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

Why is the Medicaid comparison limited to Tennessee 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. Tennessee (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.

Healthstar Physicians, P.C. (NPI 1184610248)

Key Findings

Field	Value
Entity Type	Organization
Organization	Healthstar Physicians, P.C.
Address	420 W Morris Blvd
City	Morristown
State	TN
ZIP	37813
Taxonomy	Family Medicine Physician
NPI Enumerated	September 23, 2005

Payer Source	Total Paid
Medicaid	$27.8M
Medicare	$0

HEALTHSTAR PHYSICIANS, P.C. is effectively a single‑payer Medicaid practice: Medicare billing is listed as none while total Medicaid revenue is $27.8M. The provider’s NPI was enumerated on 2005-09-23 (~21 years ago), indicating long-standing enrollment and an established presence in the state Medicaid market.

Revenue is heavily concentrated in three Medicaid codes: 99213 ($7.1M revenue, 31.5% of this provider's total Medicaid revenue), 99214 ($6.7M revenue, 29.6% of this provider's total Medicaid revenue), and 59400 ($1.7M revenue, 7.5% of this provider's total Medicaid revenue); these top three account for 68.6% of the provider's Medicaid revenue. This concentration implies the business is driven primarily by high-volume ambulatory E/M visits for established patients plus a meaningful volume of global obstetric deliveries.

The code mix signals a family medicine practice with broad ambulatory services and procedural capabilities: dominant E/M codes (99213 and 99214) reflect routine office care for established patients, while 59400 indicates provision of global obstetric services. Complementary service lines with measurable revenue include allergen preparation 95165 ($588.2K, 2.6%), vaccine administration 90460 ($587.7K, 2.6%), and therapeutic injections 96372 ($345.4K, 1.5%), consistent with an integrated primary care practice that delivers immunotherapy, vaccinations, and in‑office injections.

For core primary care E/M volume the provider is a statewide outlier: 99213 is $7.1M (31.5%) and ranks #7 of 4050 providers in‑state (100th percentile; extreme outlier), and 99214 is $6.7M (29.6%) and ranks #7 of 3759 providers in‑state (100th percentile; extreme outlier). These ranks place HEALTHSTAR among the highest Medicaid billers in Tennessee for established office visits, suggesting local market dominance for routine primary care encounters.

Beyond primary care, the practice shows notable specialty testing and procedure volumes relative to peers: 95913 ($285.8K, 1.3%) ranks #1 of 8 providers in‑state (100th percentile), and 92557 ($254.6K, 1.1%) ranks #1 of 55 providers in‑state (100th percentile). Those top ranks indicate unusually high state-level activity in nerve conduction studies and audiology testing within a family medicine‑taxonomized practice, signaling either on-site diagnostic capability or close integration with diagnostic services.

Several codes reflect high point‑of‑care testing and infectious disease screening volume: 87426 ($362.2K, 1.6%) ranks #10 of 354 (97th percentile; typical, unremarkable), 87880 ($344.9K, 1.5%) ranks #9 of 995 (99th percentile; notably above typical), and 87804 ($288.6K, 1.3%) ranks #12 of 1047 (99th percentile; typical, unremarkable). These figures point to substantial rapid testing throughput (COVID, strep, influenza) and routine lab work (85025 $214.7K, 1.0% and rank #25 of 554, 96th percentile) supporting high visit volumes.

The provider also reports appreciable preventive and pediatric well‑visit revenue (99392 $312.4K, 1.4%; 99393 $227.4K, 1.0%; 99391 $215.2K, 1.0%), aligning with family medicine scope and a patient panel that includes children and routine preventive care. Combined with high E/M volumes, this mix reinforces a practice model focused on longitudinal primary care and preventive services under Medicaid.

Single‑payer concentration creates policy and reimbursement exposure: with Medicare recorded as none and Medicaid at $27.8M, HEALTHSTAR’s financial performance and patient access are highly sensitive to Medicaid rate changes, prior authorization rules, and state program design. Analysts evaluating contracting or network placement should weigh the provider’s Medicaid dominance and the operational reliance implied by the top‑3 codes (68.6% of Medicaid revenue).

Medicaid: Complete Services Breakdown

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

344 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…	236,930	$30	$7.1M
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…	215,320	$30	$6.7M
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	1,240	$1,360	$1.7M
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	6,060	$100	$588.2K
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.	12,500	$50	$587.7K
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…	11,370	$50	$534.5K
99203	The provider sees a new 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 provider…	11,720	$50	$527.5K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	3,480	$120	$430.9K
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,…	13,410	$30	$362.2K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	43,180	$10	$345.4K

Showing 1–10 of 344

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Healthstar Physicians, P.C. — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

344 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0585	Injection, onabotulinumtoxina, 1 unit	15	20	200	$880	$709.1K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	18	50	140	$850	$541.1K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	27	70	160	$500	$421.5K
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…	98	360	350	$50	$414.4K
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	7	80	100	$1,260	$405.3K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	7	80	330	$170	$342.3K
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…	340	440	530	$70	$282.3K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	42	240	840	$20	$259.2K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	7	40	200	$20	$234.7K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	32	150	390	$60	$220.9K

Showing 1–10 of 344

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Christopher Bowlin	TN	Foot & Ankle Surgery Podiatrist	$705K	$550
Joseph Prohaska	TN	MOHS-Micrographic Surgery Physician	$236.8K	$0
Rual Swanson	TN	Family Medicine Physician	$227.7K	$0
Joanne Langton	TN	Endocrinology, Diabetes & Metabolism Physician	$208.2K	$0
Donna Dillard	TN	Family Medicine Physician	$201.5K	$0
Rajkamal Harricharan Singh	TN	Family Medicine Physician	$179.1K	$0
Michael Dillard	TN	Otolaryngology Physician	$169.9K	$0
Bonnie Burnette-vick	TN	Family Medicine Physician	$155.6K	$0
Jessica Ball	TN	Family Nurse Practitioner	$129.1K	$0
Amy Pitts	TN	Family Nurse Practitioner	$127.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lakeway Achievement Center	TN	Developmental Disabilities Clinic/Center	$0	$5.4M
Brad S. Johnson, Dmd, PLLC	TN	Oral and Maxillofacial Surgery (Dentist)	$0	$3.8M
Lisa M. Marshall	TN	Speech-Language Pathologist	$0	$3.4M
Eyecare Associates Of Morristown, Inc.	TN	Optometrist	$0	$3.3M
Jordan C Black	TN	Physical Therapist	$0	$3.1M
Rajeev Gupta	TN	Geriatric Medicine (Family Medicine) Physician	$442.2K	$0
Krystal Weaver	TN	Physician Assistant	$35.7K	$383K
Joseph Dichiara	TN	Pain Medicine (Anesthesiology) Physician	$204.8K	$0
Arthur Hyde	TN	Optometrist	$138.9K	$0
Jana Bunsic	TN	Family Medicine Physician	$119.1K	$0

Healthstar Physicians, P.C. — Billing Profile & Reimbursement Data

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Healthstar Physicians, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References