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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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 Health Of Carolina, PA (NPI 1932353208)

Field	Value
Entity Type	Organization
Organization	Children's Health Of Carolina, PA
Address	1738 Owen Dr Ste 107
City	Fayetteville
State	NC
ZIP	28304
Taxonomy	Pediatrics Physician
NPI Enumerated	November 12, 2008

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

Medicaid: Complete Services Breakdown

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

67 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…	31,390	$60	$1.8M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	251,460	$10	$1.5M
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…	13,200	$90	$1.1M
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…	6,210	$80	$515.3K
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…	6,200	$80	$508.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,030	$90	$346.4K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	9,910	$30	$337K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	16,790	$20	$302.1K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	7,330	$30	$249.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,340	$100	$226.9K

Showing 1–10 of 67

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Children's Health Of Carolina, PA — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

67 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	131	2,850	10,910	$10	$330.3K
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…	333	4,400	960	$60	$271.3K
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…	81	520	1,080	$80	$262.1K
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…	79	550	970	$90	$258.9K
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…	120	4,130	670	$50	$219.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	95	590	490	$90	$179.8K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	9	100	550	$50	$153.4K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	163	330	300	$10	$142.3K
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…	210	300	140	$130	$121.5K
A4627	Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler	44	60	190	$40	$118.4K

Showing 1–10 of 67

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Health Of Carolina, PA	NC	Pediatrics Physician	$0	$90.4M
Children's Health Of Carolina, PA	NC	Pediatrics Physician	$0	$18.2M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cumberland County Hospital System Inc	NC	General Acute Care Hospital	$0	$75.8M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$32.8M
Valleygate Dental Surgery Center Of Fayetteville, LLC	NC	Ambulatory Surgical Clinic/Center	$0	$26.5M
Cfvhs Ed Physicians	NC	Emergency Medicine Physician	$0	$26.2M
Rafael Rivera, Jr., Dds, PLLC	NC	Dentist	$0	$14.2M
Pediatric Developmental Therapy	NC	Speech-Language Pathologist	$0	$12.1M
Cumberland County Hospital System Inc	NC	Internal Medicine Physician	$0	$8M
Calvary Pediatrics	NC	Pediatrics Physician	$0	$7.8M
Chauncy Nelson	NC	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$7.4M
Fayetteville Ambulatory Surgery Center LLC	NC	Ambulatory Surgical Clinic/Center	$1.4M	$2.2M

Children's Health Of Carolina, PA — Billing Profile & Reimbursement Data

Sign up for Children's Health Of Carolina, PA — Billing Profile & Reimbursement Data policy alerts

Children's Health Of Carolina, PA — Billing Profile & Reimbursement Data

Sign up for Children's Health Of Carolina, PA — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References