Clinic
Pediatric Care Specialists
Pediatric Care Specialists was paid $3.87M by Medicaid between Jan 2018 and Dec 2024, across 61 billing codes. Its largest line is 99213, doctor's office visit, returning patient (routine) — 23% of everything it billed.
33Billing provider infoPEDIATRIC CARE SPECIALISTS
JOHNSTOWN, PA 15904
JOHNSTOWN, PA 15904
33aNPI1346236833assigned 09/21/2005
33bProvider typePrimary Care Clinic/Center
28Total paid$3.87M
24GClaims108,894
24DCodes billed61
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Primary Care Clinic/Center providers in Pennsylvania
Rank by total paid#1 of 43
Median peer was paid$55K
This provider vs. median71×
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.
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 | |
|---|---|---|---|
| 2018 | 854 | $40K | |
| 2019 | 1,568 | $63K | |
| 2020 | 5,418 | $165K | |
| 2021 | 36,851 | $1.30M | |
| 2022 | 31,797 | $1.23M | |
| 2023 | 17,748 | $565K | |
| 2024incomplete | 14,658 | $503K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 23% | 23,197 | 21,852 | $908K |
| 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 | 15% | 9,540 | 9,057 | $569K |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 9.7% | 10,358 | 5,796 | $376K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | 9.1% | 3,292 | 3,255 | $353K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | 7.5% | 2,902 | 2,865 | $289K |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | 6.0% | 2,299 | 2,275 | $234K |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | 6.0% | 5,197 | 4,920 | $233K |
| 90791 | Psychiatric diagnostic evaluationPsychiatric diagnostic evaluation | 5.5% | 1,036 | 1,032 | $211K |
| 96131 | 3.7% | 953 | 944 | $144K | |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 3.1% | 4,415 | 4,334 | $118K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 2.5% | 979 | 949 | $96K |
| 96130 | 1.4% | 920 | 913 | $53K |
49 more codes
| 92551 | 1.0% | 7,862 | $41K | |
| 90834 | Psychotherapy session, about 45 minutes | 1.0% | 664 | $40K |
| 90792 | Psychiatric diagnostic evaluation with medical services | <1% | 232 | $36K |
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 2,325 | $33K |
| 99188 | <1% | 1,319 | $29K | |
| 99173 | <1% | 7,496 | $29K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 2,696 | $21K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 199 | $7K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 1,289 | $7K |
| 90686 | <1% | 1,859 | $6K | |
| 92012 | Ophthalmological services: medical examination and evaluation, intermediate, established patient | <1% | 131 | $4K |
| 96127 | <1% | 1,483 | $4K | |
| 96160 | <1% | 1,796 | $4K | |
| 90853 | Group psychotherapy (other than of a multiple-family group) | <1% | 204 | $4K |
| 90698 | <1% | 1,003 | $4K | |
| 96161 | <1% | 1,339 | $3K | |
| 90670 | <1% | 916 | $3K | |
| 0071A | <1% | 52 | $2K | |
| 90832 | Psychotherapy session, about 30 minutes | <1% | 114 | $2K |
| 90744 | <1% | 305 | $2K | |
| 90461 | <1% | 28 | $2K | |
| 90680 | <1% | 944 | $2K | |
| 0072A | <1% | 33 | $1K | |
| 92002 | <1% | 31 | $878.54 | |
| 90716 | <1% | 209 | $800.00 | |
| 90633 | <1% | 571 | $790.00 | |
| 90707 | <1% | 207 | $790.00 | |
| 92015 | Determination of refractive state | <1% | 164 | $737.77 |
| 90651 | <1% | 176 | $260.00 | |
| 90696 | <1% | 134 | $130.00 | |
| 92340 | Fitting of spectacles, except for aphakia; monofocal | <1% | 13 | $130.00 |
| 85018 | <1% | 12 | $23.50 | |
| 83655 | <1% | 1,396 | $12.08 | |
| 3008F | 0% | 3,772 | $0.00 | |
| G0136 | Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months | 0% | 155 | $0.00 |
| 90697 | 0% | 535 | $0.00 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | 0% | 179 | $0.00 |
| 90677 | 0% | 222 | $0.00 | |
| 90620 | 0% | 81 | $0.00 | |
| 90619 | 0% | 231 | $0.00 | |
| 90656 | 0% | 123 | $0.00 | |
| 91307 | 0% | 15 | $0.00 | |
| 90381 | 0% | 13 | $0.00 | |
| 90710 | 0% | 334 | $0.00 | |
| 90715 | 0% | 111 | $0.00 | |
| G9920 | Screening performed and negative | 0% | 404 | $0.00 |
| 90671 | 0% | 379 | $0.00 | |
| 98966 | 0% | 38 | $0.00 | |
| 80061 | Lipid panel | 0% | 12 | $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 officialPARSHALL, SHERRI (BILLING CLERK)