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

Why is the Medicaid comparison limited to Puerto Rico 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. Puerto Rico (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 Home Care Services LLC (NPI 1831234301)

Field	Value
Entity Type	Organization
Organization	Pediatric Home Care Services LLC
Address	1502 Calle Bori
City	San Juan
State	PR
ZIP	00927
Taxonomy	Pediatric Skilled Nursing Facility
NPI Enumerated	February 21, 2007

Payer Source	Total Paid
Medicaid	$31.8M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file and total Medicaid revenue is $31.8M, so Medicaid accounts for the entire reported lifetime revenue stream. The absence of Medicare activity indicates the entity’s billing footprint is concentrated in Medicaid-covered patients and services rather than a mixed Medicare/Medicaid case mix.

Taxonomy and code mix point to a focused pediatric home nursing operation: the listed taxonomy is Pediatric Skilled Nursing Facility and the top Medicaid codes are S9123 (nursing care in the home by registered nurse, per hour) and T1030 (nursing care in the home by registered nurse, per diem). Together these codes indicate the business model centers on in‑home RN services for pediatric patients rather than facility‑based or physician services.

Revenue concentration is extreme at the code level: the precomputed top‑3 Medicaid codes account for 100.0% of this provider’s Medicaid revenue, with S9123 alone contributing $30.6M (96.2% of the provider’s Medicaid revenue). This level of concentration indicates the provider’s financial performance is heavily dependent on one principal service line.

S9123 performance and competitive standing: S9123 generates $30.6M and ranks #1 of 2 providers in‑state (100th percentile; described as typical, unremarkable volume for this code). In plain terms, this provider is the top in‑state biller for hourly in‑home RN nursing under S9123, even though the activity level for the code is characterized as typical when benchmarked.

T1030 performance and competitive standing: T1030 accounts for $1.2M (3.8% of the provider’s Medicaid revenue), with the provider ranking #4 of 27 in‑state (88th percentile; typical, unremarkable volume). This places the provider above most peers for per‑diem in‑home RN billing within the state, suggesting a meaningful secondary presence in per‑day nursing reimbursement.

Tenure and market presence: the provider’s NPI was enumerated on 2007-02-21 (~19 years ago), indicating a long‑standing enrollment and operational history in the market. The duration supports that the current revenue concentration and code mix represent an established service pattern rather than a transient or newly developed line.

Operational and business risk implications: reliance on S9123 for 96.2% of Medicaid revenue and on Medicaid overall ($31.8M) creates material concentration risk; changes in Medicaid coverage rules, reimbursement policy, or utilization management for in‑home RN services could disproportionately affect this provider’s revenue. The narrow code mix suggests limited diversification across other pediatric or nursing services.

Statistical outlier assessment: despite the heavy revenue concentration, the two leading codes are described as "typical, unremarkable volume" in the comparative labels provided, and no codes are flagged as extreme outliers. This indicates that while the provider is highly specialized and concentrated, its billing volumes for these specific home‑nursing codes fall within expected ranges relative to peers rather than reflecting anomalous utilization patterns.

Medicaid: Complete Services Breakdown

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

2 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	35,530	$860	$30.6M
T1030	Nursing care, in the home, by registered nurse, per diem	6,840	$180	$1.2M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Puerto Rico Distribution

Pediatric Home Care Services LLC — 1 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

2 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	1	10	19,760	$800	$15.8M
T1030	Nursing care, in the home, by registered nurse, per diem	4	30	1,360	$80	$228.4K

Nearby Providers

Other providers in the same ZIP code as Pediatric Home Care Services LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eliel Ortho Medical Corp	PR	Prosthetic/Orthotic Supplier	$0	$10.4M
Tech Medical Group, Inc.	PR	Prosthetic/Orthotic Supplier	$0	$7.8M
Centro De Cancer De La Universidad	PR	Specialist	$0	$3.8M
Cmt Group, Corp	PR	Health Service Clinic/Center	$2K	$2.3M
Puerto Rico Medical Transport, Inc.	PR	Non-emergency Medical Transport (VAN)	$0	$920.5K
Eddiemar Ortiz Cruz	PR	Hematology & Oncology Physician	$0	$841.6K
Sandra Cerda	PR	Pediatric Dentistry	$0	$656.9K
Sheilla Ocasio Arce	PR	Audiologist	$11.1K	$130.3K
Harry Jimenez	PR	Endocrinology, Diabetes & Metabolism Physician	$11.9K	$95.2K
Eric Carro Jimenez	PR	Interventional Cardiology Physician	$26.9K	$63.7K

Pediatric Home Care Services LLC — Billing Profile & Reimbursement Data

Sign up for Pediatric Home Care Services LLC — Billing Profile & Reimbursement Data policy alerts

Pediatric Home Care Services LLC — Billing Profile & Reimbursement Data

Sign up for Pediatric Home Care Services LLC — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References