Physician
Children's Community Care
Children's Community Care was paid $628K by Medicaid between Nov 2019 and Dec 2024, across 33 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 42% of everything it billed.
33Billing provider infoCHILDREN'S COMMUNITY CARE
MONONGAHELA, PA 15063
MONONGAHELA, PA 15063
33aNPI1053702621assigned 02/18/2015
33bProvider typePediatrics Physician
28Total paid$628K
24GClaims12,764
24DCodes billed33
24AFirst – last monthNov 2019 – Dec 2024
Compared with peers
Next to other Pediatrics Physician providers in Pennsylvania
Rank by total paid#159 of 1,257
Median peer was paid$45K
This provider vs. median14×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Entity ProliferationAuthorized official MARTINEZ, LORI controls 20+ related entities in our dataset. Read more
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2019 | 18 | $253.00 | |
| 2020 | 213 | $9K | |
| 2021 | 2,145 | $118K | |
| 2022 | 2,704 | $157K | |
| 2023 | 3,653 | $174K | |
| 2024incomplete | 4,031 | $170K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 42% | 3,117 | 2,852 | $262K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 21% | 2,357 | 2,191 | $129K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 13% | 902 | 868 | $81K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 11% | 715 | 690 | $71K |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | 3.9% | 455 | 443 | $24K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 3.1% | 206 | 206 | $20K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | 1.8% | 605 | 313 | $12K |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 1.7% | 412 | 401 | $10K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 1.1% | 71 | 70 | $7K |
| 99188 | <1% | 288 | 260 | $4K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 381 | 356 | $4K |
| 87428 | <1% | 120 | 115 | $2K |
21 more codes
| 90686 | <1% | 415 | $874.64 | |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) | <1% | 379 | $255.20 |
| 96127 | <1% | 79 | $56.00 | |
| 96160 | <1% | 80 | $41.78 | |
| 90715 | 0% | 12 | $0.00 | |
| 90670 | 0% | 190 | $0.00 | |
| 90648 | 0% | 370 | $0.00 | |
| 90633 | 0% | 108 | $0.00 | |
| G9920 | Screening performed and negative | 0% | 461 | $0.00 |
| 99177 | 0% | 25 | $0.00 | |
| 90661 | 0% | 25 | $0.00 | |
| 99173 | 0% | 14 | $0.00 | |
| 90723 | 0% | 225 | $0.00 | |
| 96161 | 0% | 148 | $0.00 | |
| 92551 | 0% | 107 | $0.00 | |
| 90680 | 0% | 126 | $0.00 | |
| 90677 | 0% | 192 | $0.00 | |
| 90619 | 0% | 33 | $0.00 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | 0% | 68 | $0.00 |
| 90656 | 0% | 61 | $0.00 | |
| 90651 | 0% | 17 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialMARTINEZ, LORI (EXECUTIVE ADMINISTRATOR III)
| Provider | Location | Paid |
|---|---|---|
| Children's Community Care | Wexford, PA | $5.17M |
| Children's Community Care | Sewickley, PA | $3.28M |
| Children's Community Care | Uniontown, PA | $1.02M |
| Children's Community Care | Pittsburgh, PA | $898K |
| Childen's Community Care | New Castle, PA | $646K |
| Children's Community Care | Erie, PA | $580K |
| Childen's Community Care | Pittsburgh, PA | $535K |
| Childen's Community Care | Hummelstown, PA | $522K |
| Children's Community Care | York, PA | $500K |
| Children's Community Care | Huntingdon, PA | $470K |
| Children's Community Care | Wexford, PA | $467K |
| Childen's Community Care | Camp Hill, PA | $438K |
| Children's Community Care | Pittsburgh, PA | $414K |
| Children's Community Care | New Castle, PA | $394K |
| Childen's Community Care | Hermitage, PA | $276K |
| Children's Community Care | North Huntingdon, PA | $252K |
| Children's Community Care | Natrona Heights, PA | $207K |
| Children's Community Care | White Oak, PA | $181K |
| Childen's Community Care | Grove City, PA | $177K |
| Children's Community Care | Shippensburg, PA | $175K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.