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

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

Pocatello Children & Adolescent Clinic (NPI 1700898822)

Key Findings

Field	Value
Entity Type	Organization
Organization	Pocatello Children & Adolescent Clinic
Address	1151 Hospital Way Bldg F
City	Pocatello
State	ID
ZIP	83201
Taxonomy	Pediatrics Physician
NPI Enumerated	August 13, 2006

Payer Source	Total Paid
Medicaid	$11M
Medicare	$0

POCATELLO CHILDREN & ADOLESCENT CLINIC’s Medicaid business is overwhelmingly driven by pediatric outpatient evaluation/management and preventive care: the top Medicaid revenue codes are 99213 ($3.7M, 55.8K claims), 99392 ($1.4M, 15.3K claims) and 90460 ($1.4M, 34.2K claims), and these three codes together account for 59.2% of the provider’s total Medicaid revenue. The dollar and claim volumes for these codes indicate the clinic functions primarily as a high-volume pediatric primary-care and well-child immunization practice rather than as a specialty or hospital-based provider.

Revenue concentration is high within Medicaid: the precomputed top-three share is 59.2% of the provider’s $11M in total Medicaid revenue, reflecting reliance on a small set of routine visit and vaccine codes for the majority of billed Medicaid dollars. That degree of concentration suggests the provider’s topline is sensitive to changes in preventive visit and immunization reimbursement or care-pattern shifts.

This provider effectively operates as a Medicaid-centric practice: there is no Medicare billing on file and total Medicaid revenue is $11M, so payer mix is essentially single-payer Medicaid at scale. The absence of Medicare activity is consistent with a pediatric-only taxonomy and the service mix dominated by well-child and immunization codes.

On competitive standing within Idaho, the practice is a market leader for multiple high-volume pediatric services: 99213 ranks #10 of 669 providers in-state (99th percentile; extreme outlier), 99392 ranks #3 of 79 (97th percentile; extreme outlier), and 90460 ranks #2 of 78 (99th percentile; extreme outlier). Additional vaccine/administration codes show similarly elevated positions — for example, 90461 is #1 of 58 providers in-state (100th percentile) — indicating the clinic delivers immunizations at a much higher volume than typical peers across the state.

The clinic has a long operational tenure: its NPI was enumerated on 2006-08-13 (~20 years ago), which supports the interpretation that this is an established pediatric practice with sustained Medicaid volume over time. Longevity combined with high state ranks suggests entrenched referral or community relationships driving steady preventive-care demand.

The code mix shows broad age-targeted well-child care and vaccination activity: in addition to adult established-visit codes, the provider bills well-patient visit codes across pediatric age bands (99391, 99392, 99393, 99394) and multiple vaccine administration codes (90460, 90461, 90471, 90472), with substantial claim volumes such as 16.2K claims for 99391 and 19.7K claims for 90461. This pattern signals an operational focus on scheduled preventive visits and bundled immunization workflows common to pediatric primary-care clinics.

Ancillary diagnostic and preventive services are present on-site: the provider bills for multiplex SARS–CoV–2/influenza testing 87636 (847 claims, $93.2K), strep testing codes 87880/87651, lead testing 83655 (827 claims, $9.9K), and topical fluoride 99188 (3.4K claims, $44.4K). These lines of business indicate capacity for point-of-care testing and basic preventive oral/lead screening that complement the clinic’s high-volume well-child and immunization services.

From a payer perspective this profile presents both risks and opportunities: the clinic’s dominance in routine E/M and immunization codes creates operational leverage to support population health initiatives (e.g., pediatric immunization campaigns) but also concentrates reimbursement exposure in a few service lines. Given the $11M Medicaid footprint and the 59.2% top-three revenue concentration, payers should monitor reimbursement changes for 99213, 99392, and 90460 and consider whether incentives for quality or vaccination uptake could align with the clinic’s existing workflow and high statewide volumes.

Medicaid: Complete Services Breakdown

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

65 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…	55,760	$70	$3.7M
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…	15,260	$90	$1.4M
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.	34,170	$40	$1.4M
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…	16,170	$80	$1.3M
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…	9,190	$100	$882.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	9,720	$90	$855.6K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	19,660	$40	$747.2K
99212	The 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,…	4,960	$40	$183.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,670	$100	$158.3K
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…	850	$110	$93.2K

Showing 1–10 of 65

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Pocatello Children & Adolescent Clinic — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

65 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	10	670	740	$40	$193.6K
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…	41	620	560	$60	$191.8K
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	80	450	$80	$171.3K
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…	2	80	380	$70	$151.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2	80	130	$80	$91.4K
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.	2	80	460	$30	$77.7K
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…	3	10	130	$110	$61.8K
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…	44	50	210	$80	$51.4K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	1	60	290	$30	$48.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	7	60	50	$70	$35.5K

Showing 1–10 of 65

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Moonlight Mountain Recovery, Inc	ID	Substance Abuse Rehabilitation Facility	$0	$17.7M
Speech Therapy Services, LLC	ID	Speech-Language Pathologist	$0	$8.5M
Pocatello Chubbuck School District #25	ID	Local Education Agency (LEA)	$0	$7.9M
Facial & Oral Surgery Associates, Inc.	ID	Oral and Maxillofacial Surgery (Dentist)	$0	$6.3M
Health West, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$6.2M
Pocatello Hospital LLC	ID	General Acute Care Hospital	$0	$6.1M
Health West, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$5.9M
Rocky Mountain Physician Group LLC	ID	Emergency Medicine Physician	$0	$5.5M
Community Mental Health	ID	Community/Behavioral Health Agency	$0	$4.3M
Medical Imaging Associates Of Idaho Falls, Inc	ID	Diagnostic Radiology Physician	$0	$4.2M

Pocatello Children & Adolescent Clinic — Billing Profile & Reimbursement Data

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Pocatello Children & Adolescent Clinic — 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