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.

Pontchartrain Pediatrics LLC (NPI 1881727691)

Pontchartrain Pediatrics LLC is a pediatrics physician provider located in Covington, Louisiana. This profile covers 0 Medicare and 59 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	Pontchartrain Pediatrics LLC
Address	4405 Highway 190 East Service Rd
City	Covington
State	LA
ZIP	70433
Taxonomy	Pediatrics Physician
NPI Enumerated	March 13, 2007

Payer Source	Total Paid
Medicaid	$11.3M
Medicare	$0

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

59 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…	51,270	$40	$2.3M
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…	25,890	$70	$1.8M
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…	14,360	$70	$1.1M
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,…	30,470	$30	$792.1K
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…	11,110	$70	$722.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10,700	$60	$684.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	8,660	$70	$606.2K
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…	10,270	$60	$595.8K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	10,640	$40	$446.8K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	31,930	$10	$415.1K

Showing 1–10 of 59

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

Pontchartrain Pediatrics LLC — 11 of 25 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

59 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	112	2,890	980	$40	$246.8K
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…	19	210	630	$70	$239.6K
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…	96	3,230	1,120	$30	$204.3K
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…	19	360	780	$50	$141.5K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	21	170	640	$30	$138.8K
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…	21	420	740	$50	$137.3K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	32	360	340	$30	$120.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	17	490	310	$50	$84.7K
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	5	70	170	$50	$81.8K
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	18	60	350	$40	$71.4K

Showing 1–10 of 59

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Tammany Parish Hospital Service District No 1	LA	General Acute Care Hospital	$0	$16.5M
Regional Radiology, LLC	LA	Diagnostic Radiology Physician	$0	$15.6M
Avenues Recovery Center At Covington	LA	Substance Abuse Rehabilitation Facility	$0	$15.4M
Right Hand Senior Care LLC	LA	In Home Supportive Care Agency	$0	$13.5M
Easter Seals Louisiana Inc.	LA	Case Management Agency	$0	$11.4M
Townsend Recovery Center New Orleans, LLC	LA	Substance Abuse Rehabilitation Facility	$0	$10.8M
Quality Support Coordination Inc	LA	Case Management Agency	$0	$10M
St Tammany Emergency Physicians Group LLC	LA	Emergency Medicine Physician	$0	$9.2M
Start Corporation	LA	Federally Qualified Health Center (FQHC)	$0	$7.5M
Van Meter Emergency Physicians Inc. Apmc	LA	Emergency Medicine Physician	$0	$7.5M

Pontchartrain Pediatrics LLC — Billing Profile & Reimbursement Data

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Pontchartrain Pediatrics 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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References