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.

Tennessee Valley Pediatric Associatesinc. (NPI 1043323439)

Key Findings

Field	Value
Entity Type	Organization
Organization	Tennessee Valley Pediatric Associatesinc.
Address	234 Keller Park Blvd
City	Tuscumbia
State	AL
ZIP	35674
Taxonomy	Pediatrics Physician
NPI Enumerated	August 17, 2006

Payer Source	Total Paid
Medicaid	$20.8M
Medicare	$0

TENNESSEE VALLEY PEDIATRIC ASSOCIATESINC. is effectively a single‑payer Medicaid provider: there is no Medicare billing on file and the practice reports $20.8M in lifetime Medicaid revenue. The group's NPI was enumerated on 2006-08-17 (~20 years ago), indicating long tenure and an established presence in its market.

Revenue is highly concentrated in a small set of outpatient E/M codes: the precomputed top‑3 Medicaid codes account for 65.4% of the provider’s Medicaid revenue, driven by 99214 ($7.9M, 40.6%), 99213 ($4M, 20.5%), and 87633 ($857.7K, 4.4%). This concentration signals that routine office visits and a single high-volume lab CPT are the primary revenue engines for the practice.

The code mix strongly indicates a high-volume pediatric ambulatory clinic focused on established patient office visits: 99214 has 95.5K claims and 99213 has 74.2K claims, which are typical of an ongoing primary care pediatrics practice managing frequent follow-ups and chronic care visits. The dominance of mid‑level and low‑level established visit codes points to continuous outpatient management rather than specialty procedural care.

Preventive care and immunization services form a significant secondary service line. Codes for well visits (99392 with 13K claims and $753.1K revenue; 99391 with 11.8K claims and $670.2K revenue; 99393 with 8.5K claims and $494.7K revenue) and multiple vaccine codes (90670, 90648, 90680, 90633) appear in the top billings, indicating systematic well‑child visits and an active immunization program integrated into routine care.

The practice operates a substantial on‑site or closely integrated diagnostic testing footprint, shown by very large volumes of rapid/POC and molecular infectious disease tests: 87428 (16.9K claims, $777.5K; ranks #1 of 166 in-state, labeled extreme outlier) and multiple rapid antigen/antibody codes such as 87880 (40.5K claims, $526.1K; rank #4 of 680, extreme outlier) and 87804 (25.2K claims, $528.9K). These high testing counts suggest a workflow optimized for high throughput of respiratory and COVID/influenza/strep testing.

Several high-volume codes are state outliers, reflecting dominant in-state market share for common pediatric services. 99214 ranks #7 of 1990 providers in-state (100th percentile; extreme outlier) and 99213 ranks #13 of 1988 providers (99th percentile; extreme outlier), while 87428 is the statewide top biller (rank #1, 100th percentile); collectively these ranks point to a major pediatric volume center in Alabama for office visits and certain lab tests.

Operationally, the revenue profile pairs very large claim counts with many low‑unit‑price diagnostic codes (for example, 87880 with 40.5K claims at $13 avg paid/claim and 87804 with 25.2K claims at $21 avg paid/claim). That mix implies the practice depends on scale and throughput—high visit volumes and frequent rapid testing—to generate Medicaid revenue rather than a small number of high‑value procedures.

From a payer or network strategy perspective, the clinic’s nearly exclusive Medicaid exposure and its dominance in high‑volume pediatric visit and testing codes suggest it would be a key partner for Medicaid plans focused on pediatric access and population health. The absence of Medicare activity confirms the practice’s pediatric specialization and means payer negotiations, risk exposure, and revenue stability will be driven primarily by Medicaid terms and pediatric service utilization patterns.

Medicaid: Complete Services Breakdown

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

84 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	95,480	$80	$7.9M
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…	74,160	$50	$4M
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	4,180	$210	$857.7K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	16,900	$50	$777.5K
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…	12,990	$60	$753.1K
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…	11,760	$60	$670.2K
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.	25,190	$20	$528.9K
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.	40,470	$10	$526.1K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	18,930	$30	$511.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8,530	$60	$494.7K

Showing 1–10 of 84

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

Tennessee Valley Pediatric Associatesinc. — 15 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

84 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	14	100	470	$130	$1.2M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	64	180	100	$120	$381.8K
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…	103	380	440	$90	$362K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	18	120	500	$50	$317.7K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	58	120	730	$60	$212.5K
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…	7	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…	19	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…	13	1,990	560	$40	$185.6K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	23	110	240	$60	$175.6K
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…	12	270	1,360	$60	$159.7K

Showing 1–10 of 84

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
James T. Gardiner Family Dentistry, P.C.	AL	Dentist	$0	$4.4M
Th Tuscumbia PLLC	AL	Pediatric Dentistry	$0	$1.3M
Air Evac Ems Inc	AL	Air Ambulance	$423.2K	$0
Javar Myatt-jones	AL	Family Medicine Physician	$206.1K	$0
Carlos Liotta	AL	Sports Medicine (Family Medicine) Physician	$155.1K	$0
Anna James	AL	Family Nurse Practitioner	$100.2K	$0
Dorene Morris	AL	Family Medicine Physician	$78.6K	$0

Tennessee Valley Pediatric Associatesinc. — Billing Profile & Reimbursement Data

Sign up for Tennessee Valley Pediatric Associatesinc. — Billing Profile & Reimbursement Data policy alerts

Tennessee Valley Pediatric Associatesinc. — Billing Profile & Reimbursement Data

Sign up for Tennessee Valley Pediatric Associatesinc. — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References