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

Why is the Medicaid comparison limited to Nebraska 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. Nebraska (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 Physicians (NPI 1750443503)

Key Findings

Field	Value
Entity Type	Organization
Organization	Children's Physicians
Address	8401 W Dodge Rd
City	Omaha
State	NE
ZIP	68114
Taxonomy	Pediatrics Physician
NPI Enumerated	December 15, 2006

Payer Source	Total Paid
Medicaid	$39.4M
Medicare	$0

CHILDREN'S PHYSICIANS has no Medicare billing on file and reports $39.4M in lifetime Medicaid revenue, making Medicaid effectively the sole payer source on record for this NPI. This single-payer picture should guide any payer/provider analyst to treat Medicaid reimbursement policy and state program changes as the primary drivers of revenue impact for this entity.

Revenue is highly concentrated: the precomputed top three Medicaid codes (99213, 99392, 99391) together account for 64.8% of the provider’s total Medicaid revenue. Specifically, 99213 generated $15.4M (40.3%), 99392 generated $5.2M (13.7%), and 99391 generated $4.2M (10.9%), indicating a heavy reliance on a small set of E/M and preventive visit codes.

The code mix points to a pediatric primary care and preventive-services operation: 99213 (established patient office visits) and the well-child/preventive codes 99392, 99391, 99393, and 99394 are the largest revenue drivers. High volumes of immunization codes (90686, 90648, 90670, 90723, 90633) and developmental screening 96110 further support the characterization of this practice as a high-throughput pediatric clinic that integrates routine vaccinations and developmental screening into office workflows.

CHILDREN'S PHYSICIANS is a dominant statewide provider for key pediatric services: 99392 and 99391 both rank #1 in-state (100th percentile; extreme outlier) and 99213 ranks #2 of 696 providers in-state (100th percentile; extreme outlier). These rank and percentile positions indicate the practice is a major volume leader in Nebraska for well-child and routine E/M visits, well above typical state volumes for these codes.

Multiple vaccine and lab/testing codes show exceptional state-level volume and percentile positions, consistent with an on-site immunization and testing capacity. Examples include 90686 (60.8K claims, $851.4K revenue; ranks #1 of 210 providers in-state, 100th percentile), 87637 (7.1K claims, $986.1K revenue; ranks #1 of 20 providers in-state, 100th percentile), and 87651 (18.3K claims, $678.7K revenue; ranks #1 of 67 providers in-state, 100th percentile), signaling unusually high throughput for vaccines and respiratory/strep testing.

The practice also delivers moderate-complexity care in addition to high-volume low-complexity visits: 99214 accounts for $3.2M (8.2% of Medicaid revenue) and ranks #11 of 596 providers in-state (98th percentile). This suggests the clinic manages a meaningful share of higher-acuity or longer encounters alongside preventive care.

The concentration of revenue in a narrow set of pediatric E/M and preventive codes (top three = 64.8%) creates sensitivity to changes in Medicaid policy, fee schedules, or coding practices for those specific codes. Because Medicaid represents the entire recorded payer base here, any state-level reimbursement adjustments to these high-volume codes could have outsized effects on the provider’s revenue profile.

The NPI has been enumerated since 2006-12-15 (~20 years ago), indicating a long-tenured operation. This tenure is consistent with the large cumulative claim volumes reported across preventive, vaccine, and testing codes and supports the conclusion that the provider is an established pediatric practice with sustained state-level market presence.

Medicaid: Complete Services Breakdown

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

112 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…	265,810	$60	$15.4M
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…	55,840	$90	$5.2M
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…	47,810	$90	$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…	36,640	$90	$3.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	28,970	$90	$2.7M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	12,670	$110	$1.3M
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	7,150	$140	$986.1K
90686	This 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…	60,820	$10	$851.4K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	18,340	$40	$678.7K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	23,020	$20	$529.6K

Showing 1–10 of 112

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Children's Physicians — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

112 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…	2	700	660	$70	$305.1K
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…	11	600	610	$70	$251.4K
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…	1	70	360	$80	$234.7K
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…	1	70	230	$90	$222.7K
0241U	N/A	7	40	210	$110	$109.1K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	1	20	50	$140	$102.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1	70	100	$100	$100.9K
94375	The provider performs a respiratory flow volume loop study to differentiate a patient's obstructive pulmonary disorder from restrictive pulmonary disorders. He may also use the procedure to…	6	10	1,550	$60	$100.8K
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	19	30	440	$60	$99.6K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	14	20	270	$60	$67K

Showing 1–10 of 112

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital & Medical Center	NE	Children's Hospital	$0	$89.8M
Nebraska Pediatric Practice, Inc	NE	Pediatrics Physician	$0	$29M
Physicians Clinic Inc	NE	Family Medicine Physician	$0	$20.5M
Nebraska Methodist Hospital	NE	General Acute Care Hospital	$0	$14.5M
Smiles 4 Kids PC	NE	General Practice Dentistry	$0	$11.5M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Nebraska Methodist Hospital	NE	Emergency Medicine Physician	$0	$5.3M
Unmc College Of Dentistry	NE	Dentist	$0	$4.8M
Stones Worth Stepping, P.C.	NE	Occupational Therapist	$0	$4.7M
Pacific Surgery Center, LLC	NE	Ambulatory Surgical Clinic/Center	$3.4M	$3.2K

Children's Physicians — 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