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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Wake Forest Pediatric Associates, PLLC (NPI 1790782126)

Field	Value
Entity Type	Organization
Organization	Wake Forest Pediatric Associates, PLLC
Address	1655 Wake Drive
City	Wake Forest
State	NC
ZIP	27587
Taxonomy	Pediatrics Physician
NPI Enumerated	June 30, 2005

Payer Source	Total Paid
Medicaid	$9.8M
Medicare	$0

Medicaid: Complete Services Breakdown

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

58 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…	49,060	$60	$3M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	270,270	$10	$1.6M
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…	17,100	$90	$1.6M
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…	6,450	$90	$593.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	29,070	$20	$581.3K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	14,110	$40	$536K
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…	4,770	$90	$405.2K
0240U	N/A	2,620	$140	$358.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2,430	$90	$226.4K
0241U	N/A	1,530	$140	$211K

Showing 1–10 of 58

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Wake Forest Pediatric Associates, PLLC — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

58 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	68	160	840	$70	$2.3M
0241U	N/A	60	140	1,140	$150	$510.8K
0240U	N/A	4	20	380	$160	$331.6K
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	120	2,850	10,910	$10	$330.3K
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…	228	4,400	960	$60	$271.3K
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…	106	520	1,080	$80	$262.1K
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…	75	550	970	$90	$258.9K
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…	65	4,130	670	$50	$219.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	145	590	490	$90	$179.8K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	204	330	300	$10	$142.3K

Showing 1–10 of 58

Nearby Providers

Other providers in the same ZIP code as Wake Forest Pediatric Associates, PLLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Radeas LLC	NC	Clinical Medical Laboratory	$6.5M	$34.3M
Amazing Kids Of Nc, Inc.	NC	Community/Behavioral Health Agency	$0	$7.5M
Trg Health Care Systems LLC	NC	Community/Behavioral Health Agency	$0	$7.1M
Elias Ayli	NC	MOHS-Micrographic Surgery Physician	$1.1M	$0
Edward Galiczynski	NC	Dermatology Physician	$1M	$0
Patricia Matheis	NC	Specialist	$985.1K	$0
Francisco Castillos	NC	Hematology & Oncology Physician	$534K	$0
Duke University Health System Inc	NC	Diagnostic Radiology Physician	$150.8K	$14.1K
Daniel Henry	NC	Physical Therapist	$157.9K	$0
Samantha Ward	NC	Optometrist	$112.6K	$0

Wake Forest Pediatric Associates, PLLC — Billing Profile & Reimbursement Data

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Wake Forest Pediatric Associates, PLLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References