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.

Cornerstone Medical Assoc., LLC (NPI 1275575888)

Key Findings

Field	Value
Entity Type	Organization
Organization	Cornerstone Medical Assoc., LLC
Address	1024 Keith Dr
City	Perry
State	GA
ZIP	31069
Taxonomy	Pediatrics Physician
NPI Enumerated	June 11, 2006

Payer Source	Total Paid
Medicaid	$14M
Medicare	$0

This provider is effectively single-payer in scale: there is no Medicare billing on file while total Medicaid revenue is $14M, which means the practice’s entire measurable fee-for-service footprint in these datasets is Medicaid-dominant. Analysts should treat Medicaid as the primary commercial signal for business and utilization patterns rather than a mixed Medicare/Medicaid practice profile.

Revenue concentration is high: the precomputed top three Medicaid codes account for 59.6% of this provider’s total Medicaid revenue. The three revenue drivers are 99213 (90.8K claims, $61 avg paid/claim, $5.5M revenue; 40.0% of this provider's total Medicaid revenue), 99214 (18.3K claims, $89 avg paid/claim, $1.6M revenue; 11.7%), and 99391 (13.4K claims, $81 avg paid/claim, $1.1M revenue; 7.8%), indicating most revenue is centered on a small set of outpatient E/M and preventive visit codes.

The code mix and volumes are consistent with a high-volume pediatric primary care operation: large counts for established-patient E/M codes (99213 and 99214) combined with substantial preventive medicine codes (99391, 99392, 99393, 99394) and immunizations (90460) point to a practice focused on routine well-child care, immunization delivery, and chronic preventive management. These service lines collectively drive the bulk of patient encounters and revenue.

Several individual codes are extreme outliers or well above typical state volumes, underscoring dominant activity in specific pediatric services. In particular, 99213 ranks #10 of 917 providers in-state (99th percentile; extreme outlier) and 90460 (27.7K claims, $38 avg paid/claim, $1.1M revenue) ranks #7 of 246 (98th percentile; extreme outlier), showing unusually high visit and vaccine-administration volume relative to peers.

Diagnostic and point-of-care testing is a notable capability of the practice: 87880 has 29.3K claims ($410.3K revenue; ranks #5 of 262, 98th percentile; notably above typical state volume) and 87804 has 13.7K claims ($246.2K revenue; ranks #6 of 252, 98th percentile). The presence of 87426 (6.1K claims, $201.8K revenue; ranks #8 of 159, 96th percentile) further indicates sustained SARS–CoV–2 testing activity, implying on-site rapid testing workflows that support high throughput pediatric assessments.

The practice also shows unusually large volumes in ancillary screening and counseling codes that extend beyond classic visit metrics, suggesting integrated preventive and behavioral workflows. For example, 97802 appears with 39.8K claims ($119.3K revenue) and ranks #1 of 61 providers in-state (100th percentile; extreme outlier), while 96127 posts 28.2K claims ($84.7K revenue) and ranks #3 of 162 (99th percentile; extreme outlier), indicating heavy use of diet-therapy and brief behavioral/developmental screening services as part of routine care.

Competitive standing within the state is strong across multiple pediatric service lines: numerous codes fall in the 96th–99th percentiles (for example, 99214 ranks #37 of 824, 96th percentile; 99391 ranks #5 of 176, 98th percentile), which characterizes the provider as a major volume participant for pediatric outpatient E/M and preventive services in Georgia rather than a modest local practice. These high percentile ranks point to significant market share in routine pediatric encounters.

Long tenure likely contributes to the practice’s volume profile: the NPI was enumerated on 2006-06-11 (~20 years ago), indicating an established presence. The billing mix also includes newborn-related and inpatient follow-up codes such as 99460 (1.4K claims, $120.3K revenue; ranks #6 of 54, 91st percentile) and 99238 (2.1K claims, $138.3K revenue; ranks #7 of 86, 93th percentile), which together suggest the group handles newborn hospital evaluations and discharge-day management as part of a longitudinal pediatric care model.

Medicaid: Complete Services Breakdown

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

101 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…	90,830	$60	$5.5M
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…	18,250	$90	$1.6M
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…	13,400	$80	$1.1M
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.	27,660	$40	$1.1M
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…	12,050	$90	$1M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7,680	$90	$683.2K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	17,280	$40	$621.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,360	$100	$525.4K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	29,310	$10	$410.3K
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.	13,680	$20	$246.2K

Showing 1–10 of 101

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

Cornerstone Medical Assoc., LLC — 14 of 25 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

101 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	10	920	370	$60	$360.6K
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…	37	820	390	$70	$245K
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…	5	180	680	$90	$226.7K
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	180	720	$90	$204.2K
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.	7	250	660	$40	$172.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8	170	500	$100	$170.6K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	14	360	370	$50	$153.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	8	160	190	$110	$129.7K
99051	The provider sees a patient during regular office hours that occur outside of traditional office hours, i.e., in the evening, on a weekend, or on a holiday.	7	50	100	$20	$119.1K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	44	120	590	$20	$118.3K

Showing 1–10 of 101

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Coast To Coast Medical Transportation	GA	Land Ambulance	$783.3K	$0
Nasser Tehrani	GA	Interventional Cardiology Physician	$535.9K	$0
343 Ambulance Service LLC	GA	Land Ambulance	$532.4K	$0
Appavuchetty Soundappan	GA	Internal Medicine Physician	$399.3K	$0
Air Evac Ems, Inc.	GA	Air Ambulance	$378.8K	$0
Joseph Stephen Lomboy	GA	Internal Medicine Physician	$337.9K	$0
Jody Velie	GA	Family Medicine Physician	$320.4K	$0
Terry Ham	GA	Internal Medicine Physician	$267.7K	$0
Gerald Brantley	GA	Internal Medicine Physician	$197K	$0
Linnea Gann	GA	Podiatrist	$145.9K	$0

Cornerstone Medical Assoc., LLC — Billing Profile & Reimbursement Data

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Cornerstone Medical Assoc., 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