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.

White's Pediatrics (NPI 1104005594)

Key Findings

Field	Value
Entity Type	Organization
Organization	White's Pediatrics
Address	1575 Chattanooga Ave
City	Dalton
State	GA
ZIP	30720
Taxonomy	Pediatrics Physician
NPI Enumerated	November 1, 2007

Payer Source	Total Paid
Medicaid	$25.1M
Medicare	$0

WHITE'S PEDIATRICS is effectively a Medicaid-focused pediatric practice with no Medicare billing on file and $25.1M in lifetime Medicaid revenue, indicating the provider’s clinical activity and reimbursement are concentrated in pediatric care for Medicaid-covered populations. The NPI was enumerated on 2007-11-01 (~19 years ago), establishing long tenure in the market which supports experience and an established patient base.

Revenue concentration is high: the precomputed top 3 Medicaid codes by revenue account for 55.9% of total Medicaid revenue, reflecting that a small set of office visit and preventive/well-child codes drive most of the practice’s Medicaid receipts. Specifically, high-volume established visit codes (99214, 99213, 99212) dominate revenue, consistent with frequent longitudinal office care.

Service-line implications from the top codes point to a primary-care pediatrics model that emphasizes in-office evaluation and management and routine preventive services: 99214 (office established visit), 99213, and 99212 together generate the largest shares, while well-child codes 99394, 99393, and 99392 show substantial volume—indicating both problem-focused visits and age-based preventive care are core services. Vaccination and point-of-care testing are also integral: 90460 (vaccine administration) and high volumes of influenza and strep rapid tests (87804, 87880) indicate on-site immunization and acute respiratory illness management.

Competitive standing in-state is strong on multiple codes. The practice ranks in the 99th–100th percentiles or near them for many pediatric and preventive codes: 99214 ranks #4 of 824 (100th percentile, extreme outlier); 99213 ranks #19 of 917 (98th percentile); 99394 and 99393 are in the 98th–99th percentiles, and several other codes (e.g., 96127, 99188, Q3014, 99429) are labeled as extreme outliers. These rankings indicate WHITE'S PEDIATRICS is a dominant Medicaid provider in Georgia for common pediatric office and preventive services.

Operational profile and ancillary services are implied by non-E/M codes with high volumes: 96127 (brief behavioral assessments) is #1 of 162 providers (100th percentile), showing routine use of standardized behavioral screening in visits; Q3014 (telehealth originating site fee) ranked #1 suggests a notable telehealth presence; and fluoride application 99188 ranked #1 highlights inclusion of oral health preventive services. Together these patterns suggest an integrated primary pediatrics practice offering immunizations, screenings, telehealth access, and some preventive dental services.

Utilization of lower-paid high-frequency counseling and prevention codes is prominent: G0447 (behavioral counseling for obesity) and 99401 (15-minute counseling) appear with very high claim counts, indicating the practice allocates visit time to preventive counseling and anticipatory guidance common in pediatric care. High claim counts with modest per-claim payments (e.g., G0447 at $3/claim) point to workflow optimized for volume in time-limited preventive interventions.

Testing and COVID-era services are material but not primary revenue drivers: 87804 (rapid influenza test) and 87880 (rapid strep) have large claim volumes and rank well in-state, and SARS–CoV-2 related codes (87811, 87635) appear with notable but smaller revenue shares. This mix is consistent with a high-throughput pediatric clinic managing acute respiratory presentations in-office.

Medicaid: Complete Services Breakdown

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

93 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…	88,800	$100	$8.6M
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…	55,700	$70	$3.8M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	34,990	$40	$1.4M
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.	30,600	$40	$1.3M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	10,870	$110	$1.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	11,460	$100	$1.2M
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…	10,650	$100	$1.1M
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…	10,410	$90	$947K
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…	4,830	$130	$622.4K
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.	34,320	$20	$583.5K

Showing 1–10 of 93

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

White's Pediatrics — 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

93 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	135	230	120	$170	$937.5K
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.	152	240	170	$120	$779.3K
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…	19	920	370	$60	$360.6K
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…	4	820	390	$70	$245K
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…	10	180	680	$90	$226.7K
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…	7	180	720	$90	$204.2K
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.	3	250	660	$40	$172.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4	170	500	$100	$170.6K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	4	360	370	$50	$153.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2	160	190	$110	$129.7K

Showing 1–10 of 93

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Highland Rivers Community Service Board	GA	Community/Behavioral Health Agency	$0	$44.1M
Family And Children First LLC	GA	Community/Behavioral Health Agency	$0	$19.5M
Hamilton Physician Group Inc	GA	Cardiovascular Disease Physician	$0	$5.9M
Pediatrics Of Dalton, PA	GA	Specialist	$0	$5.5M
Dalton Ear Nose & Throat Associates	GA	Otolaryngology Physician	$0	$4M
Skin Cancer & Cosmetic Dermatology Center, PC	GA	Dermatology Physician	$0	$3.4M
John Chung	GA	MOHS-Micrographic Surgery Physician	$2.5M	$0
Hamilton Emergency Medical Services	GA	Land Ambulance	$1.2M	$0
Hosam Saad-naguib	GA	Hematology & Oncology Physician	$1M	$0
Professional Eye Associates, Inc.	GA	Ambulatory Surgical Clinic/Center	$698.9K	$0

White's Pediatrics — 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