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

Why is the Medicaid comparison limited to Florida 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. Florida (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 Of South Carolina PA (NPI 1992802607)

Field	Value
Entity Type	Organization
Organization	Pediatrix Medical Group Of South Carolina PA
Address	1301 Concord Ter
City	Sunrise
State	FL
ZIP	33323
Taxonomy	Neonatal-Perinatal Medicine Physician
NPI Enumerated	September 17, 2006

Payer Source	Total Paid
Medicaid	$51.3M
Medicare	$0

Key Findings

This provider reports $51.3M in lifetime Medicaid revenue and has no Medicare billing on file, making its public payer footprint effectively single‑payer Medicaid. The NPI was enumerated on 2006-09-17 (~20 years ago), indicating long-standing enrollment during which the reported Medicaid volumes were earned.

The code mix is heavily neonatal and NICU‑centered: the largest revenue-driving codes are 99469, 99479, and 99480, which correspond to subsequent and directed care of newborns and recovering low birth weight infants in neonatal critical care or step‑down settings. High volumes on these newborn‑focused critical care and low‑birth‑weight direction codes indicate the group operates primarily as a neonatal/perinatal inpatient service line rather than a general pediatric outpatient practice.

Revenue concentration is high: the top 3 Medicaid codes by revenue (99469, 99479, 99480) account for 73.1% of this provider's total Medicaid revenue. Individually those codes generate $20.1M (39.1%), $11.5M (22.5%), and $5.9M (11.5%) respectively, showing that a small set of neonatal management codes drives the bulk of Medicaid earnings.

On statewide competitiveness, the provider ranks as a dominant volume leader for multiple top codes: 99469, 99479, and 99480 each rank #1 in-state and are labeled as extreme outliers (100th percentile, far above typical state volume). Additional NICU codes such as 99472 also rank #1 in-state (described as notably above typical state volume), which collectively positions the practice as a major in-state provider of neonatal inpatient and low birthweight management services.

Beyond the top three, the profile shows concentrated but complementary service lines: 92650 (hearing screening) contributes $2.7M (5.3%) and ranks #3 in-state (98th percentile; extreme outlier), while 99460 ($1.5M, 3.0%) and 99238 ($1.3M, 2.6%) also rank in very high percentiles (98th and 99th respectively and described as extreme outliers). These additional high-volume inpatient newborn evaluation and discharge codes reinforce that the group delivers a broad set of NICU‑adjacent services at scale.

The reliance on a narrow set of high-volume neonatal codes creates operational and reimbursement concentration risk: because 73.1% of Medicaid revenue is tied to three procedure codes, changes in Medicaid policy, reimbursement rates, or clinical pathways affecting those specific codes could materially alter the provider’s revenue stream. This concentration also means payer negotiations or network decisions around neonatal services would have outsized impact on overall revenue.

Although several codes are extreme outliers, the dataset also contains many codes with typical or unremarkable volumes (for example 92586, 99468, and multiple E/M codes listed as typical, unremarkable volume for the code). That mix — very high volumes on a focused set of neonatal critical‑care codes alongside routine volumes for other newborn and inpatient E/M services — suggests a specialized NICU operational footprint with otherwise conventional inpatient pediatrics activity.

Taken together, long enrollment tenure (~20 years) plus repeated 100th‑percentile rankings for core neonatal codes indicate an established, high‑volume neonatal inpatient provider in the state Medicaid market. Analysts should treat this entity as a leading in‑state NICU services provider whose Medicaid performance is driven by a concentrated set of newborn critical‑care and low‑birth‑weight management procedures.

Medicaid: Complete Services Breakdown

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

25 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.	53,920	$370	$20.1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	97,750	$120	$11.5M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	52,420	$110	$5.9M
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.	13,020	$390	$5M
92650	In this procedure, the provider measures the patient’s response to sound stimuli to screen auditory potential (electrical response). The screening uses frequency nonspecific stimuli and automated…	31,290	$90	$2.7M
92586	N/A	27,570	$70	$1.8M
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	18,230	$90	$1.5M
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…	19,640	$70	$1.3M
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.	630	$870	$549.7K
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…	2,670	$100	$253.6K

Showing 1–10 of 25

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Florida Distribution

Pediatrix Medical Group Of South Carolina PA — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Florida

Full comparison — all codes billed, vs. Florida median

25 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.	1	30	2,120	$320	$2.3M
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.	1	30	2,220	$350	$1.3M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	50	570	$100	$1.1M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	1	40	830	$100	$785.9K
92586	N/A	5	50	270	$40	$293.9K
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	20	40	$800	$292.5K
92650	In this procedure, the provider measures the patient’s response to sound stimuli to screen auditory potential (electrical response). The screening uses frequency nonspecific stimuli and automated…	3	90	1,130	$50	$182.8K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	5	170	300	$60	$121.4K
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…	1,117	1,500	470	$30	$87.2K
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…	963	1,980	660	$20	$74.4K

Showing 1–10 of 25

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pediatrix Medical Group Of Georgia, P.C.	FL	Maternal & Fetal Medicine Physician	$0	$50.6M
Pediatrix Medical Group Of Florida Inc	FL	Pediatric Cardiology Physician	$0	$35.9M
Pediatrix Medical Group Of Michigan PC	FL	Neonatal-Perinatal Medicine Physician	$0	$26.4M
Pediatrix Medical Group Of North Carolina PC	FL	Neonatal-Perinatal Medicine Physician	$0	$23.1M
Pediatrix Medical Group Of California, A Professional Corporation	FL	Neonatal-Perinatal Medicine Physician	$0	$10.8M
Kellee Campbell	FL	Podiatrist	$283.5K	$0
Dileep Ravi	FL	Emergency Medicine Physician	$142.5K	$0
Burak Ilsin	FL	Anesthesiology Physician	$60.4K	$0
Andrea Banta	FL	Certified Registered Nurse Anesthetist	$52.5K	$0
Will Crowthers	FL	Certified Registered Nurse Anesthetist	$51K	$0

Pediatrix Medical Group Of South Carolina PA — Billing Profile & Reimbursement Data

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Pediatrix Medical Group Of South Carolina PA — 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