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

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

Pediatric Emergency Specialists, PC (NPI 1760482434)

Field	Value
Entity Type	Organization
Organization	Pediatric Emergency Specialists, PC
Address	848 Adams Ave
City	Memphis
State	TN
ZIP	38103
Taxonomy	Pediatric Emergency Medicine (Emergency Medicine) Physician
NPI Enumerated	July 26, 2005

Payer Source	Total Paid
Medicaid	$39.1M
Medicare	$0

Key Findings

PEDIATRIC EMERGENCY SPECIALISTS, PC reports no Medicare billing on file and $39.1M in lifetime Medicaid revenue, making its billing profile effectively single-payer with Medicaid as the dominant source of reimbursements. The absence of Medicare activity indicates the group’s commercial exposure and risk profile are concentrated in the Medicaid population rather than split across federal and state payers.

Revenue is highly concentrated in three emergency department E/M codes: 99284 generated $19.5M (49.7% of Medicaid revenue), 99285 generated $11.3M (28.9%), and 99283 generated $8.1M (20.6%); these top three codes together account for 99.2% of the provider’s Medicaid revenue. This extreme concentration means the practice’s financial performance is tightly tied to ED evaluation-and-management volume and reimbursement for those specific service levels.

The code mix indicates an operational focus on pediatric emergency department care with a substantial share of moderate- and high-complexity ED visits. The predominance of 99284 and 99285 (moderate and high medical decision making) alongside 99283 (low complexity) suggests the group operates at scale as an ED staffing or freestanding ED service line that handles a wide acuity range, with the billing profile concentrated in point-of-care E/M services rather than ancillary diagnostics.

Volume and competitive standing in-state are unusually large for ED E/M services: 99284 sits at rank #10 of 625 providers in-state (99th percentile, labeled an extreme outlier), 99283 is rank #8 of 611 (99th percentile, extreme outlier), and 99285 is rank #12 of 565 (98th percentile, notably above typical state volume). Those ranks indicate the practice is a major, high-volume Medicaid ED provider within Tennessee for pediatric emergency E/M services and is far above typical state peers for these codes.

Claim counts and average paid-per-claim reinforce the operational picture: 99284 shows 147.5K claims at $132 avg paid/claim, 99283 shows 103.4K claims at $78 avg paid/claim, and 99285 shows 60.8K claims at $186 avg paid/claim. The combination of high claim volumes and materially different average payments by code level highlights that throughput and case mix (not ancillary testing) are the primary drivers of revenue.

Critical care and ancillary services represent only a small fraction of Medicaid revenue: 99291 (critical care) produced $301.7K (0.8% of Medicaid revenue) and ranks #33 of 162 providers in-state (80th percentile, typical), while 93010 (ECG interpretation) produced $4.1K (0.0% of revenue) and sits near the middle of peers (44th percentile). These figures indicate occasional higher-acuity interventions occur but do not materially change the practice’s dependency on ED E/M billing.

The NPI has been enumerated since 2005-07-26 (~21 years ago), indicating long tenure in the market; combined with the provider’s top-state ranks for core ED codes, this longevity and scale support the interpretation that the group is an established pediatric emergency provider in Memphis with sustained Medicaid-focused activity. Analysts should treat Medicaid reimbursement policy, ED utilization trends, and state-level rate changes as primary levers that would materially affect this provider’s revenue given its concentrated code mix.

Medicaid: Complete Services Breakdown

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

5 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.	147,460	$130	$19.5M
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.	60,760	$190	$11.3M
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.	103,440	$80	$8.1M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	1,110	$270	$301.7K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	310	$10	$4.1K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Pediatric Emergency Specialists, PC — 3 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	10	630	510	$120	$1.1M
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.	8	610	570	$110	$884.4K
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.	12	570	640	$100	$637.8K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	33	160	110	$90	$96K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	228	410	400	$1	$22.1K

Nearby Providers

Other providers in the same ZIP code as Pediatric Emergency Specialists, PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Methodist Healthcare - Memphis Hospitals	TN	Children's Hospital	$0	$84.4M
Ut Lebonheur Pediatric Specialists, Inc.	TN	Pediatrics Physician	$0	$63.8M
Shelby County Health Care Corporation	TN	General Acute Care Hospital	$0	$56.1M
City Of Memphis General City Govt.	TN	Land Ambulance	$3.8M	$52M
Ut Regional One Physicians Inc	TN	Surgery Physician	$0	$24.1M
Meritan, Inc	TN	Home Health Agency	$0	$16.9M
Lebonheur Patient Transportation	TN	Land Ambulance	$0	$4.5M
Pediatric Anesthesiologists P A	TN	Anesthesiology Physician	$0	$4.4M
University Of Tennessee	TN	Dentist	$0	$3.1M
Ut Regional One Physicians Inc	TN	Anesthesiology Physician	$0	$2.3M

Pediatric Emergency Specialists, PC — Billing Profile & Reimbursement Data

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Pediatric Emergency Specialists, PC — 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