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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Pediatrix Medical Group PC (NPI 1992728117)

Field	Value
Entity Type	Organization
Organization	Pediatrix Medical Group PC
Address	800 Pennsylvania Ave
City	Charleston
State	WV
ZIP	25302
Taxonomy	Neonatal-Perinatal Medicine Physician
NPI Enumerated	July 26, 2006

Payer Source	Total Paid
Medicaid	$3.7M
Medicare	$0

Medicaid: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3,780	$280	$1.1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	9,850	$110	$1.1M
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	6,000	$60	$359.8K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	3,270	$90	$290.7K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	3,850	$80	$288.5K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	940	$250	$235.4K
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	400	$510	$200.7K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	1,910	$30	$61.1K
99464	The provider is present during the delivery, at the request of the delivering provider, and during the basic stabilization of the newborn immediately after birth, typically when fetal distress or…	950	$40	$39.9K
99471	The provider performs initial evaluation and management of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	80	$450	$35.4K

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Pediatrix Medical Group PC — 5 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

16 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	2	10	3,780	$250	$1.1M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2	10	940	$260	$683.6K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	2	10	7,500	$100	$617.9K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	10	3,270	$90	$365.7K
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	3	10	420	$560	$246.4K
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…	170	190	660	$40	$226.4K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	39	60	170	$130	$189.3K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	40	90	200	$30	$78.8K
99471	The provider performs initial evaluation and management of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2	10	150	$480	$72.8K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	26	60	160	$60	$67.5K

Showing 1–10 of 16

Related Providers

Other providers that share a Tax Identification Number (TIN) with Pediatrix Medical Group PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pediatrix Medical Group Of Texas Billing, Inc.	TX	Neonatal-Perinatal Medicine Physician	$0	$85.3M
Union Associated Physicians Clinic, LLC	IN	Family Medicine Physician	$0	$31.1M
Pediatrix Medical Group Of The Mid-atlantic PC	MD	Maternal & Fetal Medicine Physician	$0	$28.4M
Pediatrix Medical Group PC	VA	Neonatal-Perinatal Medicine Physician	$0	$10.8M
Pediatrix Medical Group Of Indiana, PC	IN	Neonatal-Perinatal Medicine Physician	$0	$2.6M
Curtiss Cook	AZ	Endocrinology, Diabetes & Metabolism Physician	$264.4K	$0
Morris Silver	FL	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	$119.2K	$0
David Bradshaw	UT	Obstetrics & Gynecology Physician	$10.2K	$22.7K
Shanti Thirumalai	NV	Neurology with Special Qualifications in Child Neurology Physician	$10.3K	$0

Nearby Providers

Other providers in the same ZIP code as Pediatrix Medical Group PC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Healthnet Aeromedical Services Inc.	WV	Air Ambulance	$4.1M	$24.1M
Home Base Inc.	WV	Community/Behavioral Health Agency	$0	$14.5M
Appalachian Labs Of Wv LLC	WV	Clinical Medical Laboratory	$359.3K	$11M
Womencare Inc	WV	Federally Qualified Health Center (FQHC)	$0	$7.4M
Allied Nursing And Community Service	WV	Case Management Agency	$0	$5.4M
Devaraj Behavioral Healthcare PLLC	WV	Community/Behavioral Health Agency	$0	$4.8M
South Charleston Pediatrics	WV	Pediatrics Physician	$0	$3.6M
Abc Pediatrics, PLLC	WV	Pediatrics Physician	$0	$2.9M
Kanawha Valley Senior Services	WV	Home Health Agency	$0	$2.2M
Randall J. Hill, M.d., P.L.L.C.	WV	Specialist	$0	$1.9M

Pediatrix Medical Group PC — Billing Profile & Reimbursement Data

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Pediatrix Medical Group PC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References