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    OpenPayerNPI Medicare & MedicaidSummersville Pediatrics, Inc.
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    Summersville Pediatrics, Inc. — Billing Profile & Reimbursement Data

    NPI 1700270436 · Webster Springs, WV · Pediatric Clinical Nurse Specialist

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    Summersville Pediatrics, Inc. is a pediatric clinical nurse specialist provider located in Webster Springs, West Virginia. This profile covers 0 Medicare and 24 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationSummersville Pediatrics, Inc.
    Address142 N Court Square
    CityWebster Springs
    StateWV
    ZIP26288
    TaxonomyPediatric Clinical Nurse Specialist
    NPI EnumeratedMarch 19, 2015

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$1.3M
    Medicare$0

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    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

    Medicaid: Complete Services Breakdown

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

    24 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    T1015Clinic visit/encounter, all-inclusive10,540$110$1.2M
    99213The 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…6,590$10$52.7K
    99212The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…1,760$1$7.1K
    92551The provider delivers a limited series of tones or sounds to a patient to determine if the patient’s hearing is in an acceptable range to detect hearing problems.1,500$1$4.5K
    90471In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.210$20$4K
    87430The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.280$10$1.4K
    99392Preventive 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…250$10$1.3K
    90686This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…250$10$1.3K
    90472This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.40$30$1.2K
    87804The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.510$1$1K

    Showing 1–10 of 24

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. West Virginia median

    24 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    T1015Clinic visit/encounter, all-inclusive1373904,610$130$2.2M
    99213The 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…2821,2701,240$30$245K
    99392Preventive 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…92150520$50$76.2K
    99391Preventive 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…127140550$50$67.2K
    99212The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…117540320$20$43.2K
    99393The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.68190220$50$42.7K
    90472This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.162200360$20$26K
    99394The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.63180140$50$24.8K
    87811The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…1370130$20$23.3K
    87804The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.107310250$20$21.7K

    Showing 1–10 of 24

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Summersville Pediatrics, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Summersville Pediatrics Inc.WVSpecialist$0$12M

    Nearby Providers

    Other providers in the same ZIP code as Summersville Pediatrics, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Webster County Memorial HosptialWVCritical Access Hospital$0$2.6M
    Webster County Memorial HospitalWVCritical Access Hospital$0$1.9M
    Webster County Commission Of Senior Citizens, Inc.WVHome Health Agency$0$1.8M
    Webster Memorial Hospital, Inc.WVCritical Access Hospital$0$1.7M
    Webster County Memorial HospitalWVRural Health Clinic/Center$0$1.4M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicaid Revenue by Year vs. West Virginia Providers
    0 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. West Virginia Distribution
    Summersville Pediatrics, Inc. — 0 of 14 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — West Virginia