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

Why is the Medicaid comparison limited to North 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. North 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.

Haywood Pediatric And Adolescent Medicine Group, P.A. (NPI 1245231364)

Haywood Pediatric And Adolescent Medicine Group, P.A. is a pediatric adolescent medicine physician provider located in Clyde, North Carolina. This profile covers 0 Medicare and 63 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Haywood Pediatric And Adolescent Medicine Group, P.A.
Address	15 Facility Dr
City	Clyde
State	NC
ZIP	28721
Taxonomy	Pediatric Adolescent Medicine Physician
NPI Enumerated	August 10, 2005

Payer Source	Total Paid
Medicaid	$11.8M
Medicare	$0

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

63 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…	66,160	$60	$4.1M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	322,490	$10	$1.6M
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…	15,570	$90	$1.5M
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.	18,680	$40	$803.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,240	$90	$672.9K
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…	6,540	$90	$595K
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…	7,550	$60	$460.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,450	$100	$449.9K
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.	13,120	$30	$380.4K
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…	3,050	$90	$268.7K

Showing 1–10 of 63

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Haywood Pediatric And Adolescent Medicine Group, P.A. — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

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

63 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	99	2,850	10,910	$10	$330.3K
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…	261	4,400	960	$60	$271.3K
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…	147	520	1,080	$80	$262.1K
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…	74	550	970	$90	$258.9K
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…	43	4,130	670	$50	$219.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	41	590	490	$90	$179.8K
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.	25	380	460	$40	$173.1K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	156	330	300	$10	$142.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	37	530	270	$90	$112.8K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	572	610	1,000	$10	$94.2K

Showing 1–10 of 63

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dlp Haywood Regional Medical Center LLC.	NC	General Acute Care Hospital	$0	$8.8M
Bhg Xxxvii, LLC	NC	Substance Use Disorder Rehabilitation Clinic/Center	$84.2K	$4.9M
David Markoff	NC	Ophthalmology Physician	$273K	$0
Michael Masters	NC	Dermatology Physician	$222.9K	$0
David Peterson	NC	Cardiovascular Disease Physician	$179.8K	$0
Clifford Riester	NC	Diagnostic Radiology Physician	$121.3K	$0
Najeeb Ghaussy	NC	Rheumatology Physician	$102.6K	$0
Luke Bidikov	NC	Urology Physician	$74.4K	$0
Howard Palay	NC	Neurology Physician	$58.3K	$0
Christopher Wenzel	NC	Specialist	$58.3K	$0

Haywood Pediatric And Adolescent Medicine Group, P.A. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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