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

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

Complete Children's Health, P.C. (NPI 1962610493)

Key Findings

Field	Value
Entity Type	Organization
Organization	Complete Children's Health, P.C.
Address	8201 Northwoods Dr
City	Lincoln
State	NE
ZIP	68505
Taxonomy	Pediatrics Physician
NPI Enumerated	May 18, 2007

Payer Source	Total Paid
Medicaid	$5.8M
Medicare	$0

COMPLETE CHILDREN'S HEALTH, P.C. is effectively a Medicaid-only provider at scale: total Medicaid revenue on file is $5.8M and there is no Medicare billing on file, and the NPI was enumerated 2007-05-18 (~19 years ago). The provider’s taxonomy is Pediatrics Physician and the location is LINCOLN, NE, which together with the code mix supports a long-standing pediatric ambulatory practice focused on state Medicaid patients.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management and preventive codes: the top three Medicaid codes account for 75.2% of this provider’s total Medicaid revenue. Those top drivers are 99213 ($2.4M revenue, 41.7% of Medicaid revenue), 99214 ($1.4M revenue, 24.9%), and 99391 ($501.1K revenue, 8.7%), indicating a narrow set of services that generate most dollars.

The code mix signals a primary-care pediatric operation that relies on high-volume established visits and routine well-child care: substantial revenue from 99213 and 99214 combined with preventive codes 99391, 99392, and 99393 shows the practice is oriented toward ongoing management of established pediatric patients plus scheduled preventive visits. This pattern is consistent with a clinic that delivers routine immunizations, developmental checks, and chronic-condition follow-up in an outpatient setting.

On competitive standing for core E/M services, the practice is a leading in-state performer: 99213 ranks #13 of 696 providers in Nebraska and is in the 98th percentile (described as notably above typical state volume), while 99214 ranks #20 of 596 and is in the 97th percentile (described as typical, unremarkable volume). Those ranks indicate a major statewide presence for routine pediatric established-patient visits.

Preventive care and immunization activity are above-average for the state: 99391 ranks #12 of 69 (84th percentile), 99392 ranks #10 of 67 (86th percentile), and 99393 ranks #9 of 72 (89th percentile), showing steady well-child visit volume. Immunization code 90686 (11K claims, $176K revenue, 3.0% of Medicaid revenue) ranks #8 of 210 in-state and is in the 97th percentile (notably above typical), which points to a robust vaccine program supporting those preventive visits.

The practice also bills for diagnostic testing and infectious-disease panels that complement outpatient care — for example, 87636 (2K claims, $162.2K revenue, 2.8% of Medicaid revenue) ranks #2 of 13 in-state (92th percentile; typical, unremarkable volume) and 87651 (1.6K claims, $55K revenue, 1.0%) ranks in the upper state decile. These entries imply either on-site specimen collection or a close referral relationship for common pediatric respiratory and strep testing.

Behavioral and developmental services are integrated into the workflow: 90834 (711 claims, $65.4K revenue, 1.1%) and 96127 (1.2K claims, $32.3K revenue, 0.6%) appear on the top code list, indicating the practice performs psychotherapy sessions and routine brief behavioral/developmental screenings as part of its ambulatory care mix. This supports a model of primary pediatric care that incorporates mental/behavioral health screening and some therapy.

Operational and reimbursement risk centers on Medicaid policy because the practice derives nearly all revenue from Medicaid and is heavily dependent on office E/M codes. With the top three codes comprising 75.2% of Medicaid revenue and no Medicare offset, changes to Medicaid E/M reimbursement, visit utilization, or vaccine/test payment could have outsized impact on overall revenue stability for this pediatric practice.

Medicaid: Complete Services Breakdown

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

52 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…	38,200	$60	$2.4M
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…	17,130	$80	$1.4M
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…	5,690	$90	$501.1K
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…	5,100	$90	$479.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,850	$100	$179.5K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	11,000	$20	$176K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	1,950	$80	$162.2K
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…	790	$80	$65.6K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	710	$90	$65.4K
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.	1,570	$40	$55K

Showing 1–10 of 52

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Complete Children's Health, P.C. — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

52 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	13	700	660	$70	$305.1K
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…	20	600	610	$70	$251.4K
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…	12	70	360	$80	$234.7K
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…	10	70	230	$90	$222.7K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	206	510	450	$100	$168.1K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	491	510	440	$140	$155.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	9	70	100	$100	$100.9K
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…	29	30	440	$60	$99.6K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	2	10	70	$90	$81.3K
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…	14	90	100	$80	$54.7K

Showing 1–10 of 52

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Houses Of Hope Of Nebraska, Inc	NE	Substance Abuse Rehabilitation Facility	$0	$4.1M
Allergy, Asthma & Immunology Associates, P.C.	NE	Allergy & Immunology Physician	$0	$1.7M
Rusty Lewis	NE	General Practice Dentistry	$0	$1.3M
Thomas Milius	NE	Pediatric Dentistry	$0	$1.2M
Osie Inc.	NE	Long Term Care Pharmacy	$125.7K	$1.1M
Multicultural Youth And Family Counseling,llc	NE	Mental Health Counselor	$0	$847.5K
Nebraska Peace Of Mind Behavioral Health	NE	Psychiatric/Mental Health Nurse Practitioner	$0	$652.2K
Suzan Pae	NE	Allergy & Immunology Physician	$516K	$0
Associates In Counseling & Treatment	NE	Addiction (Substance Use Disorder) Counselor	$0	$486.9K
Nextcare Nebraska Providers LLC	NE	Urgent Care Clinic/Center	$0	$468.9K

Complete Children's Health, P.C. — Billing Profile & Reimbursement Data

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Complete Children's Health, P.C. — 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

Nearby Providers

Frequently Asked Questions

References