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

Why is the Medicaid comparison limited to Wisconsin 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. Wisconsin (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 And Health System, Inc. (NPI 1992713531)

Field	Value
Entity Type	Organization
Organization	Children's Hospital And Health System, Inc.
Address	9000 W Wisconsin Ave
City	Milwaukee
State	WI
ZIP	53226
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	August 3, 2006

Payer Source	Total Paid
Medicaid	$17.7M
Medicare	$0

Key Findings

This provider reports no Medicare billing on file and $17.7M in lifetime Medicaid revenue, making its effective payer footprint single-payer (Medicaid) at present. The absence of Medicare revenue should be treated as a material characteristic of the provider’s commercial/payer mix and network relevance for Medicare populations is minimal to nil based on the available billing data.

Revenue is extremely concentrated in a single service line: the top three Medicaid codes account for 100.0% of the provider’s Medicaid revenue, with T1016 alone accounting for $17.7M and 99.7% of the provider’s total Medicaid revenue. That degree of concentration indicates the organization’s financial performance is overwhelmingly driven by case management services rather than a diversified set of clinical procedures.

The code mix and descriptions point to an operational focus on case management and pediatric-focused therapy services rather than typical urgent-care visit throughput. T1016 (case management, each 15 minutes) dominates the billing profile, while 92523 (SLP evaluation) and 97166 (OT evaluation) appear as much smaller, ancillary revenue lines, suggesting primary business activity is programmatic case management with secondary rehabilitative therapy evaluations.

Competitive standing for the dominant code is statewide leadership: T1016 ranks #1 of 224 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), which characterizes the provider as a dominant statewide provider of Medicaid case management services. By contrast, participation in therapy lines is modest—92523 ranks #15 of 50 in-state (71th percentile; typical, unremarkable volume) and 97166 ranks #20 of 46 in-state (58th percentile; typical, unremarkable volume)—indicating ordinary, non-dominant presence in those markets.

The business is operationally sensitive to policy or rate changes tied to T1016 because nearly all Medicaid revenue flows from that single code. Any payer policy adjustment, prior authorization change, or reimbursement-rate movement affecting case management billing for T1016 could materially affect the provider’s revenue given the 99.7% reliance on that code.

Despite its taxonomy as an Urgent Care Clinic/Center, the heavy use of T1016 and the presence of SLP/OT evaluation codes indicate service-line specialization that may not align with a typical episodic urgent-care model; analysts should treat this provider as programmatic case management and pediatric therapy-focused when evaluating network value or service coverage.

The presence of ancillary rehabilitative codes with small dollar amounts (92523: $23.5K, 0.1% of Medicaid revenue; 97166: $12.8K, 0.1% of Medicaid revenue; 97163: $8.5K, 0.0% of Medicaid revenue) shows the organization bills some evaluation-based therapy services, but those services currently contribute only a sliver of total Medicaid revenue and do not offset the extreme concentration in case management.

The provider’s NPI was enumerated on 2006-08-03 (~20 years ago), indicating a long-established operational tenure in the market; that longevity helps explain how it may have achieved the scale to lead statewide in T1016 billing and is a relevant factor for contracting and competitive assessments.

Medicaid: Complete Services Breakdown

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

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1016	Case management, each 15 minutes	411,140	$40	$17.7M
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	350	$70	$23.5K
97166	The occupational therapist (OT) performs an evaluation requiring clinical decision–making of moderate analytic complexity, which includes analysis of occupational profile, problem–focused assessment…	250	$50	$12.8K
97163	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history of a patient with three or more personal factors that may affect care, assess a clinical…	140	$60	$8.5K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Children's Hospital And Health System, Inc. — 1 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

4 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1016	Case management, each 15 minutes	1	220	7,110	$70	$1.7M
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	15	50	80	$80	$37.8K
97166	The occupational therapist (OT) performs an evaluation requiring clinical decision–making of moderate analytic complexity, which includes analysis of occupational profile, problem–focused assessment…	20	50	130	$30	$22.7K
97163	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history of a patient with three or more personal factors that may affect care, assess a clinical…	18	40	90	$30	$15.3K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Of Wisconsin, Inc.	WI	Children's Hospital	$0	$262.3M
Providence Health & Services Washington	WA	Pulmonary Disease Physician	$0	$78.6M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Sutter Valley Medical Foundation	CA	Multi-Specialty Clinic/Center	$0	$41.2M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Childrens Hospital Of Wisconsin, Inc.	WI	Pediatrics Physician	$0	$19M
Thomas Schlesinger	CA	Retina Specialist (Ophthalmology) Physician	$4.3M	$7.9M
Children's Specialty Group, Inc.	WI	Pediatrics Physician	$0	$10.4M
Stephen Meffert	CA	Retina Specialist (Ophthalmology) Physician	$3.2M	$5.5M
Louis Chang	CA	Ophthalmology Physician	$2.2M	$5.9M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Froedtert Memorial Lutheran Hospital, Inc.	WI	General Acute Care Hospital	$0	$157.8M
The Medical College Of Wisconsin, Inc.	WI	Internal Medicine Physician	$17.8K	$74.8M
Emergency Medicine Specialists, S.c.	WI	Emergency Medicine Physician	$0	$35.3M
Wisconsin Diagnostic Laboratories LLC	WI	Clinical Medical Laboratory	$2.3M	$22.7M
Option Care Home Care Inc	WI	Pharmacy	$0	$12.5M
Curative Care Network, Inc.	WI	Rehabilitation Clinic/Center	$0	$12.2M
Brian Blocher	WI	Oral & Maxillofacial Surgery (D.M.D.)	$0	$5.5M
Nicholas Tosi	WI	Retina Specialist (Ophthalmology) Physician	$4.9M	$0
Wisconsin Laser And Surgery Center LLC	WI	Ambulatory Surgical Clinic/Center	$1.1M	$2.9M
Retina & Vitreous Consultants Of Wi, Ltd.	WI	Retina Specialist (Ophthalmology) Physician	$0	$3.8M

Children's Hospital And Health System, Inc. — Billing Profile & Reimbursement Data

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Children's Hospital And Health System, Inc. — 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