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

Why is the Medicaid comparison limited to Arizona 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. Arizona (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.

Phoenix Children's Hospital (NPI 1922112044)

Key Findings

Field	Value
Entity Type	Organization
Organization	Phoenix Children's Hospital
Address	1919 E Thomas Rd
City	Phoenix
State	AZ
ZIP	85016
Taxonomy	Pediatrics Physician
NPI Enumerated	August 18, 2006

Payer Source	Total Paid
Medicaid	$162.4M
Medicare	$0

PHOENIX CHILDREN'S HOSPITAL is effectively a Medicaid-focused provider: there is no Medicare billing on file and the entity reports $162.4M in lifetime Medicaid revenue. Combined with the listed taxonomy of Pediatrics Physician, the observed payer mix and service codes indicate a pediatric specialty provider operating at scale within the Medicaid population rather than as a dual Medicare/Medicaid provider.

Revenue is concentrated in a small set of E/M codes: the precomputed top-three Medicaid codes (99214, 99283, 99284) account for 32.6% of the provider's total Medicaid revenue. Those three codes individually read as 99214: $17.1M (13.3%), 99283: $13.8M (10.7%), and 99284: $11M (8.5%), showing a heavy reliance on office/outpatient and emergency-department evaluation-and-management encounters for revenue.

Emergency department services appear to be a major service line. High-volume ED codes such as 99283 ($13.8M, 10.7%) rank #1 of 258 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code) and 99284 ($11M, 8.5%) ranks #11 of 259 providers (96th percentile; notably above typical state volume), while additional ED codes 99285 ($3M, 2.3%) and 99282 ($2.6M, 2.0%) are also present, signaling substantial ED throughput.

Inpatient and higher-acuity services are material contributors: subsequent inpatient/observation visit codes 99232 ($8.4M, 6.5%) and 99233 ($7.9M, 6.1%) rank #3 of 613 (100th percentile; extreme outlier) and #12 of 537 (98th percentile; notably above typical state volume) respectively, and critical care code 99291 ($1.6M, 1.2%) is present as well (rank #17 of 200; 92th percentile; typical, unremarkable volume). These patterns indicate the provider handles substantial inpatient and critical pediatric cases in addition to ambulatory work.

Outpatient office visits and consultations are another dominant mix element. Codes such as 99214 ($17.1M, 13.3%) and 99213 ($10.4M, 8.1%) both rank in the 100th percentile for in-state providers (99214 rank #6 of 3041; 99213 rank #9 of 2775; both labeled extreme outlier), and consultation codes like 99244 ($5.7M, 4.4%) and 99243 ($3.6M, 2.8%) rank as high outliers, pointing to large-volume specialty clinic activity and complex outpatient care.

The provider shows substantial embedded ophthalmology and cardiac imaging volumes for a pediatric specialty center. Ophthalmology codes 92014 ($6.6M, 5.1%), 92004 ($5.6M, 4.4%), and 92012 ($3.3M, 2.6%) all rank at or near the top in-state (92014 rank #2 of 149; 92004 rank #2 of 122; 92012 rank #2 of 85; all 99th percentile or higher), while echocardiography codes 93303 ($2.5M, 2.0%) and 93306 ($1.7M, 1.3%) are also concentrated (93303 rank #1 of 21; 100th percentile), suggesting integrated vision and cardiac diagnostic services aligned with pediatric specialty care.

Preventive and procedural pediatric services appear consistently present across outpatient activity: immunization code 90460 ($3.1M, 2.4%) ranks #7 of 417 providers in-state (99th percentile; extreme outlier), and preventive visit 99392 ($1.5M, 1.2%) ranks #10 of 304 (97th percentile; notably above typical state volume). These volumes support a broad ambulatory preventive care footprint alongside higher-acuity services.

Competitive standing in-state is dominant across many pediatric codes: numerous high-revenue items are labeled "extreme outlier" or "notably above typical state volume" and occupy top ranks (multiple #1 or top-3 placements). The provider’s NPI was enumerated 2006-08-18 (~20 years ago), indicating long tenure to build this Medicaid-dominant, high-volume pediatric service mix; however, the absence of Medicare activity means national Medicare benchmarking is not applicable for this entity.

Medicaid: Complete Services Breakdown

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

380 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	247,930	$70	$17.1M
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.	233,510	$60	$13.8M
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.	105,520	$100	$11M
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…	204,470	$50	$10.4M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	133,630	$60	$8.4M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	90,190	$90	$8M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	85,440	$90	$7.9M
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	54,620	$120	$6.6M
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	39,820	$140	$5.7M
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	37,670	$150	$5.6M

Showing 1–10 of 380

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Phoenix Children's Hospital — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

380 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	60	260	1,330	$240	$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.	11	260	3,030	$190	$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.	1	260	2,600	$170	$2.6M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	77	180	1,490	$320	$2.2M
44970	Laparoscopy, surgical, appendectomy	6	10	110	$4,670	$2.1M
67311	The provider realigns an imbalance in the eye muscles by either recession, which weakens the eye muscle or resection, which strengthens the muscles so as to restore normal vision. This procedure is…	3	10	110	$2,720	$1.7M
T1016	Case management, each 15 minutes	670	1,160	2,110	$30	$1.2M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	5	40	210	$1,710	$1.2M
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…	1	20	160	$270	$1.1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	3	10	4,480	$110	$1.1M

Showing 1–10 of 380

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Phoenix Children's Hospital	AZ	Children's Hospital	$0	$555.8M
Leslie Padrnos	AZ	Hematology & Oncology Physician	$670.9K	$0
Jamal Mcclendon	AZ	Neurological Surgery Physician	$128.3K	$0
Judd Cummings	AZ	Orthopaedic Surgery Physician	$126.5K	$0
Bernard Bendok	AZ	Neurological Surgery Physician	$117K	$0
Matthew Troester	AZ	Sleep Medicine (Psychiatry & Neurology) Physician	$64K	$13.5K
Jeffrey Mckenna	AZ	Otolaryngology Physician	$73.6K	$0
James Plotnik	AZ	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	$69K	$0
Mark Salevitz	AZ	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	$15K	$0
Paul Caruso	AZ	Pediatric Radiology Physician	$14.7K	$110

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Instant Care Of Arizona	AZ	Home Health Agency	$0	$230.5M
Bethany Ranch Home, Inc	AZ	Intellectual Disabilities Intermediate Care Facility	$0	$74.4M
Creative Innervisions LLC	AZ	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$29.7M
Stellar Home Health, LLC	AZ	In Home Supportive Care Agency	$0	$29.4M
Crossroads, Inc	AZ	Substance Abuse Rehabilitation Facility	$0	$23.9M
Thomas Road Senior Housing, Inc.	AZ	Assisted Living Facility	$0	$19.2M
Anod Care Services,inc	AZ	Behavior Analyst	$0	$14.2M
National Council On Alcoholism Greater Phoenix Area	AZ	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$13.5M
Neighborhood Outreach Access To Health	AZ	Federally Qualified Health Center (FQHC)	$0	$12.8M
Olive Grove Real Estate LLC	AZ	Assisted Living Facility	$0	$12.7M

Phoenix 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