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

Why is the Medicaid comparison limited to Tennessee 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. Tennessee (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.

Fort Sanders Perinatal Center (NPI 1003811381)

Field	Value
Entity Type	Organization
Organization	Fort Sanders Perinatal Center
Address	501 19th St
City	Knoxville
State	TN
ZIP	37916
Taxonomy	Maternal & Fetal Medicine Physician
NPI Enumerated	June 14, 2005

Payer Source	Total Paid
Medicaid	$46.5M
Medicare	$0

Medicaid: Complete Services Breakdown

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

65 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	76,880	$90	$6.8M
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	84,550	$60	$5.2M
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	61,750	$80	$5.2M
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	3,100	$1,650	$5.1M
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	21,750	$190	$4M
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	34,450	$90	$3.1M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	43,320	$50	$2.2M
G0108	Diabetes outpatient self-management training services, individual, per 30 minutes	26,000	$70	$1.7M
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	13,470	$110	$1.5M
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	15,000	$90	$1.4M

Showing 1–10 of 65

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Fort Sanders Perinatal Center — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

65 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	1	80	100	$1,260	$405.3K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	2	60	320	$140	$346.9K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	3	100	670	$60	$342.9K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	1	50	490	$50	$333.3K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	1	150	390	$60	$220.9K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	216	3,760	610	$40	$202.3K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	96	4,050	620	$30	$183.9K
59510	In this global service, the provider provides all of the antepartum care, admission to the hospital for delivery, delivery of the fetus and placenta via an abdominal incision, and inpatient and…	2	30	50	$1,230	$164.2K
76825	The provider performs real–time fetal echocardiography, with or without M–mode recording, for complete evaluation of a fetal cardiovascular system.	3	20	150	$130	$157.5K
76821	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the middle cerebral artery. This test determines the timing of labor induction and…	12	20	200	$60	$143.8K

Showing 1–10 of 65

Related Providers

Other providers that share a Tax Identification Number (TIN) with Fort Sanders Perinatal Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Ayres	TN	Interventional Cardiology Physician	$79.3K	$0
Lee Dilworth	TN	Cardiovascular Disease Physician	$28.4K	$0
Kimberly Sawyer	TN	Obstetrics & Gynecology Physician	$22.3K	$0

Nearby Providers

Other providers in the same ZIP code as Fort Sanders Perinatal Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
East Tennessee Children's Hospital Association, Inc.	TN	Children's Hospital	$0	$88.6M
East Tennessee Children's Primary Care Center, Inc.	TN	Pediatrics Physician	$0	$31.4M
Fort Sanders Regional Medical Center	TN	General Acute Care Hospital	$0	$26.8M
Vista Radiology, PC.	TN	Diagnostic Radiology Physician	$0	$10.7M
Allergy & Asthma Affiliates, PC	TN	Allergy & Immunology Physician	$0	$7M
Knoxville Pediatric Associates, P.C.	TN	Pediatrics Physician	$0	$6.1M
American Anesthesiology Of Tennessee, P.C.	TN	Certified Registered Nurse Anesthetist	$0	$4.9M
Dba: Dolly Parton Children's Hospital Cardiology	TN	Pediatric Cardiology Physician	$0	$3.5M
Knoxville Pediatric Ophthalmology, PLLC	TN	Ophthalmology Physician	$0	$3.3M
East Tennessee Children's Hospital Association, Inc.	TN	Pediatric Pulmonology Physician	$0	$2.6M

Fort Sanders Perinatal Center — Billing Profile & Reimbursement Data

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Fort Sanders Perinatal Center — 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