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

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

Windward Pediatrics, Inc. (NPI 1528085222)

Windward Pediatrics, Inc. is a specialist provider located in Kaneohe, Hawaii. This profile covers 0 Medicare and 30 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	Windward Pediatrics, Inc.
Address	45-710 Kamehameha Hwy
City	Kaneohe
State	HI
ZIP	96744
Taxonomy	Specialist
NPI Enumerated	July 17, 2006

Payer Source	Total Paid
Medicaid	$848.2K
Medicare	$0

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

30 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	7,000	$70	$489.7K
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…	880	$110	$99K
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…	720	$110	$82.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	630	$110	$71.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	300	$120	$35K
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…	620	$60	$34.2K
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.	420	$30	$11.8K
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.	630	$20	$9.5K
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.	210	$30	$6.2K
G2012	Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an…	530	$10	$5.3K

Showing 1–10 of 30

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Windward Pediatrics, Inc. — 0 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

30 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	360	710	650	$90	$274.1K
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…	56	690	650	$90	$235.4K
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…	25	100	210	$120	$116.7K
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…	30	100	210	$110	$101.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	35	110	230	$90	$55.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	39	90	180	$70	$31.4K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	12	40	160	$60	$31K
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.	41	90	180	$10	$14.5K
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.	23	80	90	$10	$12.5K
90651	This code represents a nonavalent human papillomavirus (HPV) vaccine product administered into the muscle to protect against HPV infection. The vaccine protects against nine HPV types (6, 11, 16, 18,…	11	30	60	$70	$9.2K

Showing 1–10 of 30

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Alcoholic Rehabilitation Services Of Hawaii Inc	HI	Substance Abuse Rehabilitation Facility	$0	$4.5M
Oahu Oral And Maxillofacial Surgery	HI	Oral and Maxillofacial Surgery Clinic/Center	$0	$3.7M
Po Ailani	HI	Mental Illness Community Based Residential Treatment Facility	$0	$3.3M
Usrc Ko'olau LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.6M
Dialysis Newco LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.1M
Western Health Resources	HI	Home Health Agency	$0	$1.9M
Dialysis Newco LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.5M
Usrc Windward, LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.4M
Paul M.t. Yim	HI	Dentist	$0	$960.9K
David Roscoe	HI	Clinical Psychologist	$0	$711.3K

Windward Pediatrics, Inc. — Billing Profile & Reimbursement Data

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Windward Pediatrics, Inc. — 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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