Physician
Children's Community Care
Children's Community Care was paid $252K by Medicaid between Jan 2018 and Dec 2024, across 18 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 96% of everything it billed.
33Billing provider infoCHILDREN'S COMMUNITY CARE
NORTH HUNTINGDON, PA 15642
NORTH HUNTINGDON, PA 15642
33aNPI1609109172assigned 09/15/2009
33bProvider typePediatrics Physician
28Total paid$252K
24GClaims3,944
24DCodes billed18
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Pediatrics Physician providers in Pennsylvania
Rank by total paid#305 of 1,257
Median peer was paid$45K
This provider vs. median5.6×
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 | |
|---|---|---|---|
| 2018 | 41 | $2K | |
| 2019 | 270 | $12K | |
| 2020 | 146 | $8K | |
| 2021 | 862 | $61K | |
| 2022 | 846 | $64K | |
| 2023 | 784 | $48K | |
| 2024incomplete | 995 | $57K |
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 | 96% | 3,188 | 2,922 | $243K |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | <1% | 45 | 44 | $2K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | <1% | 31 | 29 | $2K |
| 90686 | <1% | 166 | 162 | $1K | |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | <1% | 14 | 14 | $1K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 12 | 12 | $959.79 |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 41 | 39 | $453.00 |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 29 | 29 | $422.30 |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | <1% | 14 | 14 | $369.70 |
| 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% | 113 | 104 | $224.60 |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | <1% | 12 | 12 | $121.00 |
| 96127 | <1% | 53 | 53 | $58.58 |
6 more codes
| 96160 | <1% | 53 | $52.07 | |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 23 | $7.69 |
| G9920 | Screening performed and negative | 0% | 78 | $0.00 |
| 90661 | 0% | 19 | $0.00 | |
| 92551 | 0% | 40 | $0.00 | |
| G8510 | Screening for depression is documented as negative, a follow-up plan is not required | 0% | 13 | $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 | Monongahela, PA | $628K |
| 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 | 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.