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.

Pediatrics Plus, P.C. (NPI 1104137439)

Key Findings

Field	Value
Entity Type	Organization
Organization	Pediatrics Plus, P.C.
Address	3312 Henry Rd
City	Anniston
State	AL
ZIP	36207
Taxonomy	Pediatric Nurse Practitioner
NPI Enumerated	July 1, 2010

Payer Source	Total Paid
Medicaid	$14.3M
Medicare	$0

This provider is effectively single-payer in scale: there is no Medicare billing on file while lifetime Medicaid revenue is $14.3M, indicating the practice’s revenue base is concentrated entirely in Medicaid. The absence of Medicare activity suggests payers should evaluate this entity primarily as a Medicaid-focused pediatric practice rather than a mixed payer clinic.

Revenue is highly concentrated in a few evaluation-and-management (E/M) codes: the top 3 Medicaid codes account for 56.6% of the provider's total Medicaid revenue. Those top drivers are 99214 ($5M, 37.7%), 99213 ($1.8M, 13.2%), and 87633 ($751.9K, 5.6%), with 99214 alone representing more than a third of Medicaid revenue.

The code mix signals a pediatric primary-care operation with both high-acuity established visits and routine preventive care: 99214 (60.5K claims) and 99213 (33.9K claims) dominate visit revenue, while preventive visit codes such as 99392 (11.8K claims, $675.2K, rank #14 of 299, 96th percentile) and 99393 (10.4K claims, $593K, rank #9 of 320, 97th percentile) also contribute meaningfully. This pattern is consistent with a high-volume pediatric clinic delivering well-child care and vaccine services alongside problem-focused visits.

The practice runs a substantial point-of-care and molecular testing operation for pediatric respiratory and infectious conditions: high claim volumes appear for 87804 (26.6K claims, $558.5K, rank #11 of 793, 99th percentile, typical, unremarkable volume), 87811 (18.8K claims, $508.9K, rank #6 of 303, 98th percentile, notably above typical state volume), and 87880 (28.1K claims, $336.8K, rank #9 of 680, 99th percentile, notably above typical state volume). These testing codes plus multiple amplified probe lab codes (e.g., 87633, 87798) indicate in-office or closely affiliated lab throughput.

State-level competitive standing is strong for several high-volume services: 99214 ranks #18 of 1990 providers in-state (99th percentile; extreme outlier, far above typical state volume), and 99213 ranks #56 of 1988 (97th percentile; notably above typical state volume), establishing this provider as a dominant payer-facing source of high-level pediatric E/M visits in Alabama. Behavioral screening is also unusually concentrated here—96127 is $123.3K and ranks #3 of 194 providers in-state (99th percentile; extreme outlier, far above typical state volume)—which suggests standardized, billed behavioral assessments are embedded in visits at scale.

Operational scale implied by claims counts supports a multi-provider or high-throughput clinic model: tens of thousands of claims for core visit and rapid-test codes (e.g., 60.5K claims for 99214; 33.9K claims for 99213; 28.1K claims for 87880) are consistent with a busy ambulatory pediatric practice rather than a solo practitioner. The provider taxonomy is Pediatric Nurse Practitioner and the NPI was enumerated 2010-07-01 (~16 years ago), indicating a sustained presence in the market.

For payers, two utilization levers are apparent: first, a heavy revenue concentration in a small set of E/M codes (top 3 = 56.6%) makes overall reimbursement sensitive to any changes in coding or visit mix; second, very high volumes of point-of-care infectious disease testing (multiple codes with high claim counts and elevated state ranks) suggest opportunities for targeted utilization management, quality review, or contract terms specific to diagnostic testing. Both levers stem directly from the reported code mix and volumes.

Preventive and vaccination services form a visible component of the practice’s portfolio: codes for well-child and immunization services (99391, 99392, 99393, 90460, 90670) collectively appear with thousands of claims and meaningful revenue (for example, 99392 is $675.2K and ranks #14 of 299, 96th percentile; 99393 is $593K and ranks #9 of 320, 97th percentile). This supports the characterization of the provider as a comprehensive pediatric primary-care clinic that pairs routine preventive care with high-volume diagnostic testing.

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…	60,510	$80	$5M
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…	33,870	$50	$1.8M
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…	3,690	$200	$751.9K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	4,360	$170	$723.1K
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…	11,850	$60	$675.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10,400	$60	$593K
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.	26,600	$20	$558.5K
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…	18,850	$30	$508.9K
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…	8,600	$60	$490.1K
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.	28,070	$10	$336.8K

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

Pediatrics Plus, P.C. — 9 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
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	20	60	1,260	$60	$1.2M
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…	17	100	470	$130	$1.2M
87581	The lab analyst performs a test for Mycoplasma pneumonia, a bacteria, using amplified nucleic acid probe technique.	14	40	1,440	$20	$372.1K
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	58	90	500	$40	$303.6K
87486	The lab analyst performs a test for Chlamydia pneumoniae using amplified nucleic acid probe technique. Chlamydia pneumoniae also known as TWAR, Taiwan Acute Respiratory agent, commonly causes mild…	14	40	2,000	$20	$273.5K
87641	The lab analyst performs a test for methicillin–resistant Staphylococcus aureus (MRSA) using an amplified nucleic acid probe technique.	13	10	3,980	$10	$225.2K
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…	18	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…	98	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…	56	1,990	560	$40	$185.6K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	19	100	480	$20	$165.1K

Showing 1–10 of 84

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pulmonary Care Services Inc	AL	Durable Medical Equipment & Medical Supplies	$0	$8M
Anniston Pediatrics, Inc	AL	Pediatrics Physician	$0	$5.7M
The Health Care Authority Of The City Of Anniston	AL	General Acute Care Hospital	$0	$5.6M
Grow Pediatric Therapy LLC	AL	Speech-Language Pathologist	$0	$2.3M
Angela M. Martin, M.d. F.a.a.p.	AL	Pediatrics Physician	$0	$2.1M
Robert Conry	AL	Hematology & Oncology Physician	$2.1M	$0
North Alabama Women's Center	AL	Specialist	$0	$1.9M
Vishala Chindalore	AL	Rheumatology Physician	$1.7M	$0
Regional Health Management Corporation	AL	Psychiatry Physician	$0	$1.6M
New Beacon Healthcare Group, LLC	AL	Community Based Hospice Care Agency	$0	$1.5M

Pediatrics Plus, P.C. — Billing Profile & Reimbursement Data

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Pediatrics Plus, P.C. — 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