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 U.S. Virgin Islands for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to U.S. Virgin Islands 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. U.S. Virgin Islands (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.

Penn Pediatrics (NPI 1598008484)

Key Findings

Field	Value
Entity Type	Organization
Organization	Penn Pediatrics
Address	1 Estate Thomas Unit No C-2
City	St Thomas
State	VI
ZIP	00802
Taxonomy	Primary Care Clinic/Center
NPI Enumerated	March 29, 2013

Payer Source	Total Paid
Medicaid	$56.2K
Medicare	$0

PENN PEDIATRICS is a Primary Care Clinic/Center located in ST THOMAS, VI with an NPI enumerated on 2013-03-29 (~13 years ago). Its claims activity is concentrated in Medicaid only — total Medicaid revenue is $56.2K and there is no Medicare billing on file, indicating an effectively single-payer billing footprint in the available data.

The provider’s highest-revenue codes are consistent with an outpatient pediatric primary care operation: 99214 (established patient E/M) generated $21.7K with a $133 avg paid/claim, 90460 (vaccine administration) generated $9.9K with a $53 avg paid/claim, and 99383 (new patient well visit, age 5–11) generated $3.6K with a $110 avg paid/claim. These codes point to routine primary care visits, well-child preventive visits, and on-site immunizations as the central service lines driving revenue.

Revenue concentration is high: the top 3 Medicaid codes (99214, 90460, 99383) account for 62.6% of this provider’s total Medicaid revenue. That concentration indicates a small set of visit types—established E/M, vaccine administration, and new-patient well visits—drive the majority of billed Medicaid dollars.

Payer mix is essentially single-payer in the dataset: $56.2K in Medicaid revenue with no Medicare revenue on file. This limits conclusions about broader commercial or Medicare-facing capacity and suggests the provider’s billing footprint, at least in the observed data, is focused on Medicaid populations.

On competitive standing for core office visits, 99214 ranks #33 of 43 in-state (24th percentile) and is described as a typical, unremarkable volume for this code, indicating the provider is a modest participant in higher-level established-patient E/M compared with in-state peers. For vaccine administration 90460 the provider ranks #4 of 4 (0th percentile) and is also described as typical, unremarkable volume; this suggests the clinic does provide immunizations but not at a high relative volume within the state dataset.

The practice shows relative local leadership in several preventive and screening services: 99383 ranks #1 of 2 (100th percentile, typical, unremarkable volume), 99384 ranks #1 of 2 (100th percentile), 92587 ranks #1 of 3 (100th percentile), and 92552 ranks #1 of 2 (100th percentile). These rank positions imply the provider is a top in-state reporter for certain new-patient well visits and hearing-screening procedures, supporting a practice profile that includes on-site preventive care and audiologic screening.

Ancillary screening and developmental assessment activity is prominent in counts but generates smaller revenue shares: 96110 appears with 187 claims producing $3.4K (6.0% of Medicaid revenue) at a $18 avg paid/claim, and 99173 shows 141 claims producing $1.1K (2.0%) at a $8 avg paid/claim. The high claim counts with low per-claim payments are consistent with routine, brief developmental and vision screens commonly paired with pediatric well visits rather than major revenue drivers.

Despite being enumerated ~13 years ago, total Medicaid revenue of $56.2K suggests a modest overall billing scale in the observed period; the practice’s mix—centered on E/M, well-child visits, immunizations, and routine screenings—fits a small ambulatory pediatric clinic focused on preventive care and childhood immunization services. Further data (commercial claims, patient volumes, or multi-year trends) would be needed to distinguish low volume from limited payer participation.

Medicaid: Complete Services Breakdown

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

16 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…	160	$130	$21.7K
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.	190	$50	$9.9K
99383	The provider performs a well–patient visit for a child who is between the ages of 5 and 11 who meets the definition of new patient.	30	$110	$3.6K
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…	40	$100	$3.5K
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…	190	$20	$3.4K
92587	Code 92587 is in the Medicine/Special Otorhinolaryngologic Services Section. It involves special procedures of the ears/nose/throat. This code is for screening purposes with interpretation and…	120	$20	$2.7K
92552	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the lowest threshold at which the patient can hear.	80	$40	$2.7K
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…	70	$40	$2.6K
99384	The provider performs a well–patient visit for an adolescent who is between the ages of 12 and 17 who meets the definition of new patient.	20	$110	$2.5K
99382	The provider performs a well–patient visit for a child who is between the ages of 1 and 4 who meets the definition of new patient.	10	$140	$1.8K

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. U.S. Virgin Islands Distribution

Penn Pediatrics — 4 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — U.S. Virgin Islands

Full comparison — all codes billed, vs. U.S. Virgin Islands median

16 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…	33	40	560	$140	$322K
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…	5	10	1,540	$150	$221.8K
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.	4	10	5,290	$20	$108.2K
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…	4	10	3,160	$30	$96.4K
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…	2	10	2,050	$20	$44.3K
99177	The provider uses instruments to conduct a vision screening exam to analyze both eyes to diagnose ocular or eye–related diseases. Both the screening and analysis take place on–site.	2	10	2,240	$10	$29.9K
92551	The provider delivers a limited series of tones or sounds to a patient to determine if the patient’s hearing is in an acceptable range to detect hearing problems.	2	10	770	$30	$19.6K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	3	10	810	$30	$17.3K
99173	The provider checks the eyesight in both eyes of a pediatric patient by asking him to read letters of varying sizes on a standard chart, such as a Snellen’s chart, which he keeps 20 feet away from…	2	10	140	$20	$9.9K
99383	The provider performs a well–patient visit for a child who is between the ages of 5 and 11 who meets the definition of new patient.	1	10	30	$130	$3.3K

Showing 1–10 of 16

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Duanne Jones	VI	Public Health Dentistry	$0	$33.2M
Vi Government Hospital And Health Facilities Corp	VI	General Acute Care Hospital	$0	$23.6M
The St Thomas East End Medical Center Corporation	VI	Federal Public Health Clinic/Center	$0	$12.8M
Aac-air Ambulance Caribbean Inc.	VI	Air Ambulance	$2M	$8.6M
Vi Relocation Services And Rentals LLC	VI	Land Ambulance	$0	$6.8M
Alicia Prentice	VI	Home Health Aide	$0	$3.9M
Stretcher Plus, LLC	VI	Non-emergency Medical Transport (VAN)	$0	$2.8M
Cog Restore, LLC	VI	Rehabilitation Clinic/Center	$0	$2.1M
Dept Of Health, Govt Of Vi Ems St Thomas	VI	Land Ambulance	$0	$1.5M
Vi Oral Surgery, Inc	VI	Oral and Maxillofacial Surgery (Dentist)	$0	$1.4M

Penn Pediatrics — 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