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

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

Winston Pediatrics PA (NPI 1629144167)

Winston Pediatrics PA is a pediatrics physician provider located in Milford, Delaware. This profile covers 0 Medicare and 23 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	Winston Pediatrics PA
Address	375 Mullet Run Street
City	Milford
State	DE
ZIP	19963
Taxonomy	Pediatrics Physician
NPI Enumerated	November 27, 2006

Payer Source	Total Paid
Medicaid	$418.6K
Medicare	$0

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

23 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…	3,150	$50	$154.1K
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…	920	$60	$58K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	660	$70	$46.6K
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…	830	$50	$43.7K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	1,510	$30	$40.9K
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…	680	$40	$29.7K
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.	1,820	$10	$14.5K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	750	$20	$11.3K
90698	This code represents a combination vaccine product administered into the muscle to protect against five diseases: diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and polio.	400	$10	$4.8K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	480	$10	$4.3K

Showing 1–10 of 23

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Winston Pediatrics PA — 0 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

23 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…	270	500	1,130	$50	$235.1K
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…	27	50	1,070	$70	$226.6K
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…	29	50	1,050	$60	$191.3K
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…	154	540	1,100	$40	$185.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	28	50	800	$70	$170.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	38	50	470	$80	$126.7K
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.	17	30	1,850	$10	$50.9K
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…	41	40	1,180	$10	$50.3K
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…	39	90	800	$10	$30.6K
90698	This code represents a combination vaccine product administered into the muscle to protect against five diseases: diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and polio.	16	30	440	$10	$29K

Showing 1–10 of 23

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayhealth Medical Center, Inc.	DE	General Acute Care Hospital	$0	$39.5M
Banyan Delaware LLC	DE	Substance Abuse Rehabilitation Facility	$0	$30.9M
Bayada Home Health Care, Inc.	DE	Home Health Agency	$0	$28.5M
Epic Health Services (de), LLC	DE	Home Health Agency	$0	$19.3M
Delaware Pediatric Dentistry	DE	Pediatric Dentistry	$0	$18.1M
Kent-sussex Industries	DE	Developmentally Disabled Services Day Training Agency	$0	$11.7M
Nurses 'n Kids Of Milford, Inc.	DE	Medically Fragile Infants and Children Day Care	$0	$9.5M
Prn Staffers Inc	DE	Home Health Agency	$0	$7.6M
People's Place Ii, Inc.	DE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$4.9M
Bayhealth Medical Center, Inc.	DE	Clinic/Center	$0	$3.7M

Winston Pediatrics PA — Billing Profile & Reimbursement Data

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Winston Pediatrics PA — 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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