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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Southern Medical Management, LLC (NPI 1114196557)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southern Medical Management, LLC
Address	424 Old Cherokee Rd
City	Lexington
State	SC
ZIP	29072
Taxonomy	Pediatrics Physician
NPI Enumerated	February 28, 2008

Payer Source	Total Paid
Medicaid	$43.9M
Medicare	$0

SOUTHERN MEDICAL MANAGEMENT, LLC is effectively a Medicaid-focused pediatric practice: it has no Medicare billing on file and reports Total Medicaid revenue of $43.9M. The provider’s NPI was enumerated on 2008-02-28 (~18 years ago), indicating roughly 18 years of enrollment and operational tenure in the state market.

Revenue is highly concentrated: the precomputed top three Medicaid codes (99213, 99214, 90460) collectively account for 56.3% of this provider’s total Medicaid revenue. Those codes individually represent $10.8M (24.9%) for 99213, $9.2M (21.4%) for 99214, and $4.3M (10.0%) for 90460, showing dependence on established ambulatory E/M visits and vaccine administration.

The code mix and volumes point to a high-throughput ambulatory pediatric primary care model: large claim counts for E/M services (99213: 158.7K claims; 99214: 96.3K claims) combined with high-volume preventive medicine codes (99392 $3.7M, 99391 $3.1M, 99393 $2.6M, 99394 $1.4M) indicate a practice structured around routine well-child visits and longitudinal primary care. This pattern is consistent with a clinic-centric operation (likely multiple sites or high daily patient throughput) focused on scheduled preventive care and established-patient follow-up.

Immunization and vaccination delivery is a major service line: 90460 accounts for $4.3M (78.6K claims) and 90461 contributes $661.1K (24.5K claims), and both codes rank highly in-state. The combined high volumes and rank-levels (90460 ranks #4 of 652; 90461 ranks #5 of 456, both 99–100th percentile language) signal an organized immunization program and reliance on vaccine delivery as a revenue driver.

The provider is a statewide outlier across core pediatric outpatient codes: 99213 ranks #6 of 2766 and 99214 ranks #7 of 2483, each described as 100th percentile and an extreme outlier, and several preventive and vaccine codes are also in the 99–100th percentile. Those rank positions indicate dominant share-of-volume in South Carolina for routine pediatric office visits and preventive services relative to peers.

SOUTHERN MEDICAL MANAGEMENT also shows unusually high point-of-care and lab testing volumes for respiratory pathogens: 87428 ($968.2K, 16.1K claims) ranks #2 of 142 (99th percentile), 87426 ($889K, 18.1K claims) ranks #3 of 236 (99th percentile), and 87804 ($449.5K, 34.6K claims) ranks #5 of 536 (99th percentile). These figures reflect substantial in-practice or closely affiliated testing activity for COVID-19 and influenza, suggesting integrated testing workflows alongside clinical visits.

Behavioral health screening and some psychotherapy appear integrated into the practice mix: 96127 (brief emotional/behavioral assessment) shows 35.4K claims and $247.5K revenue and ranks #3 of 296 (99th percentile, extreme outlier), while 90837 (psychotherapy) contributes $2.3M and is ranked #24 of 647 (96th percentile, notably above typical). The presence and high ranking of both brief standardized assessments and longer psychotherapy sessions imply on-site behavioral health capacity or regular behavioral health billing within the pediatric setting.

From a business-profile perspective this provider is both highly specialized and concentrated: reliance on Medicaid only (no Medicare revenue) and the fact that 56.3% of Medicaid revenue is concentrated in three codes mean that the organization’s financial performance is closely tied to ambulatory E/M and vaccination volumes. At the same time, the repeated “extreme outlier” and high-percentile ranks across many codes point to clear competitive dominance in statewide pediatric outpatient care and associated testing services rather than a modest or typical participant profile.

Medicaid: Complete Services Breakdown

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

82 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	158,690	$70	$10.8M
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…	96,280	$100	$9.2M
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.	78,630	$60	$4.3M
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…	36,670	$100	$3.7M
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…	33,820	$90	$3.1M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	26,060	$100	$2.6M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	21,660	$110	$2.3M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	12,700	$110	$1.4M
G9153	Mapcp demonstration - physician incentive pool	23,890	$50	$1.2M
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…	16,140	$60	$968.2K

Showing 1–10 of 82

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Southern Medical Management, LLC — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

82 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	66	210	320	$130	$707.4K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	24	650	800	$120	$413.8K
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…	5	280	600	$90	$299K
0241U	N/A	37	50	1,840	$90	$291.4K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	81	160	270	$70	$268.1K
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…	6	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	188	710	350	$60	$247.2K
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…	7	2,480	350	$80	$246K
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…	4	380	160	$100	$226.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3	390	100	$100	$148.3K

Showing 1–10 of 82

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Allcaregivers, Inc.	SC	Nursing Care Agency	$0	$33.3M
South Carolina Dept Of Mental Health Accounting Office	SC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$32M
Lexington County Ems	SC	Ambulance	$2.9M	$6.9M
Lexington Health Inc	SC	Urgent Care Clinic/Center	$0	$8.7M
Key Care Health Services, LLC	SC	Home Health Agency	$0	$8.5M
Capital City Therapy Group, LLC	SC	Specialist	$0	$7.3M
Health Promotion Specialists	SC	Dental Hygienist	$0	$6.5M
Lexington School District One	SC	Local Education Agency (LEA)	$0	$5.7M
Lexington Health Inc	SC	Pediatric Adolescent Medicine Physician	$0	$5.7M
Amedisys Sc, LLC	SC	Home Health Agency	$0	$4.5M

Southern Medical Management, LLC — Billing Profile & Reimbursement Data

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Southern Medical Management, LLC — 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