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

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

Emory Medical Care Foundation Inc (NPI 1063452381)

Key Findings

Field	Value
Entity Type	Organization
Organization	Emory Medical Care Foundation Inc
Address	80 Jesse Hill Jr Drive
City	Atlanta
State	GA
ZIP	30303
Taxonomy	Internal Medicine Physician
NPI Enumerated	June 7, 2006

Payer Source	Total Paid
Medicaid	$41.4M
Medicare	$0

The provider has no Medicare billing on file and $41.4M in lifetime Medicaid revenue, making EMORY MEDICAL CARE FOUNDATION INC effectively a Medicaid-centric billing entity rather than a dual-payer operation. Analysts should treat all utilization and competitive conclusions here as Medicaid-driven rather than split between Medicare and Medicaid.

Revenue is highly concentrated in a small group of ED evaluation-and-management codes: the precomputed top 3 Medicaid codes account for 45.4% of this provider’s total Medicaid revenue. In particular, 99283 generated $7.7M (22.6%), 99285 generated $4.8M (14.0%), and 99284 generated $3M (8.9%), indicating that nearly half of Medicaid dollars flow through a triad of emergency-care codes.

The code mix and volumes point to a high-acuity emergency and acute-care operation: 99283 (135.4K claims, $57 avg paid/claim, $7.7M) is an extreme outlier in-state (rank #3 of 237, 99th percentile), and 99285 (54.3K claims, $88 avg paid/claim, $4.8M) is also far above typical state volume (rank #4 of 139, 98th percentile). Those tallies, together with large volumes for 99284, imply sustained heavy emergency-department throughput with a meaningful share of high-complexity visits.

The provider is a major statewide provider of neonatal and newborn follow-up services: 99479 (16.7K claims, $85 avg paid/claim, $1.4M) ranks #1 of 7 providers in-state (100th percentile), 99480 (7.4K claims, $69 avg paid/claim, $511.3K) also ranks #1 of 7 (100th percentile), and 99460 (10.8K claims, $75 avg paid/claim, $811.7K) ranks #2 of 54 (98th percentile). These patterns indicate a sizable perinatal/neonatal service line that contributes meaningfully to Medicaid revenue and positions the provider as a top in-state participant for caring for low-birth-weight and newborn patients.

Hospital inpatient and observation care is another material service line: 99232 (88.1K claims, $16 avg paid/claim, $1.4M) ranks #1 of 191 providers in-state (100th percentile; extreme outlier) and 99233 (44.2K claims, $21 avg paid/claim, $927.3K) ranks #5 of 160 (97th percentile). Additional inpatient-related codes such as 99238 (18K claims, $47 avg paid/claim, $848K) also show top-in-state standing, indicating substantial hospital-based follow-up and discharge management activity billed to Medicaid.

Preventive and pediatric well-visits appear as a meaningful secondary line: 99391 (15.6K claims, $74 avg paid/claim, $1.2M) ranks #3 of 176 providers (99th percentile) and 99392/99393 also appear in the top-25 by revenue. The presence of high-volume well-child and preventive codes alongside neonatal services suggests broad maternal–child health coverage spanning newborn care through early-childhood preventive visits.

Diagnostic, imaging, and pathology services are billed at high volumes relative to peers, supporting on-site or closely affiliated ancillary services: 71045 shows 123.2K claims ($4 avg paid/claim, $492.8K) and ranks #2 of 121 providers in-state (99th percentile; extreme outlier), 93010 has 90K claims ($4 avg paid/claim, $360.1K) and ranks #2 of 101 (99th percentile), and pathology codes 88305 and 88307 rank in the top decile to top percentile. These volumes indicate significant throughput of routine imaging, ECGs, and surgical pathology that supplement the provider’s clinical revenue base.

Across multiple distinct service lines this provider ranks at or near the top in Georgia on state comparisons: several codes are labeled "extreme outlier" or "notably above typical state volume," with multiple #1 and #2 statewide ranks. The NPI was enumerated on 2006-06-07 (~20 years ago), so this pattern reflects a long-tenured operation with entrenched Medicaid-facing service lines and dominant competitive standing in several in-state specialties.

Medicaid: Complete Services Breakdown

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

275 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	135,430	$60	$7.7M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	54,280	$90	$4.8M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	33,430	$90	$3M
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…	66,570	$40	$2.7M
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…	61,700	$40	$2.2M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	16,740	$90	$1.4M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	88,140	$20	$1.4M
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…	15,630	$70	$1.2M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	44,160	$20	$927.3K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	18,040	$50	$848K

Showing 1–10 of 275

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Emory Medical Care Foundation Inc — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

275 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	5	10	3,360	$330	$2.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	4	140	200	$280	$1.9M
D7240	N/A	8	10	580	$240	$1M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	15	230	120	$170	$937.5K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	7	20	310	$900	$893.2K
70551	The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam.	9	30	550	$540	$834.8K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	12	20	190	$1,120	$833.4K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	3	240	170	$120	$779.3K
74183	The provider performs magnetic resonance imaging of the structures and organs of the abdomen, initially without control and then with additional sequences after injection of contrast.	5	10	460	$950	$722.3K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	10	6,030	$100	$683.9K

Showing 1–10 of 275

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Emory Clinic Inc	GA	Ambulatory Surgical Clinic/Center	$1.4M	$26.6M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Grady Memorial Hospital Corporation	GA	Family Medicine Physician	$0	$5.9M
Christopher Stelton	FL	Retina Specialist (Ophthalmology) Physician	$4.2M	$0
Joseph Ricotta	FL	Vascular Surgery Physician	$4M	$0
Jorge Fortun	FL	Ophthalmology Physician	$3.7M	$0
Robin Ray	GA	Ophthalmology Physician	$3.5M	$0
Vasileios Assikis	GA	Hematology & Oncology Physician	$3M	$0
The Emory Clinic Inc	GA	Ambulatory Surgical Clinic/Center	$212.1K	$2.1M
John Schreiber	MD	Diagnostic Radiology Physician	$2.3M	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ace Care Management LLC	GA	Case Management Agency	$0	$16.5M
Children's Healthcare Of Atlanta At Hughes Spalding	GA	Children's Hospital	$0	$5.2M
Grady Memorial Hospital Corporation	GA	General Acute Care Hospital	$0	$1.7M
Walker Family Services LLC	GA	Community/Behavioral Health Agency	$0	$1.2M
Emerginet, LLC	GA	Emergency Medical Services (Emergency Medicine) Physician	$0	$790.7K
Ronak Shah	GA	Diagnostic Radiology Physician	$710.2K	$0
Emerginet Henry, LLC	GA	Emergency Medical Services (Emergency Medicine) Physician	$0	$413.4K
Time Organization, Inc.	GA	Psychiatry Physician	$0	$283.8K
April Farley	GA	Diagnostic Radiology Physician	$243.5K	$550
Sam Sheikali	GA	Emergency Medicine Physician	$52.1K	$144.9K

Emory Medical Care Foundation Inc — Billing Profile & Reimbursement Data

Sign up for Emory Medical Care Foundation Inc — Billing Profile & Reimbursement Data policy alerts

Emory Medical Care Foundation Inc — Billing Profile & Reimbursement Data

Sign up for Emory Medical Care Foundation Inc — Billing Profile & Reimbursement Data policy alerts

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