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

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

Ada Pediatrics, P.A. (NPI 1609805779)

Ada Pediatrics, P.A. is a pediatrics physician provider located in Boise, Idaho. This profile covers 0 Medicare and 37 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	Ada Pediatrics, P.A.
Address	650 N Cole Rd
City	Boise
State	ID
ZIP	83704
Taxonomy	Pediatrics Physician
NPI Enumerated	July 1, 2006

Payer Source	Total Paid
Medicaid	$1.7M
Medicare	$0

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

37 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…	8,400	$70	$570.9K
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…	2,810	$100	$277.8K
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…	2,900	$90	$252.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,550	$100	$150.5K
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.	7,490	$20	$149.8K
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…	3,760	$30	$93.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	370	$110	$40.7K
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…	370	$110	$39.4K
99401	At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient’s age, family history, and areas of concern. The subjects…	970	$40	$37.8K
99188	The provider applies a fluoride adhesive over the tooth surface to prevent tooth decay, provide remineralization, or treat hypersensitivity.	2,220	$10	$31K

Showing 1–10 of 37

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Ada Pediatrics, P.A. — 0 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

37 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…	80	670	740	$40	$193.6K
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…	346	620	560	$60	$191.8K
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…	20	80	450	$80	$171.3K
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…	18	80	380	$70	$151.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	16	80	130	$80	$91.4K
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.	6	80	460	$30	$77.7K
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…	6	60	290	$30	$48.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	14	60	50	$70	$35.5K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	13	30	100	$50	$27.3K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	41	60	140	$30	$16.1K

Showing 1–10 of 37

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Full Circle Health, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$53.3M
Community Connections, Inc	ID	Case Management Agency	$0	$30M
K A Health Services LLC	ID	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$13.9M
County Of Ada	ID	Land Ambulance	$2M	$11.4M
Developmental Concepts, Inc.	ID	Developmental Disabilities Clinic/Center	$0	$13.2M
Pathways Of Idaho, LLC	ID	Community/Behavioral Health Agency	$0	$12M
Havenwood Caregiver Services Of Idaho, LLC	ID	In Home Supportive Care Agency	$0	$10.7M
Living Independently Forever, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$9.8M
Community Partnerships Of Idaho, Inc.	ID	Developmental Disabilities Clinic/Center	$0	$7.6M
All Horizons Inc	ID	Mental Health Counselor	$0	$6.7M

Ada Pediatrics, P.A. — Billing Profile & Reimbursement Data

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Ada Pediatrics, P.A. — 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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