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

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

Phoenix Children's Hospital (NPI 1760480503)

Field	Value
Entity Type	Organization
Organization	Phoenix Children's Hospital
Address	1919 E Thomas Rd
City	Phoenix
State	AZ
ZIP	85016
Taxonomy	Children's Hospital
NPI Enumerated	July 13, 2005

Payer Source	Total Paid
Medicaid	$555.8M
Medicare	$0

Key Findings

PHOENIX CHILDREN'S HOSPITAL is effectively a single-payer Medicaid provider in this dataset: it has no Medicare billing on file and reports $555.8M in lifetime Medicaid revenue. The absence of Medicare revenue indicates its payer mix in Medicare/Medicaid terms is heavily concentrated on Medicaid-covered pediatric care rather than adult Medicare services.

Revenue concentration is high: the top three Medicaid codes (99284, 99285, 99283) account for 52.8% of the provider's total Medicaid revenue, signaling that emergency department evaluation-and-management services are the primary revenue drivers. Each of those ED codes also produces large absolute revenues ($82.4M for 99284, $68M for 99285, $63.3M for 99283), reinforcing a heavy operational emphasis on acute pediatric emergency care.

The provider’s emergency department volumes are extreme compared with in-state peers: 99284 ranks #5 of 259 providers (98th percentile, labeled an extreme outlier), 99283 ranks #3 of 258 (99th percentile, extreme outlier), and 99285 ranks #13 of 257 (95th percentile, notably above typical state volume). These rank/percentile patterns characterize PHOENIX CHILDREN'S HOSPITAL as a major regional ED center for pediatric patients, substantially outpacing typical state volumes for high-acuity and moderate-acuity ED visits.

Beyond ED services, the code mix shows a broad pediatric specialty and surgical footprint: high-revenue procedural and diagnostic codes include 42820 ($20.1M), 44970 ($14.4M), 93303 ($16.5M), 93306 ($10.2M), 92587 ($7.5M), 95810 ($6.7M), and 69436 ($6.6M). Many of these codes are surgical or specialized diagnostic services (tonsil/adenoid removal, appendectomy, echocardiography, newborn hearing screening, polysomnography, tympanostomy), which is consistent with an integrated tertiary pediatric hospital that provides both acute and specialty care.

PHOENIX CHILDREN'S shows dominant statewide standing for multiple pediatric procedures: 42820, 44970, J1745, 54161, 67311, 95810, 69436, and 92587 each rank #1 among in-state providers (100th percentile) and are described as extreme outlier or notably above typical state volume. These #1 rankings indicate the hospital functions as a referral hub for pediatric surgical procedures, specialized diagnostics, and high-cost therapies within Arizona.

High-cost drug and infusion services contribute materially to Medicaid revenue: J1459 reports $11.1M (rank #1 of 2, 100th percentile) and J1745 reports $9M (rank #1 of 13, 100th percentile). The presence of sizeable revenue from these injectable therapies underscores that the hospital provides complex, resource-intensive outpatient or inpatient therapeutic services in addition to surgical and ED care.

Operational breadth is further evidenced by high volumes in imaging, lab, and ancillary services: 70551 ($6.1M, rank #3, 98th percentile), 70553 ($4.6M), 80053 ($6.2M), and 97530 ($4.8M) all appear in the top-25 Medicaid codes. These entries point to substantial on-site diagnostic and rehabilitative capacity supporting both inpatient and outpatient pediatric populations rather than a narrow service offering.

The provider’s enrollment history shows longevity in the market: NPI enumerated on 2005-07-13 (~21 years ago). Combined with its statewide top ranks and concentrated Medicaid revenue base, this tenure supports its profile as an established pediatric tertiary/referral center with sustained high-volume ED and specialty procedural activity.

Medicaid: Complete Services Breakdown

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

770 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.	129,760	$640	$82.4M
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.	74,610	$910	$68M
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.	177,310	$360	$63.3M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	5,740	$3,510	$20.1M
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…	21,030	$790	$16.5M
44970	Laparoscopy, surgical, appendectomy	2,520	$5,690	$14.4M
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	6,080	$1,930	$11.7M
J1459	Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg	2,890	$3,820	$11.1M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	16,320	$630	$10.2M
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	13,210	$720	$9.5M

Showing 1–10 of 770

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Phoenix Children's Hospital — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

770 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1459	Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg	1	10	1,480	$3,750	$5.5M
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.	13	260	1,330	$240	$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.	5	260	3,030	$190	$3.4M
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.	3	260	2,600	$170	$2.6M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	2	10	1,160	$2,210	$2.3M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	64	180	1,490	$320	$2.2M
44970	Laparoscopy, surgical, appendectomy	1	10	110	$4,670	$2.1M
86902	The lab analyst performs an antigen test to screen a potential donor blood unit using reagent serum for possible reactive antigens by mixing part of the unit with serum from the recipient patient.	1	10	4,500	$400	$1.8M
67311	The provider realigns an imbalance in the eye muscles by either recession, which weakens the eye muscle or resection, which strengthens the muscles so as to restore normal vision. This procedure is…	1	10	110	$2,720	$1.7M
24538	The provider treats a fracture of the humerus, the upper arm bone, through or above a condyle, a rounded projection at the end of the bone, but without extending between the condyles, in a…	1	10	210	$7,770	$1.6M

Showing 1–10 of 770

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Phoenix Children's Hospital	AZ	Pediatrics Physician	$0	$162.4M
Jamal Mcclendon	AZ	Neurological Surgery Physician	$128.3K	$0
Judd Cummings	AZ	Orthopaedic Surgery Physician	$126.5K	$0
Bernard Bendok	AZ	Neurological Surgery Physician	$117K	$0
Matthew Troester	AZ	Sleep Medicine (Psychiatry & Neurology) Physician	$64K	$13.5K
Jeffrey Mckenna	AZ	Otolaryngology Physician	$73.6K	$0
James Plotnik	AZ	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	$69K	$0
Mark Salevitz	AZ	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	$15K	$0
Paul Caruso	AZ	Pediatric Radiology Physician	$14.7K	$110
Richard Golub	AZ	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	$13.2K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Instant Care Of Arizona	AZ	Home Health Agency	$0	$230.5M
Bethany Ranch Home, Inc	AZ	Intellectual Disabilities Intermediate Care Facility	$0	$74.4M
Creative Innervisions LLC	AZ	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$29.7M
Stellar Home Health, LLC	AZ	In Home Supportive Care Agency	$0	$29.4M
Crossroads, Inc	AZ	Substance Abuse Rehabilitation Facility	$0	$23.9M
Thomas Road Senior Housing, Inc.	AZ	Assisted Living Facility	$0	$19.2M
Anod Care Services,inc	AZ	Behavior Analyst	$0	$14.2M
National Council On Alcoholism Greater Phoenix Area	AZ	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$13.5M
Neighborhood Outreach Access To Health	AZ	Federally Qualified Health Center (FQHC)	$0	$12.8M
Olive Grove Real Estate LLC	AZ	Assisted Living Facility	$0	$12.7M

Phoenix Children's Hospital — 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