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 District of Columbia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to District of Columbia 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. District of Columbia (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 Hospital (NPI 1780800128)

Key Findings

Field	Value
Entity Type	Organization
Organization	Children's Hospital
Address	111 Michigan Ave Nw
City	Washington
State	DC
ZIP	20010
Taxonomy	Pediatrics Physician
NPI Enumerated	April 17, 2007

Payer Source	Total Paid
Medicaid	$115.3M
Medicare	$0

This provider has no Medicare billing on file and is effectively a single-payer Medicaid operation: Total Medicaid revenue on file is $115.3M and there is no Medicare revenue reported, indicating Medicaid is the dominant and near-exclusive payer exposure for this entity. Analysts should treat comparisons and risk adjustments with a Medicaid-centric lens.

Revenue concentration is high: the precomputed top-three Medicaid codes account for 40.9% of the provider's Medicaid revenue. Those top drivers are 99213 ($16.1M, 16.6%), 99214 ($12.7M, 13.1%), and 99283 ($10.8M, 11.2%), showing a narrow set of high-volume evaluation-and-management services dominate collections.

The code mix indicates a large ambulatory pediatric practice plus a high-volume pediatric emergency and inpatient service line. Heavy revenue and claim counts for office/outpatient E/M codes 99213 and 99214 alongside ED codes 99283 and 99284 ($10.5M) point to combined clinic and emergency throughput, while substantial payment for inpatient follow-up and neonatal critical care (99233 $5.8M; 99472 $6.5M) signals significant hospital-based pediatric capacity.

Competitive standing within-state is dominant for many pediatric outpatient and ED codes: 99213 ranks #1 of 316 providers in-state (100th percentile; extreme outlier), 99214 ranks #1 of 305 (100th percentile; extreme outlier), and 99283 ranks #1 of 38 (100th percentile; extreme outlier). These high ranks and percentiles indicate the provider is a major statewide player and far above typical state volumes for core pediatric E/M services.

Preventive care and vaccination services are a meaningful component of the operating footprint, consistent with a pediatric focus: 99393 (well-child age 5–11) generated $2.1M on 32.8K claims, 99392 generated $2.0M on 31.7K claims, and vaccine administration 90460 accounted for $885.2K on 42.2K claims. The volumes suggest a broad longitudinal primary-care and immunization program co-located with higher-acuity services.

The provider demonstrates inpatient and critical-care capability in addition to ambulatory services: critical care code 99291 contributed $2.7M (ranks #4 of 27, 88th percentile), 99460 (newborn evaluation) generated $720.2K (rank #1 of 6), and 99233 contributed $5.8M (rank #1 of 48, 100th percentile; extreme outlier). This mix supports a care model that spans ED, inpatient, neonatal, and follow-up pediatric care.

Across the top code list many entries are labeled as extreme outliers or notably above typical state volume (for example, 99215 $8.2M ranks #1 of 121, 99392/99393 are both #1 and extreme outliers), indicating the provider’s volumes are consistently far above peers for multiple pediatric service lines. For network planning or competitive analysis, these repeated outlier designations signal entrenched scale rather than isolated spikes in a single code.

The NPI was enumerated on 2007-04-17 (~19 years ago), indicating long tenure in the market; coupled with the large Medicaid revenue base and repeated top-state rankings, this suggests an established referral footprint and operating scale that should be considered when assessing competitive dynamics and contracting strategies.

Medicaid: Complete Services Breakdown

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

292 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…	264,370	$60	$16.1M
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…	140,880	$90	$12.7M
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.	177,570	$60	$10.8M
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.	102,060	$100	$10.5M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	65,980	$130	$8.2M
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.	21,420	$300	$6.5M
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…	66,540	$90	$5.8M
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…	19,400	$140	$2.8M
99204	The provider sees a new 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 provider…	20,800	$130	$2.7M
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…	13,690	$200	$2.7M

Showing 1–10 of 292

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. District of Columbia Distribution

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

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — District of Columbia

Full comparison — all codes billed, vs. District of Columbia median

292 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	1	10	21,420	$300	$6.5M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	1	10	2,470	$1,430	$3.5M
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.	8	30	4,480	$140	$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.	3	30	540	$140	$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.	1	40	190	$150	$3.3M
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…	1	10	12,440	$180	$2.2M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	4	10	5,170	$170	$1.9M
99281	The provider sees a patient for the lowest level emergency department visit.	7	10	1,890	$220	$1.6M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	2	10	1,220	$1,170	$1.4M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	7	30	1,320	$110	$1M

Showing 1–10 of 292

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital	DC	Children's Hospital	$0	$243.1M
Children's Pediatricians & Associates, LLC	MD	Pediatrics Physician	$0	$17.5M
Mary Washington Healthcare Physicians	VA	Family Medicine Physician	$0	$13.3M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Gayatri Reilly	MD	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Reginald Sanders	MD	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Children's Hospital	DC	Pediatric Dentistry	$0	$2.8M
Juanita Bryant	DC	Retina Specialist (Ophthalmology) Physician	$1.9M	$239.4K
Aziz Khanifar	MD	Retina Specialist (Ophthalmology) Physician	$1.9M	$0
Manan Mehta	VA	Hematology & Oncology Physician	$1.5M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Medstar Washington Hospital Center	DC	General Acute Care Hospital	$0	$239M
Whc Physician Group LLC	DC	General Practice Physician	$0	$93.8M
Medstar Medical Group Radiology, LLC	DC	Diagnostic Radiology Physician	$0	$17.5M
National Rehabilitation Hospital Inc	DC	Rehabilitation Hospital	$0	$16.9M
Hero Dental Of Washington Dc PC	DC	General Practice Dentistry	$0	$11.7M
Medstar Heart Institute LLC	DC	Surgery Physician	$0	$4.8M
Bio-medical Applications Of Columbia Heights, Inc.	DC	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.6M
Washington Hospital Center Corp	DC	General Practice Physician	$0	$3.7M
Capital Area Renal Associates, PC	DC	Internal Medicine Physician	$0	$3.6M
Pediatric Professionals, PC	DC	Pediatrics Physician	$0	$3.6M

Children's Hospital — Billing Profile & Reimbursement Data

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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