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.

Advanced Diagnostic Imaging, PC (NPI 1093741464)

Key Findings

Field	Value
Entity Type	Organization
Organization	Advanced Diagnostic Imaging, PC
Address	3024 Business Park Cir
City	Goodlettsville
State	TN
ZIP	37072
Taxonomy	Internal Medicine Physician
NPI Enumerated	June 25, 2006

Payer Source	Total Paid
Medicaid	$29.9M
Medicare	$0

ADVANCED DIAGNOSTIC IMAGING, PC reports no Medicare billing on file and $29.9M in lifetime Medicaid revenue, making Medicaid the de facto sole payer of record in the data. This concentration means payers and network managers should treat the entity as effectively single‑payer from a Medicare/Medicaid dataset perspective when assessing market impact or contracting exposure.

Medicaid revenue is highly concentrated in ambulatory evaluation-and-management codes: the precomputed top three Medicaid codes (99214, 99213, 99204) account for 66.6% of this provider's total Medicaid revenue. Specifically, 99214 alone represents $11.2M (44.4% of Medicaid revenue), followed by 99213 with $3.8M (15.0%) and 99204 with $1.8M (7.2%), signaling that a small set of E/M services drive the majority of dollars.

The code mix indicates a large ambulatory/internal medicine throughput supplemented by facility and procedure work. High-volume office visit codes (99214: 449.6K claims; 99213: 172.7K claims) point to a high-volume outpatient practice model, while notable volumes in nursing facility visits (99309: 80.3K claims) and critical care (99291: 10.4K claims) suggest the organization also provides post-acute and higher-acuity services.

For core office visit codes the provider is a dominant in-state competitor: 99214 ranks #2 of 3759 providers in Tennessee (100th percentile; extreme outlier) and 99213 ranks #13 of 4050 (100th percentile; extreme outlier). 99204 also ranks highly at #6 of 1078 (100th percentile; extreme outlier). These ranks indicate market-leading scale for routine and new-patient E/M visits compared with in-state peers.

Several procedure and diagnostic codes show substantial state-level standing that diversifies the clinical footprint beyond E/M. Interventional spine/pain codes such as 64635 ($504.1K, rank #2 of 29, 96th percentile, notably above typical) and 62323 ($248.1K, rank #1 of 51, 100th percentile, extreme outlier) plus fluoroscopic facet procedures 64493 ($260.5K, rank #2 of 62, 98th percentile, extreme outlier) point to meaningful procedural volume; laboratory and definitive drug testing codes (80307, G0482) also appear in the top-25 Medicaid list.

Multiple top codes are explicitly flagged as extreme outliers relative to Tennessee peers (examples include 99214, 99213, 99204, 99291, 62323, 64493). That repeated extreme-outlier designation suggests unusually high service volumes per code that will materially shape any utilization reviews, network adequacy assessments, or competitive analyses.

There is a material concentration risk for payers and the provider: the top three codes account for 66.6% of Medicaid revenue and the provider has no Medicare revenue on file. This dual concentration — by payer and by a narrow set of E/M codes — increases sensitivity to policy, rate, or authorization changes affecting office visits and related outpatient services.

The provider has a long tenure in the NPI registry (NPI enumerated 2006-06-25 (~20 years ago)) and is listed under the Internal Medicine Physician taxonomy in Goodlettsville, TN. The combination of long registration, high outpatient volumes, and strong in-state ranks suggests an established, high-throughput ambulatory organization that also performs significant procedural and post-acute work.

Medicaid: Complete Services Breakdown

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

320 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…	449,610	$30	$11.2M
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…	172,700	$20	$3.8M
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…	32,380	$60	$1.8M
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…	24,230	$40	$1M
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	80,290	$10	$722.6K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	56,460	$10	$677.5K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	4,490	$140	$636.9K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	10,390	$60	$612.9K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	23,400	$20	$561.6K
64635	Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue.	3,790	$130	$504.1K

Showing 1–10 of 320

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

Advanced Diagnostic Imaging, PC — 17 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

320 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	3	60	430	$50	$1M
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	15	70	180	$60	$589.9K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	9	50	140	$850	$541.1K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	26	30	1,060	$130	$484.1K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	12	70	160	$500	$421.5K
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…	57	80	100	$1,260	$405.3K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	98	340	1,400	$40	$354.2K
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	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.	41	100	670	$60	$342.9K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	10	80	330	$170	$342.3K

Showing 1–10 of 320

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Covenant Medical Group	TX	Family Medicine Physician	$0	$34.3M
Covenant Medical Group, Inc.	TN	Family Medicine Physician	$0	$17.9M
Sivalingam Kanagasegar	TN	Rheumatology Physician	$1.5M	$46.5K
Jose Pratts Emanuelli	TN	Diagnostic Radiology Physician	$759.9K	$16.3K
Selcuk Tombul	TN	Cardiovascular Disease Physician	$734.6K	$27K
Keith Loven	TN	Dermatology Physician	$702.1K	$0
Robert Chen	TN	Dermatology Physician	$544.5K	$103.3K
Paul Fleser	TN	Vascular Surgery Physician	$574.4K	$0
Gibran Naddy	TN	Internal Medicine Physician	$545K	$28.9K
Kenneth Homolya	TN	Pain Medicine (Anesthesiology) Physician	$551.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Associated Children's Dentistry, PLLC	TN	Pediatric Dentistry	$0	$15.7M
Tennessee Voices For Children	TN	Community/Behavioral Health Agency	$0	$7.9M
Ambulnz Tn LLC	TN	Ambulance	$1.2M	$2.2M
Goodlettsville Pediatrics, PC	TN	Pediatrics Physician	$0	$3.1M
James Anderson	TN	Specialist	$299.9K	$2.2M
Quality Senior Care, LLC	TN	In Home Supportive Care Agency	$0	$2.2M
Rivergate Pediatrics PC	TN	Pediatrics Physician	$0	$2.1M
Music City Surgery Center, LLC	TN	Ambulatory Surgical Clinic/Center	$852.1K	$0
James Loden	TN	Ophthalmology Physician	$530K	$360
Andrew Hutchens	TN	Diagnostic Radiology Physician	$424.1K	$0

Advanced Diagnostic Imaging, PC — Billing Profile & Reimbursement Data

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Advanced Diagnostic Imaging, PC — 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