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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

After Hours Pediatrics PC (NPI 1588730360)

Key Findings

Field	Value
Entity Type	Organization
Organization	After Hours Pediatrics PC
Address	9201 Montgomery Blvd Ne
City	Albuquerque
State	NM
ZIP	87111
Taxonomy	Pediatrics Physician
NPI Enumerated	November 25, 2006

Payer Source	Total Paid
Medicaid	$34M
Medicare	$0

Payer mix and scale: AFTER HOURS PEDIATRICS PC has no Medicare billing on file and reports $34M in lifetime Medicaid revenue, making its financial footprint effectively single‑payer (Medicaid) in the available claims data. This concentration means analyses of utilization and risk should be interpreted through a Medicaid-only lens rather than a mixed Medicare/Medicaid profile.

Revenue concentration: the provider’s top three Medicaid codes account for 60.7% of this provider's total Medicaid revenue. The dominant driver is 99213 at $14.8M (43.8% of Medicaid revenue), supplemented by preventive medicine codes 99392 at $2.9M (8.5%) and 99391 at $2.8M (8.3%).

Business/service-line implications: the code mix—high-volume 99213 plus strong volumes of preventive codes 99392, 99391 and immunization administration codes 90460/90461—indicates the practice operates primarily as a high-throughput pediatric primary care and well-child clinic with routine immunization delivery embedded in visits. The preponderance of E&M and well-care codes suggests an emphasis on scheduled outpatient visits and preventive care rather than specialty procedural services.

Competitive standing within the state: for several high-volume pediatric and vaccination codes this provider ranks among the state leaders, reflecting market dominance in those services. Notably, 99213 ranks #3 of 932 providers (100th percentile; extreme outlier) and 99391/99392 rank in the 98th–99th percentiles, signaling volumes far above typical in-state peers for core well-child and established patient visits.

Access and extended-hours pattern: unusually high billing for 99051 (57.5K claims, $460.3K revenue) where the provider ranks #1 of 26 providers (100th percentile; extreme outlier) combined with telehealth/phone E&M codes 99441/99442 suggests significant after-hours or alternative-access activity consistent with the practice name. High volumes of 99080 (forms/reports) at rank #1 further point to heavy administrative throughput and frequent documentation-related billing.

Preventive care and immunization throughput: large claim counts for vaccine administration codes—90460 (57.1K claims, $2M revenue, ranks #3 of 150, 99th percentile; extreme outlier) and 90461 (38.5K claims, $2.4M revenue, ranks #2 of 111, 99th percentile; extreme outlier)—show immunizations are a material revenue and service line. Complementary high ranks on well-patient age-specific codes like 99393 (17.2K claims, $1.8M, ranks #3 of 124, 98th percentile) reinforce a strong well-child/well-adolescent preventive practice.

Point-of-care testing and screenings: the provider reports high volumes and statewide-leading positions for several screening and rapid tests—87811 (9K claims, $340.8K revenue, ranks #1 of 40, 100th percentile; extreme outlier) and 92551 (21.3K claims, $255.1K revenue, ranks #1 of 27, 100th percentile; extreme outlier) among others—indicating an on-site, broad preventive screening capability (vision, hearing, COVID, strep, influenza) that supports same-visit diagnosis and counseling.

Encounter complexity mix: while low-to-moderate established visit volume is extremely high (99213 at $14.8M), higher complexity E&M such as 99214 ($1.8M, rank #58 of 963, 94th percentile; typical) and 99215 ($91.3K, rank #112 of 319, 65th percentile; typical) are comparatively modest. This distribution suggests the clinic’s case mix is largely routine outpatient management and preventive visits rather than a high share of complex, resource-intensive pediatric encounters.

Medicaid: Complete Services Breakdown

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

74 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…	208,160	$70	$14.8M
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…	27,390	$110	$2.9M
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…	26,480	$110	$2.8M
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…	38,550	$60	$2.4M
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.	57,090	$40	$2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	17,170	$110	$1.8M
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…	15,650	$110	$1.8M
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…	7,010	$100	$707.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,330	$110	$559.1K
99051	The provider sees a patient during regular office hours that occur outside of traditional office hours, i.e., in the evening, on a weekend, or on a holiday.	57,540	$10	$460.3K

Showing 1–10 of 74

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

After Hours Pediatrics PC — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

74 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…	3	930	910	$80	$521.6K
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…	58	960	1,010	$90	$490K
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…	2	100	1,100	$110	$362K
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…	479	920	860	$120	$361.9K
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…	3	120	670	$110	$301.2K
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,…	12	380	220	$160	$273.9K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	11	40	460	$90	$207.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3	120	430	$110	$205.4K
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…	2	110	610	$40	$148.2K
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…	112	320	220	$110	$146.2K

Showing 1–10 of 74

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jessica Aragon	NM	Physician Assistant	$92.1K	$0
Robert Frost	NM	Prescribing (Medical) Psychologist	$52.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Duke City Urgent Care	NM	Urgent Care Clinic/Center	$0	$29.3M
New Pathways Inc	NM	Developmentally Disabled Services Day Training Agency	$0	$24.4M
Heartwell Services LLC	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$22.2M
Transitional Lifestyles Community Inc.	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$14.7M
Michael Cito Dds LLC	NM	Pediatric Dentistry	$0	$9.9M
Epiphany Dermatology Of New Mexico, LLC	NM	Dermatology Physician	$0	$6.3M
All About You , Homehealthcare LLC	NM	Home Health Agency	$0	$5.5M
Planned Parenthood Of The Rocky Mountains, Inc	NM	Ambulatory Family Planning Facility	$0	$3.2M
Solana Care, Lc	NM	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$3M
Carefree Assisted Living	NM	Assisted Living Facility	$0	$2.7M

After Hours Pediatrics PC — Billing Profile & Reimbursement Data

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After Hours Pediatrics PC — 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