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

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

Cook Children's Physician Network (NPI 1750369203)

Key Findings

Field	Value
Entity Type	Organization
Organization	Cook Children's Physician Network
Address	801 7th Ave
City	Fort Worth
State	TX
ZIP	76104
Taxonomy	Pediatrics Physician
NPI Enumerated	January 5, 2006

Payer Source	Total Paid
Medicaid	$106.2M
Medicare	$0

Payer mix and scale: COOK CHILDREN'S PHYSICIAN NETWORK reports no Medicare revenue on file and $106.2M in lifetime Medicaid revenue, making its billing effectively single‑payer Medicaid‑centric in the available data. This concentration of revenue on Medicaid should orient payer/provider analyses toward Medicaid program performance and contracting metrics rather than Medicare comparisons.

Revenue concentration: the provider’s top three Medicaid codes account for 39.6% of its total Medicaid revenue. Those top three codes are 99213 ($17.1M, 19.4%), 99214 ($11.3M, 12.8%), and 99391 ($6.5M, 7.4%), indicating that a relatively small set of office and preventive visit codes drive a large share of Medicaid revenue.

Business and service‑line profile — ambulatory primary and preventive pediatrics: the code mix is dominated by high‑volume outpatient E/M and pediatric preventive visit codes (99213, 99214, 99391, 99392, 99393, 99394) and large vaccine volumes (90460, 90471, 90472). High claim counts such as 99213 at 329.7K claims and 90460 at 183.6K claims together with substantial preventive visit revenue ($6.5M for 99391 and $6.4M for 99392) point to a system primarily operating large-scale pediatric primary care and well‑child/immunization clinics.

Hospital and higher‑acuity services present alongside ambulatory care: sizable Medicaid revenue and claim volumes for inpatient and consult codes (99233: 88.1K claims, $6M; 99232: 59.2K claims, $3M; 99222: 8.8K claims, $937.5K) plus critical care 99291 ($1.8M) and neonatal follow‑up 99472 ($1.6M) indicate the network also provides substantial inpatient, observation, and higher‑acuity pediatric services. Several of these inpatient and consult codes rank at or near the top statewide (many listed as 100th percentile; extreme outlier), signaling integrated hospital‑based capacity in addition to outpatient clinics.

Statewide competitive standing: across many leading pediatric codes the provider ranks as a dominant in‑state performer — for example 99213 ranks #5 of 6037 providers in Texas (100th percentile; extreme outlier), 99214 ranks #8 of 5814 (100th percentile; extreme outlier), and 99392 ranks #2 of 1499 (100th percentile; extreme outlier). These rank/percentile patterns describe a provider that is a major, high‑volume pediatric billing entity in Texas rather than a modest participant for its core services.

Scale effects in low‑unit‑payment services: the network reports very large claim volumes for relatively low average paid amounts per claim, for example 90460 at 183.6K claims with $8 avg paid/claim ($1.5M revenue) and 96110 at 97.3K claims with $9 avg paid/claim ($875.8K revenue). This combination of high volume and low unit payment is consistent with broad preventive and screening programs (vaccination campaigns and developmental screening) that generate substantial aggregate Medicaid revenue through scale.

Mixed specialty footprint: while many pediatric E/M and preventive codes are extreme outliers statewide, several specialized codes show typical or only moderately elevated state volumes — for example 99472 ranks #8 of 26 providers in‑state (72th percentile; typical, unremarkable), 01922 ranks #3 of 20 (89th percentile; typical, unremarkable), and 00170 ranks #12 of 96 (88th percentile; typical, unremarkable). These entries indicate that certain niche anesthesia or specialized inpatient neonatal services are present but not statewide outliers in the same way as the core outpatient pediatric lines.

Organizational tenure and operational implications: the NPI was enumerated on 2006-01-05 (~20 years ago), indicating an established presence in the market. Coupled with the provider’s persistent high ranks and concentrated Medicaid revenue, the data are consistent with a long‑standing regional pediatric network with the scale and infrastructure to sustain large Medicaid volumes across ambulatory, preventive, and inpatient pediatric services.

Medicaid: Complete Services Breakdown

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

270 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…	329,720	$50	$17.1M
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…	176,640	$60	$11.3M
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…	80,310	$80	$6.5M
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…	76,920	$80	$6.4M
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…	88,070	$70	$6M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	42,090	$130	$5.3M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	57,320	$90	$5M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	35,600	$100	$3.4M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	59,180	$50	$3M
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	32,830	$90	$3M

Showing 1–10 of 270

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Cook Children's Physician Network — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

270 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S3620	Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis;…	2	110	90	$270	$3.5M
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.	489	710	1,790	$200	$2.1M
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.	8	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.	605	730	1,960	$100	$1M
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.	565	590	740	$170	$969.2K
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…	42	70	850	$180	$621.2K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	7	110	80	$1,260	$398.1K
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	12	100	410	$160	$390K
01922	The provider performs anesthesia services for a patient undergoing non–invasive imaging or radiation therapy.	3	20	340	$210	$299.2K
95720	A physician or other QHCP reviews recorded events and analyzes spike and seizure detection of a continuous electroencephalography, a study of the electrical activity of the brain. A video is…	2	20	390	$170	$271.2K

Showing 1–10 of 270

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cook Children's Medical Center	TX	Children's Hospital	$0	$286.6M
Cook Children's Physician Network	TX	Pediatric Emergency Medicine (Emergency Medicine) Physician	$0	$25.7M
Cook Children's Medical Center	TX	Pediatrics Physician	$0	$21.3M
Allaaddin Mollabashy	TX	Orthopaedic Surgery Physician	$170K	$0
Nathan Gilbert	TX	Orthopaedic Surgery Physician	$100.2K	$0
Andrea Armstrong	TX	Family Nurse Practitioner	$22K	$0
Scott Pilgrim	TX	Adult Congenital Heart Disease Physician	$2.4K	$0
Bradley Maddy	TX	Physician Assistant	$910	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cook Childrens Home Health	TX	Durable Medical Equipment & Medical Supplies	$0	$64.4M
Tarrant County Hospital District	TX	General Acute Care Hospital	$0	$61.8M
Acclaim Physician Group, Inc	TX	Internal Medicine Physician	$0	$30.9M
Texas Health Harris Methodist Hospital Fort Worth	TX	General Acute Care Hospital	$0	$13.8M
James Haden	TX	Allergy & Immunology (Internal Medicine) Physician	$819.3K	$2.5M
Physicians Surgical Center Of Ft. Worth LLP	TX	Ambulatory Surgical Clinic/Center	$2.9M	$0
Sleep Telemedicine Services, Inc	TX	Sleep Disorder Diagnostic Clinic/Center	$187.3K	$2M
Matthew Cavey	TX	Radiation Oncology Physician	$1.9M	$0
Surgical Caregivers Of Fort Worth LLC	TX	Ambulatory Surgical Clinic/Center	$1.2M	$1.3K
Harshal Broker	TX	Vascular Surgery Physician	$1.2M	$0

Cook Children's Physician Network — 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