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

Why is the Medicaid comparison limited to South 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. South 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.

Prisma Health University Medical Group (NPI 1295763217)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prisma Health University Medical Group
Address	2a Cleveland Ct
City	Greenville
State	SC
ZIP	29607
Taxonomy	Family Medicine Physician
NPI Enumerated	June 29, 2006

Payer Source	Total Paid
Medicaid	$171.7M
Medicare	$0

PRISMA HEALTH UNIVERSITY MEDICAL GROUP has no Medicare billing on file and is effectively a single-payer Medicaid provider at scale: reported Medicaid revenue is $171.7M with zero Medicare revenue, so operational and contract strategies will be driven almost entirely by Medicaid reimbursement and population management dynamics. This payer concentration means payer negotiation levers and risk exposure are tied to state Medicaid policy rather than Medicare fee schedules.

Revenue concentration is high: the top 3 Medicaid codes (99214, 99213, 99284) account for 55.9% of the provider's total Medicaid revenue, indicating a heavy dependence on evaluation & management office and emergency department visit volumes for the majority of cash flow. This concentration suggests targeted operational and utilization reviews on those code lines would capture the bulk of financial impact for the organization.

The code mix points to a dominant ambulatory primary-care footprint with a substantial emergency department component. High-volume primary care codes 99214 (521.6K claims, $37M revenue, 24.2%) and 99213 (672.4K claims, $33.6M revenue, 22.0%) together represent nearly half of Medicaid revenue, while 99284 (181.5K claims, $14.9M revenue, 9.7%) and other ED codes (99285, 99283) show significant emergency care throughput.

Competing statewide, this entity is a major outlier on numerous codes: it ranks #1 in-state for 99214 and 99213 (100th percentile, labeled extreme outlier) and similarly leads or is near the top for many preventive, obstetric, and consult codes. These #1 rankings across high-volume E/M and preventive codes indicate market dominance in Greenville/SC Medicaid for both routine primary care and pediatric/preventive services.

Clinical service lines beyond primary care are prominent: high Medicaid revenue from obstetric and prenatal-related codes (59409: 6.4K claims, $6.9M revenue; 76816: 30.6K claims, $2.7M revenue; 76811: 12.7K claims, $1.9M revenue) plus delivery code 59514 ($1.1M revenue) point to a sizable maternal-fetal service line. The presence of both high-volume well-patient codes 99391/99392 (combined >$10M) and vaccination administration codes 90460/90461 (140.1K and 42.1K claims respectively) underscores a broad primary care platform that includes pediatrics and immunization services.

Several individual codes are flagged as statistical outliers in-state, which speaks to scale and potential referral capture: examples include 99214 and 99213 (both extreme outlier, 100th percentile), 99284 (100th percentile, extreme outlier and ranks #2 of 353), and 99391/99392 (100th percentile, ranks #1). These labels indicate volumes far above typical state peers and suggest operational capacity (clinician workforce, clinic access, ED throughput) that exceeds virtually all other in-state providers for these services.

From a contracting and utilization-management perspective, operational levers should focus on high-volume E/M and ED visits given their revenue share and outlier status; care pathways, appointment access, and ED diversion strategies will materially affect revenue and utilization metrics. Similarly, preventive and pediatric vaccine volumes create opportunities for population health initiatives tied to childhood immunization and well-child visit metrics that already drive meaningful Medicaid dollars.

The provider has an established NPI tenure dating to 2006-06-29 (~20 years ago), which supports that these high volumes and market positions are not new or transient. Longevity combined with consistent top-state rankings suggests institutional scale and entrenched referral networks in the Greenville, SC Medicaid market.

Medicaid: Complete Services Breakdown

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

297 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	521,590	$70	$37M
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…	672,380	$50	$33.6M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	181,480	$80	$14.9M
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…	68,610	$100	$7.1M
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	6,410	$1,080	$6.9M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	59,210	$110	$6.6M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	129,840	$50	$5.8M
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…	74,790	$70	$5.4M
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…	65,460	$80	$5.1M
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.	140,070	$30	$3.9M

Showing 1–10 of 297

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Prisma Health University Medical Group — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

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

297 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	3	10	150	$410	$1.4M
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	11	10	510	$180	$1.3M
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…	28	210	320	$130	$707.4K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	23	90	260	$430	$688.8K
J0475	Injection, baclofen, 10 mg	3	10	1,220	$540	$596.8K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	3	10	120	$100	$502.6K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	3	340	110	$40	$450.5K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	2	350	100	$50	$446.9K
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	4	200	1,680	$50	$443.2K
95782	A patient under the age of 6 undergoes an attended sleep study with identification of sleep levels and at least four additional sleep parameters.	2	20	380	$520	$421.9K

Showing 1–10 of 297

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$86.9M
Prisma Health Medical Group-midlands	SC	Multi-Specialty Clinic/Center	$0	$77.6M
Anmed Health	SC	General Acute Care Hospital	$0	$75.9M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$74.6M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$68.3M
Centra Medical Group, LLC	VA	Family Medicine Physician	$0	$60.1M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$28.1M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$25M
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$22M
Prisma Health-upstate	SC	Developmental Disabilities Clinic/Center	$0	$19.7M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Greenville County Disabilities And Special Needs Board	SC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$51.7M
Heart Of The Carolinas Medical Supply, LLC	SC	Nursing Care Agency	$0	$36.4M
Caris Healthcare LLC	SC	Community Based Hospice Care Agency	$0	$36.3M
Greenville County Commission On Alcohol And Drug Abuse	SC	Substance Use Disorder Rehabilitation Clinic/Center	$0	$12.7M
St. Francis Hospital Inc	SC	General Acute Care Hospital	$0	$9M
Tribe513, P.A.	SC	Pediatric Adolescent Medicine Physician	$0	$8.6M
Luxor Scientific, LLC	SC	Clinical Medical Laboratory	$2.2M	$5.6M
Pleasantburg Drive Dental Health Center, P.C.	SC	General Practice Dentistry	$0	$6.5M
Inspirium Ihc Upstate, LLC	SC	Home Health Agency	$0	$6.4M
Bon Secours Ambulatory Services - St. Francis, LLC	SC	Urgent Care Clinic/Center	$0	$6.4M

Prisma Health University Medical Group — 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