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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Children's Health Of Carolina, PA (NPI 1598729014)

Key Findings

Field	Value
Entity Type	Organization
Organization	Children's Health Of Carolina, PA
Address	400 Liberty Hill Rd
City	Lumberton
State	NC
ZIP	28358
Taxonomy	Pediatrics Physician
NPI Enumerated	April 13, 2006

Payer Source	Total Paid
Medicaid	$90.4M
Medicare	$0

This entity is effectively a Medicaid-focused provider: there is no Medicare billing on file and total Medicaid revenue is $90.4M, so operational and revenue risk is heavily concentrated in the Medicaid payer. Analysts should treat this profile as single-payer–dominated when modeling reimbursement sensitivity or network value.

Revenue is highly concentrated in a very small set of codes: the precomputed top-three Medicaid codes account for 73.1% of the provider's Medicaid revenue. In particular, 99199 alone generates $46.7M (52.1% of Medicaid revenue), followed by 99213 with $14.4M (16.1%) and U0002 with $4.4M (4.9%).

The code mix points to a high-volume pediatric outpatient and preventive care operation that also runs substantial testing and vaccination activity. High-volume E/M codes 99213 (248.4K claims) and 99214 (45K claims), broad preventive codes 99391/99392/99393/99394 (tens of thousands of claims each), and multiple vaccine administration codes (90471, 90472) are all prominent, consistent with a large pediatric primary care footprint serving routine well visits and immunizations.

99199 is an outlier driver of revenue and should be flagged for business-model interpretation rather than judgment: the provider ranks #1 of 2853 in-state on 99199 (100th percentile; extreme outlier) and reported 5.8M claims for that code. The dominance of an “other medicine services” code, responsible for $46.7M, indicates a substantial volume of services billed under an unlisted/other category and materially shapes the provider’s revenue profile.

Competitive standing in-state is dominant for many pediatric and testing codes: 99213 ranks #5 of 4130 providers (100th percentile; extreme outlier), U0002 ranks #1 of 104 providers (100th percentile; extreme outlier), and 87400 ranks #1 of 47 providers (100th percentile; extreme outlier). These rank and percentile positions indicate this provider is a major Medicaid-era pediatric services and testing provider in North Carolina, well above typical state volumes for several high-impact codes.

Testing and immunization throughput is a notable operational characteristic: U0002 has 93.8K claims ($47 avg paid/claim, $4.4M revenue), 87400 has 91.6K claims ($24 avg paid/claim, $2.2M revenue), and vaccine administration codes 90471/90472 report 87.8K and 53.4K claims respectively. These large claim counts, together with many codes labeled “extreme outlier,” are consistent with centralized or high-throughput testing and vaccine delivery capability integrated into routine pediatric care.

Preventive pediatric services are a clear strength: 99392 (34.4K claims, $3.1M), 99391 (33.4K claims, $2.8M), 99393 (23.8K claims, $2.1M), and 99394 (17.5K claims, $1.7M) all appear in the top code list and rank in high state percentiles. The volume and revenue from these well-patient visit codes indicate a substantial focus on age-based preventive care and routine preventative visit capacity.

The provider has long tenure on the registry (NPI enumerated 2006-04-13, ~20 years ago), which combined with $90.4M in Medicaid revenue and multiple top-percentile code rankings suggests an established, large-scale pediatric operation primarily serving Medicaid populations in North Carolina. Analysts should treat this profile as a mature regional pediatric provider with concentrated Medicaid exposure and outsized in-state market share for testing, immunizations, and routine pediatric visits.

Medicaid: Complete Services Breakdown

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

93 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	5,831,720	$10	$46.7M
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…	248,380	$60	$14.4M
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	93,770	$50	$4.4M
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…	45,040	$90	$3.9M
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…	34,430	$90	$3.1M
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…	33,420	$80	$2.8M
87400	The lab analyst performs the technical lab test to detect antigens of influenza A or B using an immunoassay technique, such as EIA. This analysis will distinguish if a patient has influenza A or B.	91,610	$20	$2.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	23,760	$90	$2.1M
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	53,360	$40	$2M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	17,490	$100	$1.7M

Showing 1–10 of 93

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Children's Health Of Carolina, PA — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

93 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	1	2,850	10,910	$10	$330.3K
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…	59	4,400	960	$60	$271.3K
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…	5	520	1,080	$80	$262.1K
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…	4	550	970	$90	$258.9K
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…	5	4,130	670	$50	$219.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5	590	490	$90	$179.8K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	188	510	480	$40	$166.3K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	1	100	550	$50	$153.4K
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.	25	330	300	$10	$142.3K
A4627	Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler	17	60	190	$40	$118.4K

Showing 1–10 of 93

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Primary Health Choice, Inc.	NC	Community/Behavioral Health Agency	$0	$93.3M
A Primary Choice, Inc.	NC	In Home Supportive Care Agency	$0	$71.2M
Southeastern Regional Medical Center	NC	General Acute Care Hospital	$0	$28.8M
Southeastern Integrated Care	NC	Family Medicine Physician	$0	$23.9M
Charles Graham	NC	Personal Care Attendant	$0	$23.9M
Speech Solutions Inc	NC	Speech-Language Pathologist	$0	$19.2M
Stephens Outreach Center, Inc	NC	Community/Behavioral Health Agency	$0	$17.4M
A Primary Choice	NC	In Home Supportive Care Agency	$0	$15.6M
Premier Behavioral Services Inc	NC	Community/Behavioral Health Agency	$0	$14.6M
Aaa Homecare	NC	Home Health Agency	$0	$12M

Children's Health Of Carolina, PA — Billing Profile & Reimbursement Data

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Children's Health Of Carolina, PA — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Health Of Carolina, PA	NC	Pediatrics Physician	$0	$18.2M
Children's Health Of Carolina, PA	NC	Pediatrics Physician	$0	$7.6M