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.

Fort Payne Pediatrics, LLC (NPI 1356746085)

Key Findings

Field	Value
Entity Type	Organization
Organization	Fort Payne Pediatrics, LLC
Address	1359 Old Water Works Rd Sw
City	Fort Payne
State	AL
ZIP	35968
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	October 23, 2014

Payer Source	Total Paid
Medicaid	$33.3M
Medicare	$0

This provider has no Medicare billing on file and is effectively a Medicaid-only operation, with total Medicaid revenue reported at $33.3M. The absence of Medicare activity makes Medicaid the sole material payer to evaluate when assessing utilization and contract/value strategies for this entity.

Revenue is highly concentrated: the top 3 Medicaid codes account for 92.1% of this provider’s total Medicaid revenue, with T1015 alone representing $29.4M (88.8% of Medicaid revenue) across 159.8K claims at an average paid/claim of $184. Such concentration means changes to reimbursement or utilization of a small set of codes would have outsized impact on the provider’s financials.

The dominance of T1015 (T1015 – Clinic visit/encounter, all-inclusive) and the heavy volume of pediatric vaccine codes indicate this Rural Health Clinic operates as a high-volume, comprehensive pediatric clinic and immunization site. Multiple vaccine codes (for example 90700, 90713, 90648, 90670) show substantial claim counts and high percentile ranks in-state, consistent with routine childhood immunization and preventive-care workflows.

On-site infectious disease testing is a clear service line: 87804 (influenza) shows 21.9K claims and $459.2K revenue, 87880 (strep A) shows 24.3K claims and $316K revenue, 87811 (COVID-19 immunoassay) shows 10.5K claims and $274K revenue, and 87633 (multiplex respiratory NAAT) contributes $634.3K. Several of these lab codes rank at or above the 90th percentile in-state (87804 at the 98th percentile described as typical, 87880 at the 98th percentile described as notably above typical), signaling the clinic performs high volumes of point-of-care and multiplex respiratory testing relative to peers.

The E/M and nursing-visit pattern shows an unusual mix of very high claim volumes at low paid/claim rates alongside higher-paid brief visit codes: 99213 records 81.9K claims and $163.9K revenue and is labeled an extreme outlier (100th percentile), while 99211 records 2.6K claims and $456K revenue and is described as notably above typical state volume (96th percentile). This combination suggests the clinic uses a high-volume, low-unit-payment E/M approach for a large outpatient pediatric panel, with substantial downstream revenue concentrated in the all-inclusive clinic visit code T1015.

Competitive standing in-state is strong for core pediatric services: T1015 ranks #7 of 243 providers in Alabama (98th percentile), and several immunization codes rank in the top decile or top five statewide (for example 90700 ranks #2 of 132 at the 99th percentile and 90713 ranks #2 of 55 at the 98th percentile). Those ranks indicate the provider is a major participant in pediatric clinic visits and vaccinations within Alabama, rather than a modest or peripheral player.

The provider’s NPI was enumerated on 2014-10-23 (~12 years ago), indicating roughly a decade-plus of operation under the current enrollment. That tenure supports the interpretation that the observed high-volume Medicaid patterns are persistent rather than short-term anomalies.

For payers and network managers, the concentration in T1015 and a cluster of high-percentile testing and vaccine codes represents both an efficiency opportunity and a monitoring priority: a single code (T1015) drives the vast majority of revenue and several codes are labeled notably above typical or extreme outlier in-state. Monitoring utilization trends for T1015, high-volume E/M codes (99213/99211), and respiratory testing/immunization codes will be important for network adequacy, payment integrity, and targeted quality reviews.

Medicaid: Complete Services Breakdown

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

60 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	159,780	$180	$29.4M
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	3,080	$210	$634.3K
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.	21,870	$20	$459.2K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	2,640	$170	$456K
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.	24,310	$10	$316K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	10,540	$30	$274K
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.	2,740	$60	$175.5K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	6,600	$30	$171.5K
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…	81,940	$1	$163.9K
90700	This code represents a DTaP vaccine product administered into the muscle to protect against diphtheria, tetanus, and pertussis (whooping cough). It is used for children younger than 7 years of age.	10,790	$10	$107.9K

Showing 1–10 of 60

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

Fort Payne Pediatrics, LLC — 12 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

60 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	7	240	6,820	$120	$2.9M
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	21	100	470	$130	$1.2M
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…	40	1,990	680	$60	$201.7K
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…	177	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…	10	1,990	560	$40	$185.6K
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…	17	270	1,360	$60	$159.7K
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…	16	300	1,160	$50	$147.8K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	29	80	220	$70	$103.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	18	320	640	$50	$98.1K
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…	47	200	170	$50	$60.5K

Showing 1–10 of 60

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Isbell Medical Group, P.C.	AL	Multi-Specialty Clinic/Center	$0	$8.5M
Dekalb County Hospital Association	AL	Land Ambulance	$1.1M	$2.2M
Fort Payne Hospital Corporation	AL	General Acute Care Hospital	$0	$2.6M
Go Play Therapy, L.L.C.	AL	Specialist	$0	$2.5M
Fort Payne Rhc Corp	AL	Internal Medicine Physician	$0	$1.7M
Insight Eye Care, LLC	AL	Optometrist	$0	$1.1M
Michael Digby	AL	Dermatology Physician	$1M	$0
Asmitha Sathiyakumar	AL	Pain Medicine (Anesthesiology) Physician	$472K	$0
Wael Al-halaseh	AL	Cardiovascular Disease Physician	$400.2K	$0
Jason Ham	AL	Family Medicine Physician	$278.6K	$0

Fort Payne Pediatrics, LLC — Billing Profile & Reimbursement Data

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Fort Payne Pediatrics, 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