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.

Shine Pediatric Therapy (NPI 1891041133)

Shine Pediatric Therapy is a occupational therapist provider located in Springfield, Tennessee. This profile covers 0 Medicare and 13 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	Shine Pediatric Therapy
Address	514 S Brown St
City	Springfield
State	TN
ZIP	37172
Taxonomy	Occupational Therapist
NPI Enumerated	July 24, 2012

Payer Source	Total Paid
Medicaid	$6.9M
Medicare	$0

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	57,690	$70	$3.8M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	62,620	$40	$2.8M
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	3,870	$50	$189.7K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	2,290	$40	$80.1K
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	790	$90	$74.4K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	970	$20	$21.4K
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	400	$20	$7.6K
97116	The provider instructs the patient in the proper ways of practicing various exercises, including climbing stairs, focusing on one or more areas, that assist them in walking comfortably and without…	400	$20	$7.3K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	50	$50	$2.6K
97164	The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she…	20	$40	$650

Showing 1–10 of 13

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

Shine Pediatric Therapy — 2 of 13 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

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	8	230	2,130	$40	$616.8K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	11	340	1,400	$40	$354.2K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	125	350	1,060	$30	$173.8K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	67	170	530	$10	$67.8K
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	7	60	540	$50	$63K
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	4	60	70	$110	$28.3K
97164	The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she…	20	30	40	$30	$22.1K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	50	80	90	$40	$18.4K
97168	The occupational therapist (OT) performs a re–evaluation focusing on changes in the patient's functional, environment, or medical status that results in a revised plan of care; re–evaluation includes…	16	20	50	$30	$16.7K
97116	The provider instructs the patient in the proper ways of practicing various exercises, including climbing stairs, focusing on one or more areas, that assist them in walking comfortably and without…	18	40	380	$10	$11.3K

Showing 1–10 of 13

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northcrest Medical Center	TN	General Acute Care Hospital	$0	$7M
Springfield Health Services, LLC	TN	General Acute Care Hospital	$0	$3.9M
Vip Midsouth, LLC	TN	Rural Health Clinic/Center	$0	$3.2M
Robertson County Government Finance Office	TN	Land Ambulance	$523.3K	$1.9M
Ramesh Chadalavada	TN	Pulmonary Disease Physician	$117.5K	$106.3K
Catherine Bixby	TN	Family Nurse Practitioner	$206.9K	$0
Sonia Murehead	TN	Family Nurse Practitioner	$184.3K	$0
Mark Sanders	TN	Surgery Physician	$129.8K	$3.5K
Kevin Davis	TN	Podiatrist	$125.4K	$760
Robert Amonette	TN	Diagnostic Radiology Physician	$105.4K	$0

Shine Pediatric Therapy — 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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