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

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

Danville Pediatrics Medical Group PLLC (NPI 1518622505)

Danville Pediatrics Medical Group PLLC is a rural health clinic/center provider located in Danville, Kentucky. 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	Danville Pediatrics Medical Group PLLC
Address	303 S 4th St Ste 100
City	Danville
State	KY
ZIP	40422
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	November 3, 2021

Payer Source	Total Paid
Medicaid	$3.6M
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…	40,190	$30	$1.3M
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.	9,610	$50	$451.5K
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…	5,800	$60	$359.8K
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…	4,940	$70	$336.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,560	$70	$235.2K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	6,010	$40	$234.4K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	11,220	$10	$157.1K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	7,810	$10	$109.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,190	$70	$86.6K
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…	1,230	$60	$69K

Showing 1–10 of 49

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Danville Pediatrics Medical Group PLLC — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

49 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	850	1,270	760	$80	$447.2K
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…	155	3,340	1,020	$30	$296K
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…	939	2,460	580	$40	$245K
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…	28	230	720	$60	$180.1K
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…	33	260	540	$70	$176.6K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	149	500	250	$60	$152.8K
95117	The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives 2 or more injections at a single visit.	34	100	580	$10	$119.8K
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.	33	400	800	$30	$113.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	26	320	180	$70	$79.9K
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…	147	310	330	$40	$71.3K

Showing 1–10 of 49

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spero Health Of Kentucky, LLC	KY	Addiction Medicine (Family Medicine) Physician	$0	$154.3M
Ephraim Mcdowell Regional Medical Center Incorporated	KY	General Acute Care Hospital	$0	$60M
Addixxion Recovery Of Kentucky, LLC	KY	Addiction Medicine (Family Medicine) Physician	$0	$16.6M
G & R Staed, Inc	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$12M
D&s Residential Services, LP	KY	Developmental Disabilities Clinic/Center	$0	$9.8M
Family Ties, LLC	KY	Developmentally Disabled Services Day Training Agency	$0	$8.7M
Empact Midwest LLC	KY	Emergency Medicine Physician	$0	$7.3M
A1 Case Management	KY	Case Management Agency	$0	$7.1M
Ekkco Inc.	KY	Adult Care Home Facility	$0	$5.5M
Ich-epg Alliance, LLC	KY	Emergency Medicine Physician	$0	$4.8M

Danville Pediatrics Medical Group PLLC — Billing Profile & Reimbursement Data

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Danville Pediatrics Medical Group PLLC — 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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