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NPI 1750351375 · Dallas, TX · Pediatrics Physician
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University Of Texas Southwestern Medical Center At Dallas is a pediatrics physician provider located in Dallas, Texas. This profile covers 0 Medicare and 105 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | University Of Texas Southwestern Medical Center At Dallas |
| Address | 5323 Harry Hines Blvd |
| City | Dallas |
| State | TX |
| ZIP | 75390 |
| Taxonomy | Pediatrics Physician |
| NPI Enumerated | January 25, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $66.3M |
| Medicare | $0 |
This entity is effectively a Medicaid-focused provider: there is no Medicare billing on file and total Medicaid revenue is $66.3M. The NPI was enumerated on 2006-01-25 (~20 years ago), indicating a long-established billing presence in the state Medicaid program.
Revenue is highly concentrated in a few high-volume codes: the top three Medicaid codes (99284, 99469, 99285) together account for 38.0% of the provider's total Medicaid revenue. Individually those codes are $8.8M (99284, 14.2%), $7.9M (99469, 12.8%), and $6.9M (99285, 11.1%), making these services critical drivers of the center’s Medicaid finances.
The code mix indicates a strong pediatric neonatal and critical-care service line: 99469 ($7.9M, 12.8%), 99479 ($4.7M, 7.6%), 99472 ($4.6M, 7.4%), and 99468 ($955.5K, 1.5%) reflect sustained volume in neonatal critical care and low birth weight follow-up. Several of these neonatal codes rank near the top of in-state peers (for example 99479 ranks #3 of 33 in-state, 94th percentile) and point to a specialized NICU-oriented operation rather than a primarily routine outpatient pediatric practice.
Emergency department and high-acuity inpatient care are major operational components: ED E/M codes 99284 ($8.8M, 14.2%) and 99285 ($6.9M, 11.1%) are both reported as extreme outliers in-state (99284 ranks #13 of 714, 98th percentile; 99285 ranks #11 of 587, 98th percentile). The presence of substantial critical care billing (99291: $1.9M, 3.1%, ranks #7 of 280, 98th percentile) reinforces that the center handles high-acuity pediatric emergencies and intensive care.
The provider also shows heavy inpatient and discharge-management activity consistent with a hospital-based pediatric service line: 99233 ($4.2M, 6.8%) ranks #4 of 956 (100th percentile; extreme outlier) and 99239 ($983.9K, 1.6%) ranks #3 of 421 (100th percentile; extreme outlier). These patterns indicate significant throughput of admitted patients and time-intensive subsequent/higher-complexity inpatient encounters.
Outpatient continuity and clinic-level visits are also significant: 99214 ($4.0M, 6.5%) and 99215 ($2.8M, 4.5%) appear among the top-revenue codes and rank extremely high versus in-state peers (99214 ranks #22 of 5814, 100th percentile; 99215 ranks #4 of 1011, 100th percentile). This suggests the organization operates a broad continuum—from high-acuity acute care through ambulatory follow-up—within its Medicaid population.
Statewide competitive standing is dominant for many pediatric acute-care codes: multiple codes are labeled as extreme outliers or in the 97–100th percentiles (examples include 99233 at the 100th percentile, 99215 at the 100th percentile, and 99239 at the 100th percentile). Those ranks imply the provider is a major hub in Texas for pediatric ED, inpatient, and NICU services rather than a modest local participant.
Operational and payer-risk implications flow from the pattern: reliance on Medicaid ($66.3M) and concentration of 38.0% of Medicaid revenue in three top codes (99284, 99469, 99285) mean that changes to Medicaid payment policy, volume shifts in ED/NICU care, or reclassification of these high-volume codes could materially affect revenue. For payers and network analysts, this combination of high concentration and specialty-intensive coding signals where utilization-management and contract negotiation focus would have the largest impact.
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
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
105 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 101,290 | $90 | $8.8M |
| 99469 | The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day. | 22,290 | $360 | $7.9M |
| 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. | 62,400 | $110 | $6.9M |
| 99479 | The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams. | 39,810 | $120 | $4.7M |
| 99472 | The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting. | 12,680 | $360 | $4.6M |
| 99233 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 63,780 | $70 | $4.2M |
| 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… | 97,980 | $40 | $4M |
| 99480 | The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams. | 31,370 | $110 | $3.6M |
| 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… | 42,860 | $70 | $2.8M |
| 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. | 50,540 | $50 | $2.3M |
Showing 1–10 of 105
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
105 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99469 | The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day. | 4 | 30 | 1,410 | $340 | $2.5M |
| 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. | 13 | 710 | 1,790 | $200 | $2.1M |
| 99479 | The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams. | 3 | 30 | 3,360 | $120 | $1.2M |
| 99472 | The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting. | 3 | 30 | 1,140 | $370 | $1.2M |
| 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. | 36 | 730 | 1,960 | $100 | $1M |
| 99480 | The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams. | 3 | 40 | 1,860 | $110 | $997.5K |
| 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. | 11 | 590 | 740 | $170 | $969.2K |
| 95782 | A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters. | 1 | 30 | 330 | $1,020 | $750.2K |
| 93303 | The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization… | 6 | 70 | 850 | $180 | $621.2K |
| 95810 | Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,… | 3 | 60 | 340 | $590 | $491.5K |
Showing 1–10 of 105
Other providers in the same ZIP code as University Of Texas Southwestern Medical Center At Dallas, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Courtney Pollard | TX | Ophthalmology Physician | $814.9K | $0 |
| Zachary Robertson | TX | Retina Specialist (Ophthalmology) Physician | $813.1K | $0 |
| Rajiv Nijhawan | TX | MOHS-Micrographic Surgery Physician | $531.5K | $0 |
| John Mchenry | TX | Ophthalmology Physician | $479K | $0 |
| Elie Saad | TX | Diagnostic Radiology Physician | $421.1K | $0 |
| Claus Roehrborn | TX | Urology Physician | $346.6K | $0 |
| Gary Lemack | TX | Urology Physician | $337.7K | $0 |
| Yair Lotan | TX | Urology Physician | $300.7K | $0 |
| Nhat-long Pham | TX | Radiation Oncology Physician | $281.6K | $0 |
| Satyam Veean | TX | Vascular & Interventional Radiology Physician | $281.1K | $0 |
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