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

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

Shoals Primary Care, LLC (NPI 1326373861)

Shoals Primary Care, LLC is a family medicine physician provider located in Sheffield, Alabama. This profile covers 0 Medicare and 119 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	Shoals Primary Care, LLC
Address	342 Cox Blvd
City	Sheffield
State	AL
ZIP	35660
Taxonomy	Family Medicine Physician
NPI Enumerated	October 15, 2009

Payer Source	Total Paid
Medicaid	$5.8M
Medicare	$0

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

119 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…	85,570	$40	$3.7M
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…	24,830	$40	$869.1K
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…	8,980	$40	$377K
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.	9,500	$10	$114K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	4,050	$20	$85.1K
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…	15,580	$10	$77.9K
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…	410	$150	$61K
92587	Code 92587 is in the Medicine/Special Otorhinolaryngologic Services Section. It involves special procedures of the ears/nose/throat. This code is for screening purposes with interpretation and…	1,530	$30	$45.8K
99204	The provider sees a new 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 provider…	520	$80	$38.9K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	440	$90	$38.9K

Showing 1–10 of 119

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

Shoals Primary Care, LLC — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

119 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	2	20	160	$20	$1.1M
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…	9	1,990	680	$60	$201.7K
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…	43	120	170	$160	$200.7K
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…	173	330	140	$240	$197.4K
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…	88	1,990	560	$40	$185.6K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	28	60	320	$130	$176.1K
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.	82	100	480	$20	$165.1K
82306	The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced…	23	80	300	$10	$159.1K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	108	110	610	$40	$143.9K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	141	250	420	$50	$133K

Showing 1–10 of 119

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Zaman Shah	AL	Internal Medicine Physician	$262.5K	$0
Brad Ginevan	AL	Family Medicine Physician	$217.3K	$0
Javar Myatt-jones	AL	Family Medicine Physician	$206.1K	$0
Aaron Karr	AL	Family Medicine Physician	$190K	$0
Warren Norman	AL	Diagnostic Radiology Physician	$185K	$0
John Scott	AL	Diagnostic Radiology Physician	$158.6K	$0
Carlos Liotta	AL	Sports Medicine (Family Medicine) Physician	$155.1K	$0
Albert Ridgeway	AL	Specialist	$142.2K	$0
Paul Morris	AL	Cardiovascular Disease Physician	$138.3K	$0
Todd Durham	AL	Diagnostic Radiology Physician	$129K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hh Health System - Shoals LLC	AL	General Acute Care Hospital	$0	$5M
Northwest Alabama Health Services, LLC	AL	Ambulance	$1.3M	$2.3M
Northwest Emergency Physician Group	AL	Emergency Medicine Physician	$0	$2.8M
Colbert County Health Dept Fp Clinic	AL	Public Health or Welfare Agency	$0	$1.9M
Oral & Facial Surgery Of The Shoals, L.L.C.	AL	Oral and Maxillofacial Surgery (Dentist)	$0	$1.6M
State Of Alabama Department Of Public Health	AL	Home Health Agency	$0	$1.3M
Faith Based Psychological Associates, Inc	AL	Community/Behavioral Health Agency	$0	$1.3M
Jerry Williams	AL	Cardiovascular Disease Physician	$370.6K	$0
Charles Thompson	AL	Family Medicine Physician	$303.5K	$0
Anthony Horton	AL	Family Medicine Physician	$301.9K	$0

Shoals Primary Care, LLC — Billing Profile & Reimbursement Data

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Shoals Primary Care, LLC — 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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