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NPI 1649377359 · Houston, TX · Neonatal-Perinatal Medicine Physician
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Pediatrix Medical Group Of Texas Billing, Inc. is a neonatal-perinatal medicine physician provider located in Houston, Texas. This profile covers 0 Medicare and 85 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Pediatrix Medical Group Of Texas Billing, Inc. |
| Address | 2929 Woodland Park Dr |
| City | Houston |
| State | TX |
| ZIP | 77082 |
| Taxonomy | Neonatal-Perinatal Medicine Physician |
| NPI Enumerated | September 17, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $85.3M |
| Medicare | $0 |
PEDIATRIX MEDICAL GROUP OF TEXAS BILLING, INC. reports $85.3M in lifetime Medicaid revenue and has no Medicare billing on file, making its observed commercial footprint effectively single‑payer Medicaid in the available dataset. The entity's NPI was enumerated 2006-09-17 (~20 years ago), indicating long-standing participation in public programs.
Revenue concentration is high: the precomputed top three Medicaid codes—99469, 99460, and 99479—together account for 55.9% of this provider's total Medicaid revenue. Individually these codes generate $23.9M (28.2%), $12M (14.1%), and $11.5M (13.6%) respectively, which signals that a small set of neonatal services drive the majority of income.
The code mix is tightly aligned with neonatal and perinatal inpatient care rather than general pediatrics or outpatient-only services. High revenues and claim volumes for newborn evaluation and neonatal critical care codes such as 99469 (64.7K claims), 99460 (153.3K claims), 99479 (92K claims), and 99480 (92.8K claims) indicate this provider operates at scale in delivery-room newborn assessments and NICU/low birth weight infant management.
Competitive standing within Texas is dominant for multiple neonatal codes: the provider ranks #1 in-state for 99469 (100th percentile, labeled an extreme outlier), 99460 (100th percentile, extreme outlier), 99479 (100th percentile, extreme outlier), 99480 (100th percentile, extreme outlier), and 99238 (100th percentile, extreme outlier). These top ranks and percentile labels imply the provider is far above typical state volumes for core newborn/NICU services, consistent with a major market position in neonatal care.
Beyond the three largest codes, the provider also posts very large volumes on related inpatient and follow‑up care CPTs that reinforce a hospital‑based model: 99238 (169.8K claims, $10.2M), 99462 (79.7K claims, $3M), and 99232 (34.9K claims, $1.4M). The prevalence of discharge management and subsequent inpatient visit codes suggests workflow spanning initial critical care through routine postnatal and discharge services.
Some codes show unusually high but more nuanced standings that broaden the clinical picture: 99472 (12.7K claims, $4.7M) is ranked #2 of 26 providers in-state at the 96th percentile and described as notably above typical state volume, while 99468 (755 claims, $638.7K) is at the 88th percentile (typical). Additionally, 99463 (3K claims, $317.3K) ranks #1 of 24 providers (100th percentile, extreme outlier), highlighting concentrated capacity for same‑day newborn evaluation and discharge activity.
Operationally, the combination of very high claim counts on newborn/NICU E/M codes and substantial volumes of procedure codes such as 54150 (13.4K claims, $992.3K) and routine preventive codes (99391/99392) points to a large-scale perinatal service line that handles both acute NICU care and routine newborn procedures. This mix suggests the provider’s revenue and utilization are driven by high throughput of births and associated immediate newborn and low‑birth‑weight management rather than outpatient chronic pediatric care.
For payer strategy and risk oversight, the provider’s Medicaid dependency and revenue concentration in a handful of neonatal/NICU codes (top 3 = 55.9%) means utilization management and contract design should prioritize NICU and newborn bundles, discharge processes, and per‑stay payment drivers. Given the provider’s repeated top‑rank and extreme outlier status on multiple neonatal codes, monitoring utilization trends for 99469, 99460, and 99479 will be especially important for forecasting Medicaid spend and negotiating network arrangements.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
85 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99469 | The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day. | 64,650 | $370 | $23.9M |
| 99460 | The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center. | 153,290 | $80 | $12M |
| 99479 | The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams. | 91,980 | $130 | $11.5M |
| 99480 | The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams. | 92,840 | $120 | $10.9M |
| 99238 | The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the… | 169,770 | $60 | $10.2M |
| 99472 | The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting. | 12,720 | $370 | $4.7M |
| 99462 | The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation. | 79,730 | $40 | $3M |
| 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… | 34,860 | $40 | $1.4M |
| 99464 | The provider is present during the delivery, at the request of the delivering provider, and during the basic stabilization of the newborn immediately after birth, typically when fetal distress or… | 12,590 | $80 | $1M |
| 54150 | The provider performs a circumcision, a surgical procedure that removes the foreskin of the penis, using a clamp or other device and regional anesthesia consisting of a dorsal penile or ring block. | 13,410 | $70 | $992.3K |
Showing 1–10 of 85
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
85 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99469 | The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day. | 1 | 30 | 1,410 | $340 | $2.5M |
| 99284 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making. | 307 | 710 | 1,790 | $200 | $2.1M |
| 99479 | The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams. | 1 | 30 | 3,360 | $120 | $1.2M |
| 99472 | The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting. | 2 | 30 | 1,140 | $370 | $1.2M |
| 99283 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making. | 138 | 730 | 1,960 | $100 | $1M |
| 99480 | The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams. | 1 | 40 | 1,860 | $110 | $997.5K |
| 99282 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making. | 33 | 370 | 360 | $120 | $279.5K |
| 99468 | The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting. | 4 | 30 | 100 | $780 | $242.1K |
| 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… | 573 | 6,040 | 710 | $40 | $232.8K |
| 99464 | The provider is present during the delivery, at the request of the delivering provider, and during the basic stabilization of the newborn immediately after birth, typically when fetal distress or… | 1 | 30 | 910 | $80 | $190K |
Showing 1–10 of 85
Other providers in the same ZIP code as Pediatrix Medical Group Of Texas Billing, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Creation Living Center | TX | Personal Care Attendant | $0 | $27.7M |
| Alexis Health Care Inc. | TX | Home Health Agency | $0 | $13.6M |
| Chca West Houston L P | TX | General Acute Care Hospital | $0 | $11.1M |
| Raza Pasha | TX | Otolaryngology Physician | $387K | $600 |
| Ahmed Jamaluddin | TX | Cardiovascular Disease Physician | $82K | $144.9K |
| Alfredo Garcia | TX | Cardiovascular Disease Physician | $143.8K | $2.1K |
| Shirley Mathew | TX | Ophthalmology Physician | $117.8K | $0 |
| Adeeba Akhtar | TX | Geriatric Medicine (Family Medicine) Physician | $108.9K | $0 |
| Andrew Huang | TX | Otolaryngology Physician | $22.6K | $0 |
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