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.

Pediatric Clinic LLC (NPI 1134286248)

Key Findings

Field	Value
Entity Type	Organization
Organization	Pediatric Clinic LLC
Address	2401 Village Professional Drive
City	Opelika
State	AL
ZIP	36801
Taxonomy	Pediatrics Physician
NPI Enumerated	January 2, 2007

Payer Source	Total Paid
Medicaid	$24.9M
Medicare	$0

PEDIATRIC CLINIC LLC is effectively a single-payer Medicaid operation: there is no Medicare billing on file and lifetime Medicaid revenue is $24.9M. The NPI was enumerated on 2007-01-02 (~19 years ago), indicating long-standing service in the community with nearly two decades of billing history.

Revenue is highly concentrated in a handful of outpatient evaluation-and-management and preventive codes: the precomputed top three Medicaid codes account for 71.0% of the provider's total Medicaid revenue. In particular, 99213 alone represents $13.8M (57.5% of Medicaid revenue) across 219.6K claims at $63 avg paid/claim, making it by far the dominant revenue line.

The code mix describes a high-volume pediatric primary care and immunization practice: top codes are 99213 (established office visits) and the preventive medicine codes 99391 and 99392 (well-child/preventive visits), with 99391 at $1.7M (7.1%) across 25.8K claims and 99392 at $1.6M (6.5%) across 24.4K claims. Vaccine codes and routine infectious-disease testing (for example 90700, 90670, 87426, and 87804) also appear prominently, supporting a workflow centered on well-child visits, immunizations, and common point-of-care diagnostics.

Competitive standing in-state is unusually strong for core pediatric services: 99213 ranks #2 of 1988 providers in-state (100th percentile; extreme outlier), 99391 ranks #2 of 270 (100th percentile; extreme outlier), and 99392 ranks #3 of 299 (99th percentile; extreme outlier). Several vaccine codes also rank at or near the top in-state (for example 90700 and 90713 rank #1 in their peer pools, both noted as 100th percentile extreme outliers), indicating the provider is a dominant volume player for pediatric preventive care in Alabama.

Beyond high-revenue E/M and preventive codes, the practice shows very high throughput on ancillary screening and point-of-care services: 99173 (vision screening) appears with 43.2K claims ($172.7K), 92551 (hearing screening) with 33.8K claims ($169.2K), and rapid antigen/antibody tests such as 87426 (27.8K claims, $694.5K) and 87804 (28.3K claims, $566.9K) are sizable contributors. These volumes are consistent with a clinic model that handles large numbers of brief, low-complexity encounters and on-site testing during preventive visits.

The visit acuity mix is weighted toward lower-complexity established visits rather than higher-complexity office visits: 99213 drives the majority of revenue while 99214 shows only 1.2K claims and $109.3K (rank #780 of 1990, 61st percentile), suggesting the clinic’s case mix is dominated by routine follow-ups and preventive care rather than higher-intensity encounters. This pattern aligns with a pediatric-focused practice delivering frequent, rapid visits and standard preventive services.

While many of the provider’s top codes are labeled as extreme outliers relative to state peers, a few diagnostic and vaccination codes show more typical volumes: e.g., 87428 ranks #13 of 166 (93rd percentile), 87651 ranks #16 of 95 (84th percentile), and 90461 ranks #13 of 161 (93rd percentile) and are described as typical or unremarkable. Overall, the profile is one of systematic high-volume preventive/pediatric care with a consistent pattern of above-typical to extreme outlier utilization across vaccines and routine screenings.

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
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…	219,640	$60	$13.8M
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…	25,770	$70	$1.7M
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…	24,450	$60	$1.6M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	15,120	$70	$982.9K
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,…	27,780	$30	$694.5K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	9,430	$70	$631.5K
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.	28,340	$20	$566.9K
90700	This code represents a DTaP vaccine product administered into the muscle to protect against diphtheria, tetanus, and pertussis (whooping cough). It is used for children younger than 7 years of age.	26,010	$20	$468.2K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	15,090	$30	$467.9K
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.	7,050	$60	$451.1K

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

Pediatric Clinic LLC — 20 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…	780	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…	2	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.	16	100	480	$20	$165.1K
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…	2	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…	3	300	1,160	$50	$147.8K
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	37	60	350	$30	$136.6K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	33	80	220	$70	$103.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4	320	640	$50	$98.1K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	37	200	170	$50	$60.5K
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.	11	230	410	$40	$59.2K

Showing 1–10 of 60

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The East Alabama Health Care Authority	AL	General Acute Care Hospital	$0	$6.2M
Pediatric Associates Of Auburn	AL	Pediatric Adolescent Medicine Physician	$0	$4.2M
East Alabama Ems, LLC	AL	Ambulance	$1.1M	$2.6M
Eamc Er Physicians	AL	Emergency Medical Services (Emergency Medicine) Physician	$0	$2.6M
Gw Stone Capital LLC	AL	Optometrist	$0	$2.2M
Lee County Health Dept Fp Clinic	AL	Public Health or Welfare Agency	$0	$2M
Premier Ob/gyn, LLC	AL	Obstetrics & Gynecology Physician	$0	$1.9M
Eamc Physicians Group	AL	General Practice Physician	$0	$1.1M
East Alabama Ear, Nose, & Throat, PC	AL	Otolaryngology Physician	$0	$869.3K
Sunil Sharma	AL	Family Medicine Physician	$370.6K	$0

Pediatric Clinic LLC — Billing Profile & Reimbursement Data

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Pediatric Clinic 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

Nearby Providers

Frequently Asked Questions

References