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

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

Urgent Care At Children's, Inc. (NPI 1659425825)

Key Findings

Field	Value
Entity Type	Organization
Organization	Urgent Care At Children's, Inc.
Address	1575 Northeast Expy Ne
City	Brookhaven
State	GA
ZIP	30329
Taxonomy	Pediatrics Physician
NPI Enumerated	January 23, 2007

Payer Source	Total Paid
Medicaid	$48.8M
Medicare	$0

This provider has no Medicare billing on file and is effectively a single-payer operation: Total Medicaid revenue is $48.8M and Medicare revenue is listed as none, so Medicaid activity entirely dominates its billing footprint. Analysts should treat Medicaid trends as the primary indicator of business performance rather than splitting analysis across payers.

Revenue is highly concentrated in a small number of evaluation-and-management codes: the top 3 Medicaid codes (99214, 99213, 99203) account for 71.9% of this provider's total Medicaid revenue, indicating that office/outpatient E/M visits are the principal revenue drivers. Those three codes individually generated $14M (99214, 28.7%), $10.9M (99213, 22.3%), and $10.1M (99203, 20.8%) of Medicaid revenue, underscoring heavy reliance on ambulatory visit volume.

The provider is a statewide volume leader for core pediatric E/M services: 99214 ranks #1 of 824 providers in-state (100th percentile; extreme outlier) and 99203 ranks #1 of 314 providers in-state (100th percentile; extreme outlier), while 99213 ranks #3 of 917 providers in-state (100th percentile; extreme outlier). These rank and percentile positions indicate dominant market share in Georgia for both new- and established-patient pediatric outpatient visits compared with in-state peers.

The code mix and ancillary services point to a high-throughput pediatric urgent-care or walk-in clinic model: very large counts and revenue for E/M codes (99214/99213/99203) combined with substantial volumes of respiratory and point-of-care testing such as 87636 ($5.8M, 11.9% of Medicaid revenue; ranks #1 of 22 in-state, 100th percentile; extreme outlier) and 87651 ($2.3M, 4.8%; ranks #1 of 42, 100th percentile). This blend of office visits plus multiplex respiratory testing and Strep A testing suggests frequent, episodic acute respiratory care for children.

Lab and ancillary procedure volumes further characterize operational scope: high counts for 87636 and 87651, plus notable placements of 87502 and 87637, reflect a substantial testing component driving material revenue share in addition to visits. Several medication/administration and DME-related codes such as J8540 (ranks #1 of 8 in-state) and J7613 (ranks #1 of 20 in-state) appear at state-leading volumes for those specific products, indicating this site also bills for common pediatric drug and inhalation treatments.

The provider exhibits outsized state-level specialization in a number of discrete codes beyond E/Ms: multiple codes are described as “extreme outlier” or “notably above typical,” including 99214, 99213, 99203, 87636, 87651, 87502 and J7613. These descriptors and the rank/percentile placements make clear this entity is not a typical-sized clinic but a concentrated volume center for specific pediatric services in Georgia. This has implications for network contracting and capacity assumptions when comparing peer clinics.

Concentration in a few high-volume codes creates revenue exposure to changes in E/M utilization or reimbursement: because 71.9% of Medicaid revenue is tied to 99214, 99213, and 99203, any policy, utilization, or coding shifts affecting those E/M codes would materially impact the organization’s Medicaid revenue base. Payers and analysts should monitor encounter volume trends for those three codes closely when forecasting spend or negotiating rates.

The provider has long-tenure credentialing in the NPI registry, enumerated 2007-01-23 (~19 years ago), which supports interpretation of these volumes as the output of an established clinic rather than a transient or newly opened operation. Long tenure combined with the extreme outlier status on multiple codes suggests an entrenched operational model focused on high-volume pediatric urgent and acute-care services.

Medicaid: Complete Services Breakdown

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

88 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	144,010	$100	$14M
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…	159,670	$70	$10.9M
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…	102,380	$100	$10.1M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	37,340	$160	$5.8M
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…	21,430	$160	$3.4M
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.	85,630	$30	$2.3M
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	4,020	$150	$618.5K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	5,840	$60	$373.4K
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.	4,410	$60	$242.6K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	8,430	$20	$160.2K

Showing 1–10 of 88

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Urgent Care At Children's, Inc. — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

88 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	90	140	200	$280	$1.9M
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.	55	230	120	$170	$937.5K
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.	43	240	170	$120	$779.3K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	1	20	190	$140	$407.6K
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	920	370	$60	$360.6K
J3490	Unclassified drugs	8	20	1,330	$20	$288.2K
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…	1	820	390	$70	$245K
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…	93	180	680	$90	$226.7K
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…	143	180	720	$90	$204.2K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	83	250	660	$40	$172.7K

Showing 1–10 of 88

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Emory Clinic Inc	GA	Ambulatory Surgical Clinic/Center	$1.4M	$26.6M
Lifebrite Laboratories, LLC	GA	Clinical Medical Laboratory	$526K	$9.4M
Marcus Autism Center, Inc.	GA	Pediatrics Physician	$0	$3.4M
Emergent Testing Lab LLC	GA	Clinical Medical Laboratory	$272.6K	$1.9M
United Physician Group LLC	GA	Family Medicine Physician	$0	$1.9M
Children's Sedation Services, LLC	GA	Critical Care Medicine (Anesthesiology) Physician	$0	$1.1M
Sharron Cross	GA	Mental Health Counselor	$0	$1.1M
Children's Anesthesia Services, LLC	GA	Pediatric Anesthesiology Physician	$0	$929.4K
Mds Digital X-ray LLC	GA	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	$602.4K	$0
Alan Freeman	GA	Neurology Physician	$301.2K	$0

Urgent Care At Children's, Inc. — Billing Profile & Reimbursement Data

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Urgent Care At Children's, Inc. — 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