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 Choice LLC (NPI 1811023989)

Pediatric Choice LLC is a pediatrics physician provider located in Lenoir City, Tennessee. This profile covers 0 Medicare and 74 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Pediatric Choice LLC
Address	5505 Creekwood Park Blvd
City	Lenoir City
State	TN
ZIP	37772
Taxonomy	Pediatrics Physician
NPI Enumerated	February 26, 2007

Payer Source	Total Paid
Medicaid	$13.1M
Medicare	$0

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

74 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…	89,940	$50	$4.5M
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	25,930	$50	$1.2M
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…	13,690	$80	$1.1M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	11,680	$80	$957.7K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	33,920	$20	$780.2K
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…	10,240	$70	$757.7K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	22,350	$30	$692.9K
92552	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the lowest threshold at which the patient can hear.	27,520	$20	$605.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,890	$90	$524.1K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	5,550	$70	$410.3K

Showing 1–10 of 74

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 Choice LLC — 8 of 25 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

74 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	32	610	1,220	$40	$206K
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…	719	3,760	610	$40	$202.3K
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…	27	520	470	$70	$187K
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…	42	4,050	620	$30	$183.9K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	45	130	370	$50	$183.3K
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…	33	480	580	$60	$174.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	21	510	240	$70	$133.7K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	20	200	300	$60	$106K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	18	620	740	$20	$88.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	20	420	150	$80	$81.8K

Showing 1–10 of 74

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Fort Loudoun Medical Center	TN	General Acute Care Hospital	$0	$5.9M
Smoky Mountain Pediatric Dentistry, PLLC	TN	Dental Clinic/Center	$0	$2.4M
Adam Priestwood	TN	Pediatric Dentistry	$0	$2.3M
Eye Surgery Center Of Lenoir City, LLC	TN	Ambulatory Surgical Clinic/Center	$489.7K	$41.1K
Matthew Lowrance	TN	Retina Specialist (Ophthalmology) Physician	$502.4K	$0
Louis Reper	TN	Foot & Ankle Surgery Podiatrist	$250.4K	$38K
Michael Craig	TN	Physical Medicine & Rehabilitation Physician	$227.9K	$0
Hassan Nadrous	TN	Pulmonary Disease Physician	$186K	$800
Ioannis Parastatidis	TN	Cardiovascular Disease Physician	$186.2K	$0
Jonathan Shaver	TN	Sports Medicine (Orthopaedic Surgery) Physician	$185.2K	$0

Pediatric Choice LLC — Billing Profile & Reimbursement Data

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Pediatric Choice LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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