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.

Gwinnett Neonatology,pc (NPI 1215095351)

Field	Value
Entity Type	Organization
Organization	Gwinnett Neonatology,pc
Address	700 Medical Center Blvd
City	Lawrenceville
State	GA
ZIP	30045
Taxonomy	Neonatal-Perinatal Medicine Physician
NPI Enumerated	December 4, 2006

Payer Source	Total Paid
Medicaid	$11.1M
Medicare	$0

Key Findings

This practice reports no Medicare billing on file and $11.1M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid-focused) billing entity in the available data. The absence of Medicare activity means comparisons to national Medicare peers are not applicable for this profile.

Revenue is highly concentrated in a small set of neonatal services: the precomputed top three Medicaid codes (99469, 99460, 99479) account for 72.9% of the provider's total Medicaid revenue. In absolute terms those codes are represented by $6M (99469), $1.1M (99460), and $1M (99479), indicating that the bulk of Medicaid receipts come from a narrow set of newborn/neonatal E/M services.

The code mix indicates a hospital-based neonatal/critical-care operation: 99469 ($6M) and 99468 ($329K, $848 avg paid/claim) are neonatal critical care subsequent and initial care codes, while 99460 ($1.1M) and 99463 ($2.9K) cover routine newborn evaluation immediately after birth. Substantial revenue from 99238 ($896.4K) and follow-up codes like 99472 ($793.2K) further points to an inpatient NICU workflow that includes admissions, prolonged stays, and discharge management.

On competitive standing within Georgia, the practice is a leading statewide provider for several of its highest-revenue codes: it ranks #1 of 6 providers for 99469 (100th percentile; typical, unremarkable volume for this code) and #1 of 54 providers for 99460 (100th percentile; extreme outlier, far above typical state volume for this code). These rank positions indicate the group is a dominant provider in the state for both neonatal critical-care subsequent care and immediate post-birth newborn evaluations.

Several codes show statistically notable volumes or outlier status: 99460 is labeled an "extreme outlier, far above typical state volume," and 99238 also appears as an "extreme outlier, far above typical state volume" (rank #2 of 86, 99th percentile), underscoring unusually high throughput for birth-related and discharge E/M services relative to peers. Other codes such as 99479 (rank #3 of 7, 67th percentile; typical, unremarkable volume) and 99472 (rank #2 of 7, 83th percentile; typical, unremarkable volume) sit closer to expected state-level participation for specialized low-birth-weight and critically ill infant follow-up.

The payer-level reimbursement mix shows higher per-claim payments on the highest-acuity services: for example 99468 reports $848 avg paid/claim and 99472 reports $371 avg paid/claim, consistent with NICU-level care intensity even though those codes contribute smaller shares of total revenue compared with 99469. This suggests the practice’s case mix includes a meaningful portion of higher-acuity neonatal patients alongside very high-volume routine newborn evaluations.

Despite concentration in a few codes, the provider bills a range of neonatal services that cover the full inpatient newborn episode of care continuum—initial and subsequent critical care (99468, 99469), routine newborn evaluations (99460, 99463, 99462), low birth weight recovery (99479, 99480), and discharge management (99238, 99239). That mix indicates operational breadth within neonatal-perinatal medicine rather than a single isolated procedure or service.

The provider’s NPI has been enumerated since 2006-12-04 (~20 years ago), indicating long tenure in the market; combined with top-state rankings on several key neonatal codes, this tenure likely supports established referral and hospital relationships that drive the observed high-volume billing pattern.

Medicaid: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	16,430	$360	$6M
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	13,040	$90	$1.1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	8,810	$120	$1M
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…	13,180	$70	$896.4K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2,140	$370	$793.2K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	6,660	$110	$739.6K
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	390	$850	$329K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	4,890	$40	$185.7K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	780	$100	$73.9K
99463	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center, through the time of discharge, or release, from the…	30	$110	$2.9K

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

Gwinnett Neonatology,pc — 4 of 10 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

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	1	10	3,360	$330	$2.1M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	3	10	6,030	$100	$683.9K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2	10	190	$370	$561.3K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	10	1,060	$90	$230.5K
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	1	10	60	$780	$101.8K
99463	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center, through the time of discharge, or release, from the…	2	10	30	$100	$60.3K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	1	50	50	$80	$56.7K
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…	2	90	90	$60	$41.4K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	15	60	130	$40	$37.5K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	2	20	70	$30	$30.4K

Nearby Providers

Other providers in the same ZIP code as Gwinnett Neonatology,pc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Genesis 7 Transport	GA	Land Ambulance	$739.9K	$0
Kirti Shah	GA	Nephrology Physician	$676.8K	$0
Jerrell Walker	GA	Professional Counselor	$0	$466.5K
Philip Shrake	GA	Radiation Oncology Physician	$408K	$0
Jean Song	GA	Pediatrics Physician	$0	$404.7K
Southern Endoscopy Suite, LLC	GA	Endoscopy Clinic/Center	$380.8K	$0
Kris Gillian	GA	Ophthalmology Physician	$351.7K	$0
Lance Friedland	GA	Cardiovascular Disease Physician	$264.4K	$0
Christopher Crooker	GA	Internal Medicine Physician	$172.1K	$0
Sagar Patel	GA	Ophthalmology Physician	$150.8K	$0

Gwinnett Neonatology,pc — Billing Profile & Reimbursement Data

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Gwinnett Neonatology,pc — 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