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

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

Prescribed Pediatric Extended Care, Inc (NPI 1760515977)

Field	Value
Entity Type	Organization
Organization	Prescribed Pediatric Extended Care, Inc
Address	2355 Drusilla Ln
City	Baton Rouge
State	LA
ZIP	70809
Taxonomy	Medically Fragile Infants and Children Day Care
NPI Enumerated	March 14, 2007

Payer Source	Total Paid
Medicaid	$40.3M
Medicare	$0

Key Findings

This provider is effectively single-payer: there is no Medicare billing on file while total Medicaid revenue is $40.3M, indicating the organization’s operations and revenue streams are almost entirely Medicaid-dependent rather than split across Medicare and Medicaid. Analysts should treat this as a Medicaid-centric entity for network, rate, and utilization analyses.

Revenue is extremely concentrated in a very small set of codes: the precomputed top 3 Medicaid codes by revenue account for 96.6% of the provider’s Medicaid revenue, with T1025 alone representing $35.7M (88.8% of Medicaid revenue). That concentration means most financial activity flows through a narrow set of intensive pediatric service billings.

The code mix and volumes point to a specialized operation focused on medically fragile pediatric care: dominant codes T1025 and T1026 are described as intensive, extended multidisciplinary services for children with complex medical, physical, mental and psychosocial impairments, billed per diem and per hour respectively. High claim counts and payment levels for those codes (T1025: 206.6K claims, $173 avg paid/claim; T1026: 22.8K claims, $90 avg paid/claim) are consistent with a high-capacity day-program or extended care clinic model delivering frequent, multidisciplinary visits.

Competitive standing within Louisiana is highly concentrated at the top for the intensive pediatric services: the provider ranks #1 of 25 for T1025 and #1 of 21 for T1026 (100th percentile; extreme outlier), signaling it is the dominant state provider for these service lines and substantially above typical state volume for these codes. This dominance suggests sizable market share and capacity relative to in‑state peers for intensive pediatric multidisciplinary care.

Ancillary therapy codes are present but are small revenue contributors and not unusual versus peers: 97530 (21.4K claims, $50 avg paid/claim, $1.1M) ranks #18 of 329 in-state (95th percentile; typical, unremarkable volume), and 92507 (14.2K claims, $51 avg paid/claim, $725.5K) ranks #46 of 413 (89th percentile; typical, unremarkable volume). These volumes indicate the provider also bills common therapy services but that these are secondary to its intensive multidisciplinary revenue drivers.

The provider’s operational model is signaled by billing cadence and payment types: very large per-diem activity (T1025) combined with per-hour billing (T1026) indicates a mix of full-day placements and hourly therapeutic services, consistent with a day‑care or extended care workflow where patients receive ongoing multidisciplinary interventions rather than isolated episodic visits. Average paid/claim values ($173 for T1025 and $90 for T1026) align with per-diem and hourly reimbursement patterns for intensive pediatric care.

There is notable financial concentration risk tied to Medicaid and a few codes: with 96.6% of Medicaid revenue coming from the top three codes and virtually all revenue from Medicaid ($40.3M), changes to Medicaid policy, authorization practices, or reimbursement for T1025/T1026 could materially affect the provider’s revenue. Analysts should prioritize monitoring state Medicaid rate-setting, prior authorization, and program eligibility changes for intensive pediatric day services.

The provider is long‑established in the NPI registry (enumerated 2007-03-14 (~19 years ago)), which supports the interpretation of sustained, high-volume operations and likely established referral pathways for medically fragile infants and children; tenure lends context to its extreme-outlier volumes for core pediatric service codes.

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1025	Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem	206,590	$170	$35.7M
T1026	Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour	22,820	$90	$2.1M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	21,440	$50	$1.1M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	14,230	$50	$725.5K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	10,570	$50	$528.3K
T2002	Non-emergency transportation; per diem	4,890	$30	$127.2K
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	80	$50	$3.8K
97163	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history of a patient with three or more personal factors that may affect care, assess a clinical…	30	$50	$1.6K
97164	The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she…	10	$50	$710

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Louisiana Distribution

Prescribed Pediatric Extended Care, Inc — 2 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Louisiana

Full comparison — all codes billed, vs. Louisiana median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1025	Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem	1	30	24,400	$220	$7M
T1026	Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour	1	20	2,050	$130	$465.7K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	18	330	1,390	$40	$236.3K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	46	410	1,990	$40	$231.2K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	43	370	1,080	$40	$212.3K
T2002	Non-emergency transportation; per diem	42	80	5,240	$20	$208.3K
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	47	70	210	$90	$70.7K
97164	The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she…	12	10	210	$20	$9.4K
97163	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history of a patient with three or more personal factors that may affect care, assess a clinical…	5	10	60	$50	$7.7K

Nearby Providers

Other providers in the same ZIP code as Prescribed Pediatric Extended Care, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cognitive Development Center Of Baton Rouge	LA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$29M
Baton Rouge General Medical Center	LA	General Acute Care Hospital	$0	$24.3M
Serenity Treatment Center Of Louisiana LLC	LA	Substance Abuse Rehabilitation Facility	$0	$22.4M
Special Needs Unlimited, L.L.C.	LA	Developmental Disabilities Clinic/Center	$0	$22.4M
Caregiver Homes Of Louisiana, Inc	LA	Case Management Agency	$0	$15.9M
Baton Rouge Treatment Center, LLC	LA	Methadone Clinic	$139.4K	$13.5M
Leading Health Care Of La, Inc.	LA	In Home Supportive Care Agency	$0	$12.8M
Alliance Care LLC	LA	In Home Supportive Care Agency	$0	$12.3M
Hometown Senior Care LLC	LA	In Home Supportive Care Agency	$0	$11M
Kredenna Beverly	LA	Pediatric Dentistry	$0	$9.2M

Prescribed Pediatric Extended Care, Inc — Billing Profile & Reimbursement Data

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Prescribed Pediatric Extended Care, Inc — 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