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

Why is the Medicaid comparison limited to Maryland 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. Maryland (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 Doctor (NPI 1639208994)

The Children's Doctor is a primary care clinic/center provider located in Hagerstown, Maryland. This profile covers 0 Medicare and 77 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	The Children's Doctor
Address	319 E Antietam St
City	Hagerstown
State	MD
ZIP	21740
Taxonomy	Primary Care Clinic/Center
NPI Enumerated	March 5, 2007

Payer Source	Total Paid
Medicaid	$9.6M
Medicare	$0

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

77 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…	37,380	$90	$3.2M
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…	23,080	$120	$2.7M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,460	$110	$578.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,280	$120	$500.8K
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…	4,170	$110	$442.2K
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…	3,170	$100	$313.8K
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…	27,430	$10	$301.7K
S0302	Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)	21,280	$10	$170.3K
99051	The provider sees a patient during regular office hours that occur outside of traditional office hours, i.e., in the evening, on a weekend, or on a holiday.	14,110	$10	$169.4K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	5,420	$30	$135.6K

Showing 1–10 of 77

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maryland Distribution

The Children's Doctor — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maryland

Full comparison — all codes billed, vs. Maryland median

77 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…	68	3,670	680	$90	$310K
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…	46	3,280	610	$80	$296.1K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	12	30	230	$220	$250.6K
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…	37	330	800	$110	$228.7K
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…	45	290	730	$100	$212.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	20	350	490	$110	$172.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	15	320	290	$120	$128K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	38	40	120	$150	$124K
S0302	Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)	1	10	2,520	$20	$102.6K
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…	654	1,000	200	$120	$96.3K

Showing 1–10 of 77

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dr. David M. Vieth 2, P.C.	MD	General Practice Dentistry	$0	$77.8M
Potomac Case Management Services, Inc.	MD	Case Management Agency	$0	$28M
Phoenix Health Center LLC	MD	Methadone Clinic	$507.7K	$21.4M
Awakenings Recovery Center, LLC	MD	Substance Abuse Rehabilitation Facility	$0	$19.8M
Qualitycare Internet, LLP	MD	Mental Health Counselor	$0	$19.4M
Walnut Street Community Health Center, Inc.	MD	Federally Qualified Health Center (FQHC)	$0	$19.3M
Board Of Education Of Washington County	MD	Local Education Agency (LEA)	$0	$19.1M
Center For Pain Management, LLC	MD	Interventional Pain Medicine Physician	$0	$18.9M
Metro Treatment Of Maryland LP	MD	Community/Behavioral Health Agency	$361K	$16.6M
The Western Maryland Counseling Center	MD	Community/Behavioral Health Agency	$0	$16.5M

The Children's Doctor — Billing Profile & Reimbursement Data

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The Children's Doctor — 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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Frequently Asked Questions

References