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 District of Columbia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to District of Columbia 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. District of Columbia (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.

Children's Hospital (NPI 1912939703)

Field	Value
Entity Type	Organization
Organization	Children's Hospital
Address	111 Michigan Ave Nw
City	Washington
State	DC
ZIP	20010
Taxonomy	Children's Hospital
NPI Enumerated	July 6, 2006

Payer Source	Total Paid
Medicaid	$243.1M
Medicare	$0

Key Findings

CHILDREN'S HOSPITAL shows a concentrated payer profile: there is no Medicare billing on file and all reported federal payer revenue is from Medicaid, totaling $243.1M. This makes the provider effectively single‑payer in the federal claims data and indicates Medicaid is the primary driver of the organization’s public-payor revenue.

Revenue is highly concentrated in a small set of outpatient and ED E/M codes: the precomputed top-three Medicaid codes account for 59.6% of the provider’s total Medicaid revenue. The top three codes driving that concentration are 99212 ($58.2M, 30.0% of Medicaid revenue), 99283 ($41.1M, 21.2%), and 99284 ($16.2M, 8.3%), pointing to heavy dependence on routine outpatient and emergency department evaluation-and-management services.

The code mix implies a pediatric acute-care and high-volume ambulatory operation: dominant use of 99212 (office/outpatient E/M) alongside large volumes of ED E/M codes 99283, 99284, 99282–99285, and hospital observation G0378 suggests a combined outpatient clinic and busy pediatric emergency/observation footprint. High utilization of respiratory intervention 94640 and IV rehydration 96361 further supports a caseload focused on acute pediatric respiratory and dehydration episodes.

CHILDREN'S HOSPITAL is a statewide volume leader on multiple measures: 99212 ranks #1 of 132 providers in-state at the 100th percentile (labeled an extreme outlier), and 99283 ranks #2 of 38 providers at the 97th percentile (also labeled an extreme outlier). The provider also ranks #1 of 21 for 94640 (100th percentile; extreme outlier), indicating it is far above typical state volumes for key pediatric E/M and respiratory treatment codes and therefore a dominant pediatric ambulatory/ED provider in the state.

Preventive and well-child services are a meaningful secondary stream: codes 99392, 99393 and 99391 appear with multi-thousand claim counts and each ranks at or near the top of in-state peers (for example, 99392 ranks #2 of 29 at the 96th percentile and 99393 ranks #2 of 35 at the 97th percentile). This pattern indicates that, in addition to high ED throughput, the hospital maintains substantial longitudinal pediatric primary/preventive care activity.

The provider also delivers procedural and specialty services consistent with a full-service pediatric center: ENT procedures such as 42820 (tonsil/adenoid removal, $6.5M, 3.3%) and 69436 (tympanostomy, $2.6M, 1.4%) and cardiac imaging 93303/93306 (combined several-million-dollar revenue) indicate in‑house surgical and diagnostic capacity beyond routine ED and office visits. Several of these procedural codes rank among the very few in-state providers reporting them, consistent with concentrated specialty capability.

Observation and higher-acuity emergency care are present but less dominant: hospital observation G0378 (19.8K claims, $4.9M, 2.5%) ranks #2 of 8 providers (86th percentile) and the high-acuity ED code 99285 appears with notable volume ($3.5M, 1.8%) but lower relative rank (#7 of 26, 76th percentile). This suggests the hospital operates an observation unit and manages higher-acuity pediatric ED cases, though those services are a smaller share of Medicaid revenue than routine E/M visits.

The provider has long tenure in federal enrollment, which supports its established market role: the NPI was enumerated on 2006-07-06 (~20 years ago). That duration, coupled with repeated top-percentile ranks on multiple pediatric codes, reinforces that CHILDREN'S HOSPITAL is an established, high-volume pediatric provider in the state Medicaid landscape.

Medicaid: Complete Services Breakdown

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

566 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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,…	264,410	$220	$58.2M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	155,020	$270	$41.1M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	61,740	$260	$16.2M
99281	The provider sees a patient for the lowest level emergency department visit.	35,330	$240	$8.4M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	34,140	$190	$6.6M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	2,400	$2,700	$6.5M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	8,230	$730	$6M
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	15,240	$330	$5M
G0378	Hospital observation service, per hour	19,760	$250	$4.9M
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…	12,480	$350	$4.3M

Showing 1–10 of 566

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. District of Columbia Distribution

Children's Hospital — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — District of Columbia

Full comparison — all codes billed, vs. District of Columbia median

566 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	2	10	2,290	$660	$22.2M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	3	10	5,630	$540	$4.4M
A0425	Ground mileage, per statute mile	2	10	3,940	$30	$3.5M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	2	10	2,470	$1,430	$3.5M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	7	30	4,480	$140	$3.5M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	5	30	540	$140	$3.4M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	2	40	190	$150	$3.3M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	2	10	12,440	$180	$2.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	9	10	6,080	$100	$2M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	2	10	5,170	$170	$1.9M

Showing 1–10 of 566

Related Providers

Other providers that share a Tax Identification Number (TIN) with Children's Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital	DC	Pediatrics Physician	$0	$115.3M
Children's Pediatricians & Associates, LLC	MD	Pediatrics Physician	$0	$17.5M
Children's Hospital	NE	Pediatric Emergency Medicine (Pediatrics) Physician	$0	$8.4M
Gayatri Reilly	MD	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Reginald Sanders	MD	Retina Specialist (Ophthalmology) Physician	$2.9M	$0
Children's Hospital	DC	Pediatric Dentistry	$0	$2.8M
Juanita Bryant	DC	Retina Specialist (Ophthalmology) Physician	$1.9M	$239.4K
Aziz Khanifar	MD	Retina Specialist (Ophthalmology) Physician	$1.9M	$0
Maral Skelsey	MD	Dermatology Physician	$1.1M	$0
David Parver	MD	Retina Specialist (Ophthalmology) Physician	$598.2K	$830

Nearby Providers

Other providers in the same ZIP code as Children's Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Medstar Washington Hospital Center	DC	General Acute Care Hospital	$0	$239M
Whc Physician Group LLC	DC	General Practice Physician	$0	$93.8M
Medstar Medical Group Radiology, LLC	DC	Diagnostic Radiology Physician	$0	$17.5M
National Rehabilitation Hospital Inc	DC	Rehabilitation Hospital	$0	$16.9M
Hero Dental Of Washington Dc PC	DC	General Practice Dentistry	$0	$11.7M
Medstar Heart Institute LLC	DC	Surgery Physician	$0	$4.8M
Bio-medical Applications Of Columbia Heights, Inc.	DC	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.6M
Washington Hospital Center Corp	DC	General Practice Physician	$0	$3.7M
Capital Area Renal Associates, PC	DC	Internal Medicine Physician	$0	$3.6M
Pediatric Professionals, PC	DC	Pediatrics Physician	$0	$3.6M

Children's Hospital — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References