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.

Southeastern Pediatric Associates, P.A. (NPI 1093907412)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southeastern Pediatric Associates, P.A.
Address	364 Honeysuckle Rd
City	Dothan
State	AL
ZIP	36305
Taxonomy	Pediatrics Physician
NPI Enumerated	August 10, 2007

Payer Source	Total Paid
Medicaid	$17.3M
Medicare	$0

SOUTHEASTERN PEDIATRIC ASSOCIATES, P.A. appears to operate effectively as a Medicaid-focused pediatric practice: there is no Medicare billing on file and total Medicaid revenue is $17.3M, making this an effectively single‑payer (Medicaid) operation. The provider has an established NPI enumeration date of 2007-08-10 (~19 years ago), indicating long-standing presence in the market.

Revenue is highly concentrated in a small set of evaluation-and-management and preventive pediatric visit codes: the precomputed top three Medicaid codes account for 74.6% of total Medicaid revenue. Those top three are 99214 ($7.2M, 42.4%), 99213 ($4.7M, 27.6%), and 99392 ($794.2K, 4.6%), indicating the bulk of dollars come from routine office and well-child visits.

The code mix signals a high-volume general pediatric primary care operation rather than a specialty clinic: 99214 and 99213 (established patient office visits) dominate revenue, while multiple well-child and preventive visit codes (99392, 99391, 99393, 99394) and vaccine administration codes are also prominent. This pattern is consistent with a clinic focused on routine pediatric care, immunizations, and preventive services delivered in-office.

SOUTHEASTERN PEDIATRIC ranks at the very top of in-state volume for core pediatric office visit codes: 99214 ranks #11 of 1990 providers in-state (99th percentile; extreme outlier, far above typical state volume for this code) and 99213 ranks #12 of 1988 providers in-state (99th percentile; extreme outlier, far above typical state volume for this code). These rankings identify the practice as one of the highest-volume pediatric E/M billers in Alabama for these codes and a major statewide participant for routine visits.

Preventive and well-child services are also materially above typical state volumes: 99392 ranks #15 of 299 providers (95th percentile; notably above typical state volume), 99391 ranks #16 of 270 (94th percentile; notably above typical state volume), 99393 ranks #13 of 320 (96th percentile; notably above typical state volume), and 99394 ranks #9 of 303 (97th percentile; notably above typical state volume). Together these placements show strong throughput for age-based preventive care in addition to problem-focused visits.

The practice reports very high volumes of point-of-care and laboratory respiratory testing, which contribute meaningful ancillary revenue: 87880 shows 30.7K claims for $368.9K revenue and ranks #6 of 680 providers in-state (99th percentile; extreme outlier, far above typical state volume for this code), while 87428 (8.2K claims, $360.4K revenue) ranks #4 of 166 providers (98th percentile; extreme outlier, far above typical state volume). These figures indicate testing for strep, SARS-CoV-2 and other respiratory pathogens is a routine, high-frequency component of the practice.

Vaccination services and associated administration codes provide additional steady revenue but are smaller than visit-driven revenue: example entries include 90670 ($198.5K, 6.2K claims, 94th percentile), 90460 ($188.8K, 3K claims, 88th percentile), and other pediatric vaccine codes (90698, 90671, 90680) that together reflect a full immunization schedule offered on-site. While individually lower than the primary E/M codes, these vaccine revenues are consistent with a comprehensive pediatric office model that bundles preventive visits with immunizations.

From a business perspective, the provider’s dependence on Medicaid dollars and extreme concentration in a few visit codes (top three = 74.6% of Medicaid revenue) creates clear operational specialization: the clinic is structured around high-volume established-patient care, well-child visits, immunizations, and rapid testing. Analysts should treat Medicaid payer concentration and revenue concentration by a small set of E/M and preventive codes as the defining commercial characteristic when benchmarking or modeling this practice’s competitive and financial profile.

Medicaid: Complete Services Breakdown

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

60 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…	76,290	$100	$7.2M
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…	75,930	$60	$4.7M
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…	11,030	$70	$794.2K
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…	9,920	$70	$714.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8,410	$70	$588.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,370	$70	$370.5K
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.	30,740	$10	$368.9K
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…	8,190	$40	$360.4K
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,…	10,510	$30	$262.7K
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.	25,730	$10	$257.3K

Showing 1–10 of 60

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

Southeastern Pediatric Associates, P.A. — 12 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

60 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	11	1,990	680	$60	$201.7K
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…	12	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…	16	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…	15	300	1,160	$50	$147.8K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	161	200	2,000	$10	$105.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	13	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…	62	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.	28	230	410	$40	$59.2K
87086	Culture, bacterial; quantitative, colony count, urine.	53	100	400	$10	$57.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	9	300	330	$50	$56.3K

Showing 1–10 of 60

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Professional Resource Management Of Wiregrass, LLC	AL	Psychiatry Physician	$0	$9M
Triad Of Alabama LLC	AL	General Acute Care Hospital	$0	$4.6M
Hejal Patel	AL	Radiation Oncology Physician	$2.2M	$0
Wiregrass Wellness Center, LLC	AL	Psychiatry Physician	$0	$1.6M
Ent Care PC	AL	Specialist	$0	$866.8K
Circle City Speech, LLC	AL	Speech-Language Pathologist	$0	$852.8K
Kirk Sturridge	AL	Ophthalmology Physician	$715.4K	$0
Alabama Eye Surgery Center LLC	AL	Ambulatory Surgical Clinic/Center	$657.1K	$0
Craig Omohundro	AL	Dermatology Physician	$466.7K	$0
Paul Lamb	AL	Gastroenterology Physician	$431.3K	$0

Southeastern Pediatric Associates, P.A. — Billing Profile & Reimbursement Data

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Southeastern Pediatric Associates, P.A. — 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

Nearby Providers

Frequently Asked Questions

References