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.

Sullivan And Ptrs (NPI 1003981093)

Sullivan And Ptrs is a gastroenterology physician provider located in Kingsport, Tennessee. This profile covers 0 Medicare and 19 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Sullivan And Ptrs
Address	2204 Pavilion Dr Ste 108
City	Kingsport
State	TN
ZIP	37660
Taxonomy	Gastroenterology Physician
NPI Enumerated	November 22, 2006

Payer Source	Total Paid
Medicaid	$2.1M
Medicare	$0

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	7,690	$80	$615.2K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	5,250	$60	$335.8K
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…	9,710	$30	$320.6K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	1,580	$100	$164.2K
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…	6,510	$20	$156.1K
99204	The provider sees a new 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 provider…	1,880	$70	$131.3K
43450	The provider passes long thin tubular devices of increasing diameter to dilate, or widen, a stricture in the patient’s esophagus to improve swallowing.	4,620	$20	$83.1K
43270	An esophagogastroduodenoscopy (EGD) is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope passed through the mouth. During the EGD, the provider passes guidewires…	570	$150	$82.9K
88342	The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,…	3,530	$20	$56.5K
88312	The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets…	1,320	$30	$34.2K

Showing 1–10 of 19

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

Sullivan And Ptrs — 5 of 18 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

19 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	5	170	340	$190	$206.8K
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…	338	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…	570	4,050	620	$30	$183.9K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	34	200	600	$30	$168.3K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	33	80	70	$200	$121.4K
99204	The provider sees a new 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 provider…	92	1,080	120	$80	$90.7K
43270	An esophagogastroduodenoscopy (EGD) is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope passed through the mouth. During the EGD, the provider passes guidewires…	1	10	450	$160	$70.9K
43450	The provider passes long thin tubular devices of increasing diameter to dilate, or widen, a stricture in the patient’s esophagus to improve swallowing.	2	30	170	$60	$62.4K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	23	80	240	$40	$60.3K
99203	The provider sees a new 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 provider…	258	1,240	120	$60	$53.1K

Showing 1–10 of 19

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Holston Medical Group PC	TN	Family Medicine Physician	$0	$37M
Wellmont Medical Associates Inc	TN	Pulmonary Disease Physician	$0	$27.8M
Wellmont Health System	TN	General Acute Care Hospital	$0	$17.6M
Mountain States Health Alliance	TN	General Acute Care Hospital	$0	$15.5M
Watauga Dental Center, PLLC	TN	General Practice Dentistry	$0	$8M
Lovinginhomecareinc	TN	In Home Supportive Care Agency	$0	$5.3M
Harville Orthodontics PLLC	TN	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$4.7M
Sbh-kingsport	TN	Psychiatric Hospital	$0	$4M
Thompson Delivery Services LLC	TN	Non-emergency Medical Transport (VAN)	$0	$3.2M
Wellmont Cardiology Services	TN	Cardiovascular Disease Physician	$0	$3.1M

Sullivan And Ptrs — Billing Profile & Reimbursement Data

Sign up for Sullivan And Ptrs — Billing Profile & Reimbursement Data policy alerts

Sullivan And Ptrs — Billing Profile & Reimbursement Data

Sign up for Sullivan And Ptrs — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References