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.

Port City Pediatrics (NPI 1558413245)

Port City Pediatrics is a pediatrics physician provider located in Norton Shores, Michigan. This profile covers 0 Medicare and 63 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	Port City Pediatrics
Address	1455 Farr Road
City	Norton Shores
State	MI
ZIP	49444
Taxonomy	Pediatrics Physician
NPI Enumerated	January 16, 2007

Payer Source	Total Paid
Medicaid	$5.9M
Medicare	$0

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

63 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…	27,470	$60	$1.7M
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…	10,760	$80	$849.7K
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…	11,450	$70	$801.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,090	$80	$474.9K
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.	18,750	$20	$450K
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…	3,510	$100	$333.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3,120	$90	$268K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	20,740	$10	$186.6K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	3,420	$50	$184.8K
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…	3,370	$40	$141.5K

Showing 1–10 of 63

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

Port City Pediatrics — 5 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

63 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…	1,120	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…	195	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…	25	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…	22	590	850	$50	$134.5K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	182	270	1,950	$10	$131.1K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	469	1,170	170	$90	$107.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	43	720	420	$60	$93.9K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	13	140	200	$50	$65.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	52	720	220	$60	$60.1K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	859	1,420	590	$20	$57.1K

Showing 1–10 of 63

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Moka Corporation	MI	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$126.2M
Mercy Health Partners	MI	General Acute Care Hospital	$0	$98.1M
Senior Resources Of West Michigan	MI	Case Management Agency	$0	$31.5M
Mgh Family Health Center	MI	Federally Qualified Health Center (FQHC)	$0	$24.4M
Hackley Community Care Center Inc	MI	Federally Qualified Health Center (FQHC)	$0	$23.1M
Orthopaedic Associates Of Muskegon, PC	MI	Orthopaedic Surgery Physician	$0	$7.1M
Radiology Muskegon PC	MI	Diagnostic Radiology Physician	$0	$5.9M
Mercy Specialty Services	MI	Internal Medicine Physician	$0	$5.3M
Paul Raphaelian	MI	Retina Specialist (Ophthalmology) Physician	$1.5M	$0
Muskegon Sc, LLC	MI	Ambulatory Surgical Clinic/Center	$967.6K	$68.1K

Port City Pediatrics — Billing Profile & Reimbursement Data

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Port City Pediatrics — 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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