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

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

Pediatrix Medical Group Of Tennessee, P.C. (NPI 1497852107)

Field	Value
Entity Type	Organization
Organization	Pediatrix Medical Group Of Tennessee, P.C.
Address	2221 Murphy Ave
City	Nashville
State	TN
ZIP	37203
Taxonomy	Neonatal-Perinatal Medicine Physician
NPI Enumerated	September 17, 2006

Payer Source	Total Paid
Medicaid	$32.3M
Medicare	$0

Key Findings

This provider is effectively single‑payer in scale: there is no Medicare billing on file while Medicaid revenue totals $32.3M, so Medicaid is the primary — and practically sole — source of reported public payer revenue for this NPI. That concentration means analyses of utilization and competitive position should be viewed through a Medicaid‑only lens rather than a mixed Medicare/Medicaid model.

Revenue is highly concentrated in a small set of neonatal care codes: the precomputed top‑3 Medicaid codes account for 59.2% of the provider’s Medicaid revenue, driven by 99469 ($7.8M, 25.3%), 99479 ($5.6M, 18.1%), and 99480 ($4.9M, 15.9%). These three codes alone represent the majority of Medicaid dollars reported and therefore define the provider’s financial profile within the dataset.

The code mix and descriptions indicate a focused neonatal‑perinatal/NICU operational footprint: top codes include 99469 (subsequent neonatal critical care), 99479/99480 (direction of care for recovering low birth weight infants) and 99460 (immediate newborn evaluation). High claim counts for these care‑management and newborn evaluation services imply continuous inpatient and transitional care activity rather than a primarily outpatient clinic model.

Statewide competitive standing is dominant on multiple core neonatal measures: the provider ranks #1 in the state for 99479 (63.5K claims; 100th percentile, labeled an "extreme outlier, far above typical state volume") and #1 for 99480 (55.7K claims; 100th percentile, "notably above typical state volume"). By contrast 99469 (27.2K claims) ranks #3 of 16 (87th percentile, described as typical/unremarkable), showing leadership on low‑birth‑weight recovery codes while other critical care codes are strong but less singularly dominant.

Indicators of high inpatient throughput appear in the data: 99238 (discharge day management) has 35.9K claims and $1.8M revenue and is ranked #1 of 311 providers in‑state (100th percentile, "extreme outlier, far above typical state volume"), and 99460 (initial newborn evaluation) is also #1 of 112 (100th percentile, "extreme outlier"). These patterns are consistent with a high‑volume hospital‑based neonatal service managing many short inpatient encounters and newborn evaluations.

The provider also delivers a broad set of ancillary newborn services at scale: 92650 (automated auditory brainstem response screening) shows 65K claims and $1.5M revenue and ranks #1 of 5 in‑state (100th percentile, "notably above typical state volume"). Cardiac imaging and obstetric ultrasound codes (93306, 93303, 76816, 76819, 76805) appear across the top 25 with modest-to-mid revenues, indicating integrated newborn screening and diagnostic capacity alongside NICU care.

Payment intensity and mix vary across codes: high average paid-per-claim items include 99469 ($287 avg paid/claim) and 99468 ($650 avg paid/claim, though only 237 claims), while high‑volume care‑management codes such as 99479 and 99480 have lower avg paid/claim ($88). This combination of high volumes on relatively low per‑claim service codes plus smaller volumes of higher‑paid critical care visits shapes the overall revenue profile and operational cash flow dynamics.

The NPI has long tenure in the dataset (NPI enumerated 2006-09-17, ~20 years ago), and sustained leadership on multiple neonatal and newborn codes suggests an established, hospital‑aligned neonatal practice in Nashville. Given the provider’s concentrated Medicaid exposure and repeated top statewide rankings on core NICU and newborn services, competitors and payers should treat this entity as a principal Medicaid neonatal services provider in Tennessee.

Medicaid: Complete Services Breakdown

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

75 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	27,200	$290	$7.8M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	63,490	$90	$5.6M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	55,700	$90	$4.9M
92586	N/A	61,220	$40	$2.2M
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…	35,910	$50	$1.8M
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	32,410	$50	$1.6M
92650	In this procedure, the provider measures the patient’s response to sound stimuli to screen auditory potential (electrical response). The screening uses frequency nonspecific stimuli and automated…	65,050	$20	$1.5M
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	13,550	$50	$609.5K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	9,300	$50	$446.5K
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…	2,460	$180	$435.8K

Showing 1–10 of 75

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Pediatrix Medical Group Of Tennessee, P.C. — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

75 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	6	10	1,110	$340	$3.6M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3	20	1,380	$300	$2.7M
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.	152	630	510	$120	$1.1M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	1	10	1,710	$90	$1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	20	890	$100	$997K
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.	118	610	570	$110	$884.4K
92586	N/A	1	10	370	$40	$555K
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…	8	30	1,060	$130	$484.1K
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	41	80	100	$1,260	$405.3K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	14	60	320	$140	$346.9K

Showing 1–10 of 75

Related Providers

Other providers that share a Tax Identification Number (TIN) with Pediatrix Medical Group Of Tennessee, P.C., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pediatrix Medical Group Of Florida Inc	FL	Pediatric Cardiology Physician	$0	$35.9M
Sedigheh Ebadi	FL	Pediatrics Physician	$0	$10.1M
Orlando Physicians Network Inc	FL	Internal Medicine Physician	$0	$9.4M
Frederick Silfen	FL	Obstetrics & Gynecology Physician	$92.1K	$0
Suying Lam Barriga	FL	Pediatric Cardiology Physician	$17.8K	$0
Todd Roth	FL	Pediatrics Physician	$9.6K	$0

Nearby Providers

Other providers in the same ZIP code as Pediatrix Medical Group Of Tennessee, P.C., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hca Health Services Of Tennessee, Inc.	TN	General Acute Care Hospital	$0	$45.9M
Saint Thomas Medical Partners	TN	Internal Medicine Physician	$0	$21.9M
Radiology Alliance PC	TN	Diagnostic Radiology Physician	$0	$13.2M
Emergency Medicine Services Of Tn, PC	TN	Emergency Medicine Physician	$0	$12.9M
Tennessee Maternal-fetal Medicine LLC	TN	Specialist	$0	$12.5M
The Next Door, Inc.	TN	Substance Abuse Rehabilitation Facility	$0	$8.6M
Tennessee Oncology PLLC	TN	Hematology & Oncology Physician	$0	$8.5M
Vcphcs Ix, LLC	TN	Substance Use Disorder Rehabilitation Clinic/Center	$257.7K	$6.6M
Tennessee Retina PC	TN	Retina Specialist (Ophthalmology) Physician	$0	$6M
Pediatric Associates Of Davidson County, P.C.	TN	Pediatrics Physician	$0	$5.8M

Pediatrix Medical Group Of Tennessee, P.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