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

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

The Children's Hospital Of Alabama (NPI 1629161112)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Children's Hospital Of Alabama
Address	1940 Elmer J. Bissell
City	Birmingham
State	AL
ZIP	35243
Taxonomy	Pediatric Otolaryngology Physician
NPI Enumerated	October 2, 2006

Payer Source	Total Paid
Medicaid	$15.8M
Medicare	$0

This provider is effectively a single-payer Medicaid biller: there is no Medicare billing on file while lifetime Medicaid revenue is reported as $15.8M, indicating that the provider’s public-payor activity is concentrated in Medicaid rather than a split Medicare/Medicaid mix. The absence of Medicare billing should be considered when benchmarking against peers that serve dual Medicare/Medicaid populations.

Revenue is highly concentrated in a small set of services: the precomputed top 3 Medicaid codes by revenue account for 77.0% of this provider's total Medicaid revenue, driven by 99244 ($5.6M, 35.1%), 69436 ($4M, 25.3%), and 42820 ($2.6M, 16.6%). This concentration indicates that a small number of consultation and ENT surgical procedures dominate the provider’s Medicaid income stream.

The code mix and volumes point to a high-volume pediatric otolaryngology surgical and ambulatory practice: large procedural counts for tympanostomy tube placement (69436, 26.8K claims) and office/outpatient consultations (99244, 26.1K claims) alongside tonsil/adenoid procedures (42820 and 42830) signal heavy operating-room and perioperative throughput for children rather than a primarily diagnostic or chronic-disease outpatient practice. These patterns align with the provider’s Pediatric Otolaryngology taxonomy.

This provider is a statewide outlier for its top procedural lines: 99244, 69436, and 42820 each rank #1 in-state and are labeled as an "extreme outlier, far above typical state volume for this code," reflecting dominant market share for these specific pediatric ENT services in Alabama. Such rank and percentile positions suggest this entity is a primary destination for these procedures in the state and should be treated as a leading competitor for pediatric ENT surgical volume.

While the top procedural codes are extreme outliers, some E/M activity is more typical: 99214 generated $1.9M (12.1% of Medicaid revenue) across 15.3K claims and ranks #91 of 1990 providers in-state (95th percentile), which is described as a typical, unremarkable volume for that code. This combination—exceptional procedural volume paired with more conventional levels of routine E/M—suggests a workflow that integrates high surgical throughput with ongoing ambulatory follow-up.

A few diagnostic and specialty-procedural codes show unique or sole-provider patterns: 31622 (bronchoscopy) has 250 claims and $67K revenue and is recorded as #1 of 1 providers in-state with no state peer volume comparison available; similarly, 31526 appears as #1 of 1 providers with $2.3K revenue and no peer comparison. These entries indicate the provider offers certain specialized airway diagnostics in a market with little or no competing Medicaid-reported supply.

Payment-per-claim differences reflect the mix of high-volume consults and higher-paid surgeries: average paid/claim is $213 for 99244, $149 for 69436, and $393 for 42820, showing that while tympanostomy is high-volume, tonsillectomy/adenoidectomy yields substantially higher payment per encounter. Analysts should consider both claim counts and avg paid/claim when modeling revenue sensitivity to volume shifts in specific procedure lines.

The NPI was enumerated on 2006-10-02 (approximately 20 years ago), indicating a long-established presence in the market; coupled with the extreme-volume rankings on core pediatric ENT procedures, this suggests organizational stability and an entrenched referral base for surgical pediatric otolaryngology in Birmingham and statewide.

Medicaid: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	26,080	$210	$5.6M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	26,840	$150	$4M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	6,670	$390	$2.6M
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…	15,250	$130	$1.9M
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	2,250	$260	$581.5K
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…	5,060	$90	$435K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	2,000	$160	$315.4K
99204	The provider sees a new 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 provider…	750	$200	$150.8K
99203	The provider sees a new 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 provider…	850	$140	$119.3K
31622	In this procedure, the provider performs diagnostic rigid or flexible bronchoscopy, a test to view airways and diagnose lung disease. He may or may not use fluoroscopic guidance to perform this test.…	250	$270	$67K

Showing 1–10 of 19

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

The Children's Hospital Of Alabama — 5 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

19 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…	91	1,990	680	$60	$201.7K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	1	120	170	$160	$200.7K
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…	227	330	140	$240	$197.4K
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…	349	1,990	560	$40	$185.6K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	1	60	320	$130	$176.1K
99245	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a high level of medical decision making or the provider spends…	16	30	120	$190	$175.5K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	1	10	60	$280	$144K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	1	40	40	$380	$123.8K
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…	292	400	470	$30	$97.1K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	8	90	160	$100	$75.1K

Showing 1–10 of 19

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Taustin Laboratories	AL	Clinical Medical Laboratory	$54.1K	$37M
Wiregrass Hospice, LLC	AL	Community Based Hospice Care Agency	$0	$3.5M
Compassus Op Of Alabama LLC	AL	Community Based Hospice Care Agency	$0	$3.5M
Benjamin Jones	AL	Hematology & Oncology Physician	$2.4M	$0
Vuepoint Diagnostics, LLC	AL	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	$1.3M	$181.3K
Continuumrx, Inc.	AL	Home Infusion Therapy Pharmacy	$0	$1.3M
Matthew Tucker	AL	Hematology & Oncology Physician	$1.3M	$0
Agape Care Alabama LLC	AL	Community Based Hospice Care Agency	$0	$1.1M
Affinity Hospital LLC	AL	General Acute Care Hospital	$0	$904.8K
Journey Hospice Of Alabama,llc	AL	Community Based Hospice Care Agency	$0	$896.8K

The Children's Hospital Of Alabama — Billing Profile & Reimbursement Data

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The Children's Hospital Of Alabama — 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
The Children's Hospital Of Alabama	AL	Children's Hospital	$0	$59M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$22.2M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$18.4M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$17.7M
The Children's Hospital Of Alabama	AL	Psychologist	$0	$12M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$7.5M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$5.7M
The Children's Hospital Of Alabama	AL	Pediatric Pulmonology Physician	$0	$5.6M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$5.3M
The Children's Hospital Of Alabama	AL	Pediatrics Physician	$0	$4.6M