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 1629116645)

Key Findings

Field	Value
Entity Type	Organization
Organization	Children's Hospital Medical Center
Address	660 Lincoln Ave
City	Cincinnati
State	OH
ZIP	45206
Taxonomy	Home Infusion Therapy Pharmacy
NPI Enumerated	February 2, 2007

Payer Source	Total Paid
Medicaid	$57M
Medicare	$0

This provider is effectively single-payer in the available data: there is no Medicare billing on file while Medicaid revenue totals $57M, indicating the organization's billing footprint in the dataset is concentrated entirely in Medicaid-covered services. The absence of Medicare claims suggests a focus on populations and services primarily reimbursed through Medicaid rather than dual-eligible or fee-for-service Medicare patients.

Revenue is highly concentrated in a small set of codes: the precomputed top three Medicaid codes (S9340, J3490, S9590) together account for 85.5% of this provider's total Medicaid revenue. In particular, S9340 alone represents $29.5M (51.8% of Medicaid revenue), and J3490 contributes $16.4M (28.8%), signaling that a handful of service lines drive the bulk of cash flow.

The code mix and descriptions point to a home infusion and enteral nutrition operation with a pediatric tilt: S9340 (home therapy; enteral nutrition administrative services) at $29.5M and multiple pediatric enteral formula codes (B4161 $1.9M, B4149 $1.1M, B4160 $920.2K) indicate substantial business in supplying and managing enteral feeding for children. The presence of home infusion/per-diem codes S9340, S9590 (home therapy, irrigation therapy $2.8M), and S5497 (catheter care $823.8K) is consistent with an integrated home infusion pharmacy model that bundles administrative and coordination services alongside drug and supply dispensing.

Competitive standing across the major codes is mixed and constrained by small peer pools: S9340 ranks #3 of 7 in-state (67th percentile; "typical, unremarkable volume"), indicating a mid-tier position among a small set of in-state enteral home-therapy providers. J3490 (unclassified drugs) ranks #16 of 216 (93th percentile; "typical, unremarkable volume"), showing relatively high placement among many state peers for unclassified drug billing, while S9590 ranks #1 of 2 (100th percentile; "typical, unremarkable volume"), but that leadership is within a very small peer group where competitive conclusions are limited.

Several specialized high-unit-value codes contribute materially to revenue beyond the top three: 90378 (RSV–IgIM) accounts for $2.4M (4.2% of Medicaid revenue) with 571 claims at $4195 avg paid/claim and ranks #5 of 8 in-state (43th percentile; "typical, unremarkable volume"). This indicates the provider also handles specialty immunoglobulin services and high-dollar biologic administrations in the home-infusion setting, augmenting their enteral and infusion portfolio.

Although many of the provider's code ranks are described as "typical, unremarkable volume," several observations reveal relative concentration versus peers: J3490's placement in the 93th percentile of 216 providers shows strong relative volume for unclassified drug billing, and S9340's $29.5M share (51.8%) marks it as the dominant revenue driver even if the provider sits at a mid-state percentile for that code. These patterns suggest operational dependence on a few high-revenue service lines despite not being an undisputed market leader across all in-state comparisons.

Service-line risk and operational focus are implied by the billing profile: dependency on per-diem home therapy codes (S9340, S9590) combined with large volumes of enteral formula codes (multiple B41xx codes) implies revenue tied to ongoing, recurring home therapy episodes rather than one-off procedures. That business model typically requires care coordination, supply logistics, and ongoing authorization/compliance work, consistent with the provider’s Home Infusion Therapy Pharmacy taxonomy.

The provider has long tenure in the NPI registry — enumerated 2007-02-02 (~19 years ago) — which, together with a concentrated Medicaid revenue base of $57M, suggests established state-market operations focused on pediatric home infusion and enteral nutrition services rather than recent or experimental lines of business. However, small peer pools for some codes and the absence of Medicare claims limit cross-payer competitive benchmarking and imply strategic focus on Medicaid-covered pediatric and home-infusion populations.

Medicaid: Complete Services Breakdown

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

18 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S9340	Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded…	16,780	$1,760	$29.5M
J3490	Unclassified drugs	9,890	$1,660	$16.4M
S9590	Home therapy, irrigation therapy (e.g., sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, care coordination, and all necessary…	1,740	$1,620	$2.8M
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	570	$4,200	$2.4M
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding…	4,180	$450	$1.9M
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	3,350	$330	$1.1M
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,…	5,320	$170	$920.2K
S5497	Home infusion therapy, catheter care / maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and…	1,730	$480	$823.8K
J7170	Injection, emicizumab-kxwh, 0.5 mg	50	$17,710	$814.6K
S9338	Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately),…	90	$1,500	$136K

Showing 1–10 of 18

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 — 1 of 18 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

18 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S9340	Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded…	3	10	670	$580	$4.6M
J7170	Injection, emicizumab-kxwh, 0.5 mg	3	10	160	$30,850	$4.4M
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	5	10	720	$2,350	$1.8M
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding…	10	30	3,220	$390	$1.5M
S9590	Home therapy, irrigation therapy (e.g., sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, care coordination, and all necessary…	1	10	970	$1,490	$1.4M
S5497	Home infusion therapy, catheter care / maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and…	1	10	1,730	$480	$824.3K
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,…	10	40	2,610	$120	$677.4K
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	5	20	1,070	$260	$575K
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include…	55	60	900	$80	$275.5K
J3490	Unclassified drugs	16	220	860	$30	$131.3K

Showing 1–10 of 18

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brightview, LLC	OH	Addiction Medicine (Internal Medicine) Physician	$2.3M	$501.1M
Greater Cincinnati Behavioral Health Services	OH	Community/Behavioral Health Agency	$0	$100.4M
Talbert House	OH	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$38M
Lighthouse Youth Services Inc.	OH	Mental Health Counselor	$0	$18.9M
Talbert House, Inc	OH	Substance Abuse Rehabilitation Facility	$0	$13.9M
First Step Home, Inc.	OH	Substance Abuse Rehabilitation Facility	$0	$9.9M
Emmanuel Rivera	OH	Geriatric Medicine (Family Medicine) Physician	$62.5K	$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

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	Pediatrics Physician	$0	$91.2M
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