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

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

Nicklaus Children's Pediatric Specialists, LLC (NPI 1588063176)

Key Findings

Field	Value
Entity Type	Organization
Organization	Nicklaus Children's Pediatric Specialists, LLC
Address	3100 Sw 62nd Ave
City	Miami
State	FL
ZIP	33155
Taxonomy	Pediatric Emergency Medicine (Pediatrics) Physician
NPI Enumerated	August 19, 2014

Payer Source	Total Paid
Medicaid	$66.2M
Medicare	$0

This provider has no Medicare billing on file and $66.2M in lifetime Medicaid revenue, making its reported claims activity effectively Medicaid-dominated rather than dual-payer. The NPI was enumerated 2014-08-19 (~12 years ago), indicating roughly a decade of enrollment during which this Medicaid-heavy pattern was established.

Revenue is highly concentrated in a small set of codes: the top three codes (99284, 99214, 99283) account for 73.8% of the provider's total Medicaid revenue. Individually those codes are reported as 99284 $19.4M (29.4%), 99214 $17.8M (26.8%), and 99283 $11.6M (17.6%), showing that the vast majority of Medicaid dollars come from a tight cluster of E/M services.

The code mix points to a combined pediatric emergency department and high-volume outpatient/clinic operation: 99284 and 99283 are emergency department E/M codes (moderate and low levels of decision making) while 99214 is an established outpatient visit with moderate decision making. The presence of 99204 $5.1M (7.7%) and 99285 $5.6M (8.4%) alongside these top codes further suggests the organization manages both new outpatient evaluations and some higher-acuity ED cases.

This provider is a statewide volume leader for its highest-revenue codes: 99214 ranks #4 of 6379 providers in-state (100th percentile; extreme outlier), 99284 ranks #10 of 739 (99th percentile; extreme outlier), and 99283 ranks #8 of 701 (99th percentile; extreme outlier). Those ranks indicate dominant billing volume relative to in-state peers for both pediatric outpatient E/M and ED visits.

Claim-level volumes and unit payments underline scale: 99214 shows 250.2K claims at $71 avg paid/claim producing $17.8M, 99284 shows 170.6K claims at $114 avg paid/claim producing $19.4M, and 99283 shows 166.2K claims at $70 avg paid/claim producing $11.6M. These very large claim counts combined with mid-range per-claim payments explain how a small set of codes drives most of the $66.2M Medicaid revenue.

While moderate- and low-acuity ED codes drive the bulk of revenue, higher-acuity ED care is also billed: 99285 accounts for $5.6M (8.4%) and ranks #32 of 658 providers in-state (95th percentile; typical, unremarkable volume). This pattern indicates the practice treats a mix of acuity but is comparatively more focused on high-volume moderate/low-acuity emergency and outpatient E/M encounters rather than concentrated high-acuity throughput.

Because 73.8% of Medicaid revenue is concentrated in a few pediatric E/M codes, the provider's financial profile is sensitive to changes in Medicaid reimbursement, coding guidance, or utilization management policies for ED and outpatient visits. The absence of Medicare revenue (no Medicare billing on file) means there is limited diversification of payer exposure to blunt state-level policy shifts.

Medicaid: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	170,560	$110	$19.4M
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…	250,180	$70	$17.8M
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.	166,210	$70	$11.6M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	35,660	$160	$5.6M
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…	39,150	$130	$5.1M
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…	101,210	$50	$5.1M
99203	The provider sees a new 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 provider…	15,960	$90	$1.5M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	2,640	$50	$121.2K
01922	The provider performs anesthesia services for a patient undergoing non–invasive imaging or radiation therapy.	40	$170	$6.6K
99205	The provider sees a new 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 provider…	60	$100	$6.2K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Florida Distribution

Nicklaus Children's Pediatric Specialists, LLC — 7 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Florida

Full comparison — all codes billed, vs. Florida median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	8	700	2,400	$80	$1.2M
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.	10	740	2,180	$70	$1.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	32	660	1,900	$70	$743.6K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	139	320	1,970	$90	$463.1K
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…	19	5,930	460	$40	$169.3K
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	6,380	430	$50	$139.3K
01922	The provider performs anesthesia services for a patient undergoing non–invasive imaging or radiation therapy.	31	40	370	$150	$122.5K
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…	758	980	120	$90	$76.8K
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…	3	1,850	90	$110	$71.5K
99203	The provider sees a new 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 provider…	12	1,670	90	$80	$69.2K

Showing 1–10 of 12

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Variety Children's Hospital	FL	Children's Hospital	$0	$175.3M
Variety Children's Hospital	FL	Children's Hospital	$0	$22.8M
Variety Children's Hospital	FL	Children's Hospital	$0	$15.5M
Variety Children's Hospital	FL	Children's Hospital	$0	$13.4M
Miami Children's Hospital Ambulatory Surgery Center, LLC	FL	Ambulatory Surgical Clinic/Center	$0	$11.3M
Variety Children's Hospital	FL	Children's Hospital	$0	$10.6M
Variety Childrens Hospital	FL	Children's Hospital	$0	$8.2M
Variety Children's Hopsital	FL	Children's Hospital	$0	$7.4M
Denis Atkinson	MN	Diagnostic Radiology Physician	$121.8K	$206.1K
Joshua Albrektson	MN	Diagnostic Radiology Physician	$264.9K	$2K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alternative Medical Healthcare Services, Corp.	FL	Home Health Agency	$0	$61.9M
Harmony Homes Of Miami, Inc	FL	Home Health Agency	$0	$41.7M
Hha Home Services Corp	FL	Developmentally Disabled Services Day Training Agency	$0	$30M
Bocasa Gourmet, LLC.	FL	Attendant Care Provider	$0	$24.8M
Continental Home Health Care, Inc.	FL	Home Health Agency	$0	$23.4M
Preferred Home Health Care, Inc.	FL	Home Health Agency	$0	$15.7M
First Quality Medical Supplies, Inc	FL	Durable Medical Equipment & Medical Supplies	$0	$14.8M
Syx, Corp.	FL	Community/Behavioral Health Agency	$0	$13.4M
Morning Star Centers Inc.	FL	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$12.6M
Mdt Home Health Care Agency, Inc.	FL	Home Health Agency	$0	$11.3M

Nicklaus Children's Pediatric Specialists, LLC — Billing Profile & Reimbursement Data

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Nicklaus Children's Pediatric Specialists, LLC — 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