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

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

New Horizon Pediatric Care P.C. (NPI 1518017664)

New Horizon Pediatric Care P.C. is a pediatrics physician provider located in Southfield, Michigan. This profile covers 0 Medicare and 49 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	New Horizon Pediatric Care P.C.
Address	23077 Greenfield Rd
City	Southfield
State	MI
ZIP	48075
Taxonomy	Pediatrics Physician
NPI Enumerated	January 11, 2007

Payer Source	Total Paid
Medicaid	$6.2M
Medicare	$0

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

49 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…	30,800	$60	$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…	10,830	$80	$845K
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.	22,500	$40	$832.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8,950	$80	$671.2K
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…	8,690	$70	$599.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,640	$80	$462.7K
99381	The provider performs a well–baby visit for a child under the age of one.	3,000	$90	$261.2K
90671	This code represents a vaccine product administered intramuscularly to protect against pneumococcal disease, a bacterial infection. This is a 15–valent vaccine, protecting against 15 strains of the…	1,450	$150	$217.9K
99383	The provider performs a well–patient visit for a child who is between the ages of 5 and 11 who meets the definition of new patient.	800	$90	$74.7K
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,…	1,200	$40	$50.6K

Showing 1–10 of 49

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

New Horizon Pediatric Care P.C. — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

49 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…	4,313	4,380	1,000	$70	$289.9K
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…	162	4,770	1,060	$50	$247.8K
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…	24	670	730	$60	$140K
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…	37	590	850	$50	$134.5K
99204	The provider sees a new 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 provider…	1,615	1,860	220	$90	$96.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	21	720	420	$60	$93.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	20	720	220	$60	$60.1K
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.	9	540	650	$20	$57K
99381	The provider performs a well–baby visit for a child under the age of one.	10	200	160	$60	$39.4K
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,…	367	1,690	230	$30	$36.9K

Showing 1–10 of 49

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
New England Emergency Response Systems Inc	MI	Emergency Response System Companies	$0	$262.6M
Valued Relationships, Inc.	MI	Emergency Response System Companies	$0	$50.3M
Independent Emergency Physicians, P.C.	MI	Emergency Medical Services (Emergency Medicine) Physician	$0	$39M
Guardian Medical Monitoring, LLC	MI	Emergency Response System Companies	$0	$30M
Creative Images Inc	MI	Non-emergency Medical Transport (VAN)	$0	$29.1M
Educators Unlimited Inc	MI	Home Health Agency	$0	$20.4M
Metro Healthcare Services Inc.	MI	Case Management Agency	$0	$20.1M
Kevdaco Human Servicea LLC	MI	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$13M
Total Home Health Aide Services	MI	Home Health Agency	$0	$12.6M
Allied Continuing Care, Inc	MI	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$11.7M

New Horizon Pediatric Care P.C. — Billing Profile & Reimbursement Data

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New Horizon Pediatric Care P.C. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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References