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 1679593107)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Children's Hospital Of Alabama
Address	520 Simmons Dr
City	Trussville
State	AL
ZIP	35173
Taxonomy	Pediatrics Physician
NPI Enumerated	July 20, 2006

Payer Source	Total Paid
Medicaid	$18.4M
Medicare	$0

THE CHILDREN'S HOSPITAL OF ALABAMA is effectively a Medicaid-focused billing entity: there is no Medicare billing on file and total Medicaid revenue is $18.4M, so Medicaid accounts for the entirety of recorded lifetime government payer revenue for this NPI. This places the provider as a near single-payer (Medicaid) operation in the available claims data rather than a mixed Medicare/Medicaid practice.

Revenue is highly concentrated in a narrow set of outpatient E/M and preventive codes: the top three Medicaid codes (99213, 99214, 99392) together account for 63.3% of this provider's total Medicaid revenue. Those three codes individually account for $5.6M (31.6%) from 99213, $4.5M (25.1%) from 99214, and $1.2M (6.6%) from 99392, indicating the majority of dollars flow from routine established-patient visits and preventive well-child visits.

The CPT/HCPCS mix is characteristic of high-volume pediatric primary care and preventive services. Large claim volumes for 99213 (82.8K claims) and 99214 (44.3K claims) combined with substantial counts for well-child/preventive codes 99392 (15.7K claims), 99391, 99393 and 99394, plus broad vaccine administration codes (90670, 90698, 90716, 90680), point to an operational emphasis on ambulatory pediatric evaluation/management, routine immunizations, and periodic well visits.

Competitive standing within Alabama is dominant on core outpatient E/M measures: 99213 ranks #9 of 1,988 in-state and is labeled an "extreme outlier, far above typical state volume for this code," while 99214 ranks #24 of 1,990 providers (99th percentile) and 99392 ranks #7 of 299 providers (98th percentile). These rank and percentile placements indicate the provider is a major statewide volume leader for established pediatric office visits and preventive services.

Vaccination and preventive service delivery is a meaningful secondary revenue stream and area of competitive strength. Codes for vaccine administration and combination vaccines (90670, 90698, 90460/90461, 90716, 90680) appear repeatedly in the top codes with notable state rankings (for example, 90698 ranks #3 of 132 at the 98th percentile and 90670 ranks #9 of 258 at the 97th percentile), signaling above-typical vaccine throughput relative to peers.

The provider also shows significant diagnostic testing volume for respiratory pathogens, reflecting a capacity for on-demand testing and seasonal infectious disease work: 87635 (SARS–CoV–2 NAAT) has 18.8K claims and $790.2K revenue (rank #9 of 296, 97th percentile), and 87502 (influenza multiplex) has 14.3K claims and $645.4K revenue (rank #6 of 112, 95th percentile). This pattern suggests an embedded testing workflow that complements high ambulatory visit volumes.

The NPI has long tenure in the dataset, enumerated on 2006-07-20 (~20 years ago), which supports interpretation of these volumes as the output of an established pediatric practice network or service line rather than a recent entrant. Longstanding enumeration paired with consistent high-volume ranks implies sustained market presence.

Operationally, the reliance on high volumes of 99213/99214 and preventive visit codes concentrates reimbursement risk in outpatient E/M demand and immunization/testing throughput: a large share of Medicaid revenue is tied to routine visits and preventive care workflows rather than high-acuity or specialty-procedural revenue. For payer or provider analysts, this profile flags opportunities to assess visit mix, capacity for preventive care delivery, and the impact of visit-volume fluctuations on Medicaid revenue stability.

Medicaid: Complete Services Breakdown

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

70 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…	82,770	$70	$5.6M
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…	44,280	$100	$4.5M
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…	15,710	$80	$1.2M
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…	12,690	$70	$926.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	11,740	$80	$904.2K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	18,820	$40	$790.2K
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…	14,340	$50	$645.4K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	9,020	$50	$423.9K
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.	7,040	$60	$422.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3,720	$90	$330.7K

Showing 1–10 of 70

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 — 15 of 25 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

70 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	44	90	500	$40	$303.6K
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…	24	1,990	680	$60	$201.7K
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…	308	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…	9	1,990	560	$40	$185.6K
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	270	1,360	$60	$159.7K
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…	7	300	1,160	$50	$147.8K
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…	6	110	610	$40	$143.9K
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	12	60	350	$30	$136.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7	320	640	$50	$98.1K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	9	300	210	$40	$77.9K

Showing 1–10 of 70

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children And Teen Dental Group Of Alabama	AL	Pediatric Dentistry	$0	$1.2M
Scott Boyken	AL	Sports Medicine (Family Medicine) Physician	$107.3K	$0
Andrew Smith	AL	Family Medicine Physician	$95.4K	$0
St Vincents Ambulatory Healthcare Network LLC	AL	Physiological Laboratory	$87.8K	$4.9K
Melanie Miller	AL	Family Medicine Physician	$61K	$0
Brittney Randolph	AL	Clinical Psychologist	$13.3K	$0

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

Sign up for The Children's Hospital Of Alabama — Billing Profile & Reimbursement Data policy alerts

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

Sign up for The Children's Hospital Of Alabama — Billing Profile & Reimbursement Data policy alerts

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	$17.7M
The Children's Hospital Of Alabama	AL	Pediatric Otolaryngology Physician	$0	$15.8M
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