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.

Dothan Pediatric Clinic, P. A. (NPI 1376508788)

Key Findings

Field	Value
Entity Type	Organization
Organization	Dothan Pediatric Clinic, P. A.
Address	126 Clinic Dr
City	Dothan
State	AL
ZIP	36303
Taxonomy	Pediatrics Physician
NPI Enumerated	April 19, 2006

Payer Source	Total Paid
Medicaid	$56.6M
Medicare	$0

This provider is effectively a Medicaid-focused practice: there is no Medicare billing on file while total Medicaid revenue is $56.6M, indicating the organization’s revenue scale is concentrated with a single public payer rather than split across Medicare and Medicaid. The absence of Medicare data limits national-peer comparisons and implies payer-mix risk is heavily weighted toward Medicaid.

Revenue concentration is extreme: the precomputed top three Medicaid codes account for 64.4% of the provider’s total Medicaid revenue. The top three drivers are 99213 ($18.5M, 35.4% of total Medicaid revenue), 99214 ($12M, 23.0% of total Medicaid revenue), and 99392 ($3.2M, 6.1% of total Medicaid revenue), which together dominate the revenue profile and highlight dependence on office/outpatient E/M and well-child preventive visits.

The code mix shows a high-volume pediatric primary care model focused on routine and preventive care. Large volumes of established-patient E/M codes (99213: 312.8K claims, $59 avg paid/claim; 99214: 131.7K claims, $91 avg paid/claim) paired with substantial preventive visit codes (99392: 46K claims, $69 avg paid/claim; 99391 and 99393–99394 also high) indicate the clinic operates as a high-throughput pediatric office with a robust well-child program.

In-state competitive standing is dominant for core pediatric services: 99213 ranks #1 of 1988 providers in-state (100th percentile; extreme outlier) and 99214 ranks #2 of 1990 providers in-state (100th percentile; extreme outlier). Multiple preventive and vaccine codes also rank at the top in-state (for example, 99392, 99391, 90698, 90670, 90680, 90651 each rank #1 in-state and are labeled extreme outliers), signaling market leadership in pediatric well visits and in-office immunizations.

Ancillary and diagnostic testing volumes are substantial relative to peers and support a full-service outpatient model that handles acute pediatric needs in-house. High claim counts and revenues for point-of-care and lab codes—87430 (64.7K claims, $12 avg paid/claim, $776.6K revenue; ranks #1), 87804 (51.8K claims, $20 avg paid/claim, $1M revenue; ranks #4 but 100th percentile label), and 87635 (23.1K claims, $41 avg paid/claim, $947.6K revenue; ranks #5)—suggest routine on-site testing for respiratory illnesses alongside vaccinations and screening services such as 99173 (88.1K claims, $4 avg paid/claim, $352.5K revenue; ranks #1).

The provider also bills for more specialized pediatric services at nontrivial levels: polysomnography 95810 ($579K revenue; ranks #1 of 27, 100th percentile; extreme outlier) and attended pediatric sleep study 95782 ($362.8K revenue; ranks #3 of 4). These entries imply the clinic either operates or partners to deliver pediatric sleep testing and interpretation in addition to primary care.

While many codes show extreme outlier status, not all volumes are uniformly exceptional across every ancillary code. A subset of codes (for example, 99244 at $867.8K revenue ranks #9 of 116, described as typical/unremarkable, and 85025 at $407K ranks #9 of 371, labeled typical/unremarkable) indicates the practice’s dominance is concentrated in pediatric primary care, immunizations, and certain diagnostics rather than across every outpatient specialty.

Tenure and scale reinforce the profile: the NPI was enumerated on 2006-04-19 (~20 years ago), consistent with a long-standing, high-volume pediatric practice that has accumulated $56.6M in Medicaid revenue and established leading in-state volumes for core pediatric visit and preventive service codes.

Medicaid: Complete Services Breakdown

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

103 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…	312,760	$60	$18.5M
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…	131,680	$90	$12M
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…	46,040	$70	$3.2M
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…	39,980	$70	$2.8M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	36,100	$70	$2.4M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	24,540	$70	$1.6M
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.	51,830	$20	$1M
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…	23,110	$40	$947.6K
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…	7,140	$130	$913.9K
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…	5,420	$160	$867.8K

Showing 1–10 of 103

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

Dothan Pediatric Clinic, P. A. — 22 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

103 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	33	90	500	$40	$303.6K
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.	3	10	820	$350	$257.1K
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	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…	9	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…	7	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…	1	1,990	560	$40	$185.6K
99245	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a high level of medical decision making or the provider spends…	6	30	120	$190	$175.5K
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…	1	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…	1	300	1,160	$50	$147.8K
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	18	60	350	$30	$136.6K

Showing 1–10 of 103

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Advantage Dental Oral Health And Vision Center Of Alabama, P.C.	AL	Pediatric Dentistry	$0	$7M
180 Medical, Inc.	AL	Durable Medical Equipment & Medical Supplies	$0	$6.8M
Aba Associates LLC	AL	Behavior Analyst	$0	$6.7M
Dothan Behavioral Medicine Clinic PC	AL	Child & Adolescent Psychiatry Physician	$0	$6.5M
Physician Management Services Of Alabama LLC	AL	Family Medicine Physician	$0	$4.2M
Foundations Pediatric Therapy	AL	Rehabilitation Clinic/Center	$0	$3.1M
Warren Thompson	AL	Ophthalmology Physician	$2.7M	$0
Milestones Psychology And Therapy Inc	AL	Professional Counselor	$0	$2.6M
Jawaunna Blackmon	AL	Hematology & Oncology Physician	$2.1M	$0
Wiregrass Therapy Associates, LLC	AL	Hearing and Speech Clinic/Center	$0	$1.9M

Dothan Pediatric Clinic, P. A. — Billing Profile & Reimbursement Data

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Dothan Pediatric Clinic, P. A. — 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