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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Black Hills Pediatrics, LLP (NPI 1639229727)

Key Findings

Field	Value
Entity Type	Organization
Organization	Black Hills Pediatrics, LLP
Address	2905 5th St
City	Rapid City
State	SD
ZIP	57701
Taxonomy	Pediatrics Physician
NPI Enumerated	January 11, 2007

Payer Source	Total Paid
Medicaid	$9.7M
Medicare	$0

BLACK HILLS PEDIATRICS, LLP is effectively a Medicaid-focused practice: the firm has no Medicare billing on file and reports $9.7M in lifetime Medicaid revenue, indicating almost all measurable payer exposure is through Medicaid. The provider’s NPI was enumerated 2007-01-11 (~19 years ago), so this is an established pediatric practice with long-standing Medicaid activity rather than a recent entrant.

Revenue is concentrated in a small set of pediatric office and specialty services: the top 3 Medicaid codes (99213, 90378, 0202U) account for 43.7% of the practice’s total Medicaid revenue, with 99213 alone generating $2.3M (24.9% of Medicaid revenue). That concentration signals heavy reliance on routine established-patient outpatient visits plus a pair of high-revenue specialty lab/immunologic services.

The code mix and volumes point to a primary-care–oriented pediatric operation with large preventive and established-patient visit throughput: 99213 has 51.6K claims ($44 avg paid/claim, $2.3M revenue) and preventive codes 99391 (10.6K claims, $686.2K) and 99392 (8.5K claims, $577K) are all materially represented. These figures, combined with high counts for 99214 and other E/M codes, indicate the practice’s core service line is routine outpatient pediatric evaluation and well-child care.

Vaccination and immunization administration are a major operational activity: 90471 (24K claims, $240.2K), 90472 (14.6K claims, $262.4K) and 90474 (6.1K claims, $61.3K) appear at very high volumes, each labeled an extreme outlier versus in-state peers. This pattern implies the clinic conducts large-scale immunization delivery (multiple injections per visit and repeat vaccine administrations) and likely runs high-throughput vaccine clinics as part of everyday office operations.

The practice shows elevated investment in on-site and proprietary respiratory diagnostics: 0202U (BioFire RP2.1 PLA) produced $698.6K (2.1K claims) and ranks #1 of 6 providers in-state (100th percentile), while respiratory and pathogen testing codes like 87633 ($333.1K, #1 of 8, 100th percentile), 87651 ($413K, #2 of 50, 98th percentile) and 87502 ($251.8K, #2 of 32, 97th percentile) are also prominent. Together these lab and molecular testing volumes indicate the practice offers high-volume respiratory pathogen testing and drives meaningful Medicaid revenue from diagnostics in addition to office visits.

90378 (RSV–IgIM) contributes $1M from 493 claims ($2047 avg paid/claim) and is billed by only two in-state providers; the dataset characterizes its percentile as 0th and labels the volume as "typical, unremarkable." The presence of a high-dollar immunoglobulin product on the bill mix nonetheless points to episodic specialized pediatric therapeutics in addition to routine primary care.

Hospital and newborn services are an important secondary revenue stream: 99460 (newborn initial hospital evaluation) generated $325.4K and ranks #1 of 18 providers (100th percentile), while discharge-day management 99238 produced $298.3K and ranks high in-state. These entries show the group provides both outpatient well-child care and significant perinatal/newborn hospital services, expanding their footprint beyond office-only pediatrics.

Competitive standing in South Dakota is strong for core pediatric ambulatory and diagnostic services: 99213 ranks #5 of 344 providers (99th percentile), 99391 and 99392 rank in the 95th–96th percentiles, and multiple lab/test codes are 98th–100th percentile or labeled "notably above typical". In combination with the practice’s Medicaid-only revenue profile, this indicates a dominant in-state position for pediatric primary care and respiratory diagnostics but limited exposure to Medicare patient populations and older-adult services.

Medicaid: Complete Services Breakdown

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

89 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…	51,580	$40	$2.3M
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…	490	$2,050	$1M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	2,070	$340	$698.6K
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…	10,560	$70	$686.2K
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…	8,490	$70	$577K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	11,470	$40	$413K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	1,140	$290	$333.1K
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…	4,550	$70	$327.3K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	4,120	$80	$325.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,500	$70	$301.2K

Showing 1–10 of 89

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Black Hills Pediatrics, LLP — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

89 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	2	10	1,740	$2,060	$3.6M
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	340	1,010	$100	$511K
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	1	10	170	$360	$236.6K
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…	35	260	860	$80	$222.6K
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…	3	40	1,100	$80	$181.3K
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…	17	70	400	$40	$172.5K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	20	60	120	$210	$171.2K
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…	3	50	410	$80	$127.2K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	1	10	230	$270	$100K
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…	23	70	130	$100	$99K

Showing 1–10 of 89

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Behavior Management Systems, Inc.	SD	Community/Behavioral Health Agency	$0	$19.8M
Monument Health Rapid City Hospital, Inc	SD	Multi-Specialty Clinic/Center	$0	$18.7M
Monument Health Rapid City Hospital, Inc.	SD	General Acute Care Hospital	$0	$11.5M
Community Health Center Of The Black Hills Inc	SD	Federally Qualified Health Center (FQHC)	$0	$10.2M
Jrk Services, Inc	SD	Home Health Agency	$0	$10.1M
Rapid City Emergency Services PA	SD	Emergency Medicine Physician	$0	$8.2M
Wellspring Inc.	SD	Psychiatry Physician	$0	$7.4M
Prema Abraham	SD	Retina Specialist (Ophthalmology) Physician	$7.1M	$0
Radiology Associates Prof, LLC	SD	Diagnostic Radiology Physician	$0	$5.3M
Monument Health Rapid City Hospital, Inc.	SD	Multi-Specialty Clinic/Center	$0	$5.2M

Black Hills Pediatrics, LLP — 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

Nearby Providers

Frequently Asked Questions

References