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

Why is the Medicaid comparison limited to Ohio 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. Ohio (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 Hospital Medical Center (NPI 1609915784)

Field	Value
Entity Type	Organization
Organization	Children's Hospital Medical Center
Address	3333 Burnet Avenue
City	Cincinnati
State	OH
ZIP	45229
Taxonomy	Pediatrics Physician
NPI Enumerated	February 6, 2007

Payer Source	Total Paid
Medicaid	$91.2M
Medicare	$0

Key Findings

CHILDREN'S HOSPITAL MEDICAL CENTER reports $91.2M in lifetime Medicaid revenue and has no Medicare billing on file, making its public payer exposure effectively single–payer Medicaid. The absence of Medicare revenue on file should be treated as a defining feature of its payer mix rather than a reporting artifact when comparing scale to peers that bill both payers.

Revenue is highly concentrated: the top three Medicaid codes (99214, 99213, T2022) account for 39.0% of the provider's total Medicaid revenue. Those top codes alone — $12.3M (16.9%) for 99214, $10.7M (14.6%) for 99213, and $5.5M (7.5%) for T2022 — drive a substantial share of the $91.2M Medicaid base, emphasizing reliance on frequent outpatient E/M visits and ongoing case management billing.

The code mix indicates a core ambulatory pediatric practice with substantial longitudinal care management: 99214 and 99213 together represent large, routine established-patient office visit revenue, while T2022 (case management, per month) contributes meaningful recurring monthly revenue. This pattern is consistent with a high-volume pediatric clinic model that pairs face-to-face visits with structured case management services.

The provider is a dominant statewide performer on several front-line pediatric outpatient codes: 99214 ranks #17 of 4514 providers in-state and 99213 ranks #10 of 5077 providers (both reported as 100th percentile and described as extreme outliers). These rankings indicate volumes far above typical state activity for routine pediatric E/M visits and position the hospital as a major source of outpatient pediatric encounters in Ohio.

Inpatient and neonatal care represent a clear service line: neonatal/newborn and inpatient E/M codes (99469, 99460, 99472, 99233, 99232) collectively generate multi-million dollar revenues and include top statewide ranks (for example, 99460 is $3.1M and ranks #1 of 86 providers at the 100th percentile; 99469 is $3.4M and ranks #2 of 13). These data points signal significant NICU/newborn and subsequent inpatient care activity beyond ambulatory clinics.

Emergency department and hospital-based E/Ms also contribute meaningfully: 99283 ($5.3M, 7.2% of Medicaid revenue) and 99284 ($2.9M, 4.0%) are high-volume Medicaid drivers and several ED codes appear at extreme or notably above–typical percentiles (99282 ranks #2 of 232 at the 100th percentile). The hospital therefore combines ambulatory, ED, and inpatient pediatric services at scale.

The provider bills a range of ancillary, procedural, and facility-related services that complement medical encounters: notable items include tympanostomy 69436 ($1.2M, rank #3 of 79, 97th percentile), surgical pathology 88305 ($1.1M, 93th percentile), and anesthesia for imaging 01922 ($856K, rank #1 of 16, 100th percentile). These higher-rank procedure and support-service codes imply in-house operative and diagnostic capacity supporting its pediatric caseload.

The NPI was enumerated on 2007-02-06 (~19 years ago), indicating long-tenured enrollment. Combined with $91.2M in Medicaid revenue and multiple codes that are state-level extreme outliers, the enrollment tenure and billing footprint are consistent with an established, high-volume pediatric services provider within Ohio's Medicaid market.

Medicaid: Complete Services Breakdown

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

271 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…	251,440	$50	$12.3M
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…	382,000	$30	$10.7M
T2022	Case management, per month	9,700	$570	$5.5M
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.	139,370	$40	$5.3M
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…	63,500	$60	$4.1M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	11,860	$290	$3.4M
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	42,990	$70	$3.1M
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.	46,210	$60	$2.9M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	59,230	$50	$2.7M
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…	74,320	$30	$2.3M

Showing 1–10 of 271

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Children's Hospital Medical Center — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

271 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.	15	480	4,510	$90	$1.8M
H2019	Therapeutic behavioral services, per 15 minutes	744	840	240	$90	$1.8M
T2022	Case management, per month	7	40	700	$150	$1.8M
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.	63	660	460	$90	$1.5M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	2	10	1,020	$280	$1.3M
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.	119	580	510	$100	$1.3M
T2023	Targeted case management; per month	9	20	1,050	$380	$1.2M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	3	10	480	$290	$1.2M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	3	20	4,730	$90	$818.4K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	5	20	1,320	$90	$727.9K

Showing 1–10 of 271

Related Providers

Other providers that share a Tax Identification Number (TIN) with Children's Hospital Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Medical Center	OH	Children's Hospital	$0	$386.8M
Children's Hospital Medical Center	OH	Home Infusion Therapy Pharmacy	$0	$57M
Children's Hospital Medical Center	OH	Durable Medical Equipment & Medical Supplies	$0	$51.1M
Children's Hospital Medical Center	OH	Home Health Agency	$0	$19.2M
Children's Hospital Medical Center	OH	Pediatric Dentistry	$0	$11.6M
Robert Sisk	OH	Ophthalmology Physician	$2.5M	$0
William Hansen	OH	Counseling Psychologist	$112.8K	$194.9K
Roxana Rivera	OH	Ophthalmology Physician	$216K	$0
Mehran Attari	OH	Clinical Cardiac Electrophysiology Physician	$207K	$0
Joel Sorger	OH	Orthopaedic Surgery Physician	$193.5K	$0

Nearby Providers

Other providers in the same ZIP code as Children's Hospital Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Central Clinic Outpatient Services	OH	Mental Health Counselor	$0	$30.8M
Ohio First Home Healthcare Inc.	OH	Home Health Aide	$0	$14.2M
Laboratory Corporation Of America Holdings	OH	Clinical Medical Laboratory	$619.7K	$4.9M
Terri Mcmillan	OH	Allergy Physician	$67.8K	$0
Ann Orlet	OH	Certified Registered Nurse Anesthetist	$52.4K	$0
Rebecca Soward	OH	Physician Assistant	$37.8K	$0
Jennifer Estes	OH	Certified Registered Nurse Anesthetist	$36.4K	$0
Howard Melvin	OH	Ophthalmology Physician	$31K	$2.8K
Jane Smith	OH	Pediatric Nurse Practitioner	$24.1K	$0
Christopher Cates	OH	Pulmonary Disease Physician	$20.4K	$0

Children's Hospital Medical Center — Billing Profile & Reimbursement Data

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Children's Hospital Medical Center — 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