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

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

Children's Hospital Corporation (NPI 1710087127)

Field	Value
Entity Type	Organization
Organization	Children's Hospital Corporation
Address	300 Longwood Ave
City	Boston
State	MA
ZIP	02115
Taxonomy	Children's Hospital
NPI Enumerated	September 25, 2006

Payer Source	Total Paid
Medicaid	$330.9M
Medicare	$0

Key Findings

CHILDREN'S HOSPITAL CORPORATION is effectively single‑payer in the public claims data: there is no Medicare billing on file and all reported lifetime revenue is from Medicaid, totaling $330.9M. This concentration indicates the provider’s public‑payer exposure and contracting considerations will be driven almost entirely by Medicaid reimbursement policies and populations.

Revenue concentration is substantial within a small set of outpatient E/M codes: the precomputed top 3 Medicaid codes account for 24.7% of the provider’s total Medicaid revenue, driven by 99213 ($17.7M, 10.2%), 99283 ($13.5M, 7.8%), and 99214 ($11.7M, 6.7%). Those three high-volume E/M codes point to a business model with large ambulatory and emergency visit volume that disproportionately drives fee‑for‑service revenue.

The coding mix shows a broad pediatric specialty footprint beyond primary care: very high volumes of ED E/M (99283, 99284, 99285) and office E/M (99213, 99214) are paired with high-volume procedural and specialty services such as tonsillectomy/adenoidectomy 42820 ($6.8M), tympanostomy 69436 ($7.0M), and pediatric dental/tooth procedures 41899 ($7.2M). Together this pattern is consistent with a major tertiary pediatric hospital that provides acute ED care, surgical procedures under general anesthesia, and outpatient clinic services.

Infusion, oncology, and high‑cost drug administration are meaningful revenue drivers: J1745 (infliximab) accounts for $10.4M (6.0%) and ranks #1 of 11 in‑state (100th percentile; notably above typical state volume for this code), 96413 (chemotherapy) contributes $10M (5.8%) and ranks in the 87th percentile, and J1561 (immune globulin) contributes $7.6M (4.3%) and ranks #1 of 4 in‑state (100th percentile; typical, unremarkable volume for this code). These signals indicate a significant infusion/oncology service line and a hub role for biologic and IV therapies in the provider’s Medicaid business.

The provider is a statewide leader on many pediatric‑specific services: multiple codes are flagged as extreme outliers or top in the state — for example, 99213 ranks #20 of 5303 (100th percentile; extreme outlier, far above typical state volume for this code), 69436 ranks #1 of 26 (100th percentile; extreme outlier, far above typical state volume for this code), 42820 ranks #1 of 16 (100th percentile; extreme outlier, far above typical state volume for this code), 70551 ranks #1 of 109 (100th percentile; extreme outlier, far above typical state volume for this code), and 87635 ranks #1 of 717 (100th percentile; extreme outlier, far above typical state volume for this code). These rankings indicate dominant in‑state market share for several high‑impact pediatric procedures and testing volumes.

Other service lines show typical or unremarkable state standing despite material revenue: codes such as 96413 (87th percentile), 96366 (87th percentile), and 96365 (82th percentile) produce meaningful income but are described as typical or unremarkable volumes in state context, suggesting these are important but not uniquely concentrated revenue streams. This mixed competitive profile implies the provider combines monopolistic strength in core pediatric procedures with standard regional participation in infusion and inpatient‑level services.

Preventive and developmental pediatrics are a visible part of the ambulatory mix: 99391 ($3.6M, 2.1%) ranks #5 of 550 in‑state (99th percentile; extreme outlier, far above typical state volume) and 99392 ($3.2M, 1.8%) ranks #3 of 628 in‑state (100th percentile; extreme outlier, far above typical state volume). High volumes of well‑child preventive visits indicate substantial primary care and developmental follow‑up activity embedded within the hospital’s outpatient operations.

The provider has long tenure in the NPI registry, enumerated on 2006-09-25 (~20 years ago), which supports interpretation of these patterns as established operational capacity rather than a short‑term or recent expansion. Given the combination of scale ($330.9M Medicaid revenue), multi‑service lines (ED, surgery, imaging, infusions, preventive care), and repeated top‑state rankings, payers should treat this entity as a major, institutionally entrenched pediatric provider in Massachusetts Medicaid networks.

Medicaid: Complete Services Breakdown

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

852 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…	135,080	$130	$17.7M
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.	74,790	$180	$13.5M
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…	75,700	$150	$11.7M
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.	57,790	$200	$11.6M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	4,980	$2,080	$10.4M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	10,660	$940	$10M
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.	36,290	$270	$9.7M
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	8,440	$920	$7.7M
J1561	Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg	4,040	$1,870	$7.6M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	4,010	$1,800	$7.2M

Showing 1–10 of 852

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Children's Hospital Corporation — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

852 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2023	Targeted case management; per month	59	70	8,210	$510	$8.6M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	2	10	470	$2,670	$6.3M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	41	90	7,560	$350	$4.2M
S9485	Crisis intervention mental health services, per diem	64	110	1,250	$540	$3.2M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1	10	1,380	$1,380	$2.7M
J1561	Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg	1	10	2,050	$1,240	$2.6M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	3	10	1,200	$1,560	$2.1M
J3380	Injection, vedolizumab, intravenous, 1 mg	7	10	330	$2,790	$1.6M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	8	50	1,870	$210	$1.4M
G0378	Hospital observation service, per hour	8	70	7,250	$100	$1.3M

Showing 1–10 of 852

Related Providers

Other providers that share a Tax Identification Number (TIN) with Children's Hospital Corporation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Pediatric Associates, Inc	MA	Pediatrics Physician	$0	$19.1M
Kee Chung	MA	Pediatric Radiology Physician	$207.1K	$107.4K
Thaddeus Herliczek	MA	Pediatric Radiology Physician	$38.7K	$264K
Nutan Sharma	MA	Neurology Physician	$286K	$0
Jeffrey Sorkin	MA	Ophthalmology Physician	$24.9K	$251.2K
Thomas Tadros	MA	Clinical Cardiac Electrophysiology Physician	$160.8K	$0
Nimesh Patel	MA	Ophthalmology Physician	$140.4K	$8K
Lisa Teot	MA	Anatomic Pathology Physician	$23.5K	$63.9K
Kevin Friedman	CO	Pediatric Cardiology Physician	$790	$68.1K
Michal Vytopil	MA	Neurology Physician	$53.9K	$0

Nearby Providers

Other providers in the same ZIP code as Children's Hospital Corporation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brigham & Womens Hospital, Inc.	MA	General Acute Care Hospital	$0	$252.7M
Brigham & Womens Physicians Organization Inc	MA	Internal Medicine Physician	$0	$43.6M
Roman Klufas	MA	Neuroradiology Physician	$475.7K	$441.9K
Paul Massey	MA	MOHS-Micrographic Surgery Physician	$621.3K	$0
John Chi	MA	Neurological Surgery Physician	$444.6K	$0
An Bui	MA	Internal Medicine Physician	$410.9K	$0
Mohammadali Mojarrad	MA	Diagnostic Radiology Physician	$343.4K	$40.3K
James Kang	MA	Orthopaedic Surgery Physician	$371.1K	$0
Monica Krishnan	MA	Radiation Oncology Physician	$340.4K	$0
Joseph Kavolus	MA	Orthopaedic Surgery Physician	$306.9K	$0

Children's Hospital Corporation — 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