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

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

Southeast Alabama Rural Health Associates (NPI 1043220585)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southeast Alabama Rural Health Associates
Address	1414 Elba Hwy
City	Troy
State	AL
ZIP	36079
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	August 8, 2006

Payer Source	Total Paid
Medicaid	$25.2M
Medicare	$0

SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES reports $25.2M in lifetime Medicaid revenue and has no Medicare billing on file, making its Medicare footprint effectively nil compared with Medicaid. The provider's NPI was enumerated on 2006-08-08 (~20 years ago), indicating long-standing enrollment in federal programs.

Revenue is extremely concentrated: the precomputed top-three Medicaid codes account for 99.7% of this provider's total Medicaid revenue. In particular, T1015 alone represents $25M and 99.2% of Medicaid revenue, while 99213 accounts for $97.3K (0.4%) and 87426 accounts for $14.4K (0.1%).

The code mix and volumes identify this entity as an FQHC operating as a high-volume primary care and community clinic. The dominance of T1015 (Clinic visit/encounter, all-inclusive) with 213.6K claims and extensive vaccine and point-of-care testing codes (for example 87426 and 87804) point to bundled encounter billing for broad primary care, vaccination, and infectious-disease screening services.

T1015 is a statewide outlier: it ranks #5 of 243 providers in-state (98th percentile; extreme outlier), consistent with the 213.6K-claim volume and $25M revenue reported for that code. This ranking indicates a dominant role in in-state FQHC encounter billing relative to peers and an unusually large share of Medicaid clinic-encounter volume.

Although 99213 is a small contributor to revenue ($97.3K), its activity volume is also an outlier: 97.3K claims and a rank of #5 of 1988 providers in-state (100th percentile; extreme outlier). Similarly, 87426 (14.4K claims) ranks #7 of 406 providers in-state (99th percentile; notably above typical), indicating unusually high throughput for COVID-19 immunoassay testing for a Medicaid population.

Operationally, the dominance of T1015 implies the FQHC is largely using the all-inclusive encounter rate to capture services rather than relying on fee-for-service E/M codes for most visits; the small revenue share for 99213 supports that most face-to-face care is billed under T1015. This pattern is consistent with an FQHC reimbursement model where bundled encounter codes drive the financial profile.

The provider also shows a broad preventive and public-health service footprint: substantial claim counts for point-of-care respiratory tests and many vaccine CPTs (examples at notable volumes include 87804 with 13.9K claims and a suite of influenza and other vaccine codes). These volumes support the interpretation that immunizations and rapid infectious-disease testing are routine operational components alongside primary care encounters.

For payer and network analysts, this profile signals concentrated Medicaid exposure in a single large FQHC claimant concentrated in encounter-based reimbursement (T1015 at $25M and 99.2% of Medicaid revenue). Given the extreme outlier rankings for key codes, payers should consider the provider a major in-state clinic-encounter claimant and validate contractual and utilization assumptions against the observed high volumes and bundled billing pattern.

Medicaid: Complete Services Breakdown

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

88 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	213,620	$120	$25M
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…	97,330	$1	$97.3K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	14,410	$1	$14.4K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	13,900	$1	$13.9K
90674	This code represents a flu vaccine product that protects against four strains of influenza. It is derived from cell cultures, contains no preservatives or antibiotics, and is administered as a 0.5 mL…	910	$10	$10.9K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	1,290	$10	$9.1K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	1,000	$10	$8K
90658	This code represents a trivalent influenza vaccine product containing split virus components. It is administered into the muscle in a 0.5 mL dosage.	770	$10	$6.1K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	6,050	$1	$6K
90651	This code represents a nonavalent human papillomavirus (HPV) vaccine product administered into the muscle to protect against HPV infection. The vaccine protects against nine HPV types (6, 11, 16, 18,…	760	$10	$5.3K

Showing 1–10 of 88

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

Southeast Alabama Rural Health Associates — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

88 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	5	240	6,820	$120	$2.9M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	277	380	440	$90	$362K
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…	26	1,990	680	$60	$201.7K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	117	330	140	$240	$197.4K
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…	5	1,990	560	$40	$185.6K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	101	270	1,360	$60	$159.7K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	59	300	1,160	$50	$147.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	36	320	640	$50	$98.1K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	163	370	1,540	$10	$65K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	179	230	410	$40	$59.2K

Showing 1–10 of 88

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sarah Dowdy	AL	Family Nurse Practitioner	$39.4K	$0
Tania Edwards	FL	Family Medicine Physician	$34.1K	$0
Richard Bendinger	AL	Family Medicine Physician	$21.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Warren Behavioral Care, Inc	AL	Clinical Psychologist	$0	$1.1M
Fernelle Warren	AL	Clinical Psychologist	$65.2K	$0

Southeast Alabama Rural Health Associates — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References