.6K
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…	101	2,380	920	$50	$376.8K
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…	40	280	880	$80	$267.2K
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…	28	290	770	$80	$250.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	20	320	310	$80	$133.9K
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…	124	160	740	$60	$119.1K
A4605	Tracheal suction catheter, closed system, each	5	10	740	$80	$103.1K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	51	390	990	$20	$74.5K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	222	290	3,410	$1	$71.5K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	52	290	130	$40	$69.8K

Showing 1–10 of 56

Nearby Providers

Other providers in the same ZIP code as Marion Pediatrics LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Grant-blackford Mental Health, Inc.	IN	Community/Behavioral Health Agency	$0	$13.7M
Personal Care Concepts, Inc	IN	Home Health Agency	$0	$7.5M
Qca, Inc	IN	Ambulance	$584.9K	$3.8M
Lincare Inc.	IN	Durable Medical Equipment & Medical Supplies	$0	$3.7M
Indiana Health Centers, Inc.	IN	Federally Qualified Health Center (FQHC)	$0	$2.9M
Kyle Shaffer	IN	Physical Therapist	$148.2K	$0
L'erin Garner	IN	Optometrist	$71.9K	$12.9K
Jamie Lang	IN	Adult Health Nurse Practitioner	$70.6K	$0
Mary Draper	IN	Clinical Social Worker	$62K	$0
Walter Scase	IN	Optometrist	$14.5K	$0

Marion Pediatrics LLC — Billing Profile & Reimbursement Data

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Marion Pediatrics LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References