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.

Doctors Care, PA (NPI 1366499048)

Key Findings

Field	Value
Entity Type	Organization
Organization	Doctors Care, PA
Address	1818 Henderson St
City	Columbia
State	SC
ZIP	29201
Taxonomy	Family Medicine Physician
NPI Enumerated	May 28, 2006

Payer Source	Total Paid
Medicaid	$50.7M
Medicare	$0

This provider is effectively single‑payer in scope: there is no Medicare billing on file and all recorded federal claims activity is Medicaid-only, with total Medicaid revenue of $50.7M. The absence of Medicare activity combined with a large Medicaid footprint means any analysis of clinical volume, payor risk, or reimbursement exposure should focus on Medicaid rules and state-level policy changes.

Revenue is highly concentrated in three office/outpatient E&M codes: the precomputed top‑3 Medicaid codes account for 66.8% of total Medicaid revenue, driven by 99214, 99213, and 99203. That concentration indicates the organization’s business is dominated by ambulatory evaluation-and-management visits rather than procedures or specialty services.

The practice shows extraordinary statewide dominance on core E&M codes: 99214 has 226.4K claims, $72 avg paid/claim, $16.3M revenue (32.2% of Medicaid revenue) and ranks #2 of 2483 providers in-state (100th percentile; extreme outlier), while 99213 has 200.4K claims, $48 avg paid/claim, $9.6M revenue (19.0%) and ranks #3 of 2766 (100th percentile; extreme outlier). These volumes and ranks identify the provider as a major ambulatory visit center in South Carolina, far above typical state volumes for primary care visits.

New patient visits are also a large part of the mix: 99203 accounts for 113.7K claims, $70 avg paid/claim, $8M revenue (15.7% of Medicaid revenue) and ranks #1 of 522 providers in-state (100th percentile; extreme outlier). High counts for 99203 alongside elevated established‑patient volumes suggest substantial new-patient throughput and likely capacity for onboarding and primary care access.

Non-visit diagnostic testing is a second high-volume service line: 87635 (SARS–COV–2 testing) shows 136K claims, $45 avg paid/claim, $6.1M revenue (12.1%) and ranks #1 of 174 providers (100th percentile; extreme outlier), and 87502 (multiplex influenza testing) shows 99.8K claims, $65 avg paid/claim, $6.5M revenue (12.8%) and ranks #1 of 105 providers (100th percentile; extreme outlier). The provider is operating at extremely high state-level volumes for respiratory infectious disease testing, indicating either a high-throughput testing site or integrated testing capacity within a high-volume ambulatory practice.

After-hours and extended‑hours access appears to be a deliberate service strategy: 99051 has 50.9K claims, $12 avg paid/claim, $610.5K revenue (1.2%) and ranks #1 of 141 providers in-state (100th percentile; extreme outlier). Significant billing for 99051 supports the interpretation of evening/weekend availability or urgent-access operations complementary to the large E&M visit volumes.

Even lower‑unit lab items register unusually high relative volumes, reinforcing the throughput profile: for example, 81003 has 30K claims, $2 avg paid/claim, $60.1K revenue (0.1%) and ranks #4 of 495 providers in-state (99th percentile; extreme outlier). The combination of very large visit counts and large point-of-care or send-out testing volumes points to a high-volume clinic model rather than a typical small private practice.

The provider has long tenure in federal enrollment, enumerated since 2006-05-28 (~20 years ago), which supports continuity of operations and helps contextualize the sustained, atypically large Medicaid volumes. The heavy dependence on a small set of visit codes (66.8% concentrated in the top three) creates a material revenue-concentration exposure to any policy or reimbursement changes affecting primary care E&M or state Medicaid payment rules.

Medicaid: Complete Services Breakdown

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

43 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…	226,400	$70	$16.3M
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…	200,370	$50	$9.6M
99203	The provider sees a new 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 provider…	113,710	$70	$8M
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…	99,820	$70	$6.5M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	136,010	$50	$6.1M
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…	18,520	$110	$2M
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.	79,190	$10	$871.1K
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.	50,870	$10	$610.5K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	5,120	$50	$276.4K
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,…	4,820	$30	$144.7K

Showing 1–10 of 43

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

Doctors Care, PA — 10 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

43 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…	3	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	73	710	350	$60	$247.2K
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…	2	2,480	350	$80	$246K
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…	75	410	330	$50	$152.6K
81001	Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other…	97	180	1,360	$20	$152.1K
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…	1	110	130	$70	$134.7K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	1	170	500	$50	$128.5K
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,…	33	610	190	$50	$98.4K
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.	43	270	120	$50	$93.2K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	77	380	660	$30	$90K

Showing 1–10 of 43

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Stephen Parks	SC	Family Medicine Physician	$3.9M	$0
Kalpesh Purohit	SC	Family Medicine Physician	$2.1M	$0
Nicole Edwards	SC	Family Medicine Physician	$300.4K	$0
Jeffrey Herman	SC	Internal Medicine Physician	$291.5K	$2.8K
Ashley Wilson	SC	Physician Assistant	$218.5K	$0
Cheryl Lonabaugh	SC	Nurse Practitioner	$148K	$0
Holly Poplin	SC	Primary Care Nurse Practitioner	$143.3K	$0
Alexandra Rateliff	SC	Physician Assistant	$141.8K	$0
Constance Lynne Maroney	SC	Internal Medicine Physician	$140.3K	$0
Bhadrik Patel	SC	Physician Assistant	$93.8K	$33K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Robertson Optical Laboratories Inc	SC	Eyewear Supplier	$0	$13.5M
Dhec Hemophilia-cshcn Program	SC	Pharmacy	$0	$13.3M
Addus Healthcare (south Carolina), Inc.	SC	In Home Supportive Care Agency	$0	$12.1M
Pruitthealth Hospice, Inc.	SC	Inpatient Hospice	$0	$11.8M
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$11.8M
State Of South Carolina	SC	Public Health or Welfare Agency	$0	$10.4M
South Carolina Dept Of Mental Health Accounting Office	SC	Community/Behavioral Health Agency	$0	$8.8M
Palladium Hospice And Palliative Care, LLC	SC	Community Based Hospice Care Agency	$0	$8.2M
Lutheran Family Services In The Carolinas	SC	Community/Behavioral Health Agency	$0	$7.8M
South Carolina Dept Of Mental Health Accounting Office	SC	Case Management Agency	$0	$7.3M

Doctors Care, PA — 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