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.

Tennessee Valley Neonatology, Inc (NPI 1376831636)

Field	Value
Entity Type	Organization
Organization	Tennessee Valley Neonatology, Inc
Address	101 Sivley Rd Sw
City	Huntsville
State	AL
ZIP	35801
Taxonomy	Neonatal-Perinatal Medicine Physician
NPI Enumerated	July 20, 2011

Payer Source	Total Paid
Medicaid	$22.2M
Medicare	$0

Key Findings

TENNESSEE VALLEY NEONATOLOGY, INC is effectively a single-payer Medicaid practice: there is no Medicare billing on file and the provider reported $22.2M in lifetime Medicaid revenue, indicating near-total revenue dependence on Medicaid payers rather than a mixed Medicare/Medicaid payer mix. This concentration of payer exposure is a foundational feature of the business profile and should frame any comparative or contract analyses.

Revenue is highly concentrated in a small set of neonatal codes: the top three Medicaid codes (99469, 99479, 99480) account for 75.6% of the provider's Medicaid revenue. Specifically, 99469 generated $8.4M (37.6%), 99479 generated $5.2M (23.2%), and 99480 generated $3.3M (14.8%), which signals that the practice’s financial performance is driven almost entirely by neonatal critical-care and low birth weight management services.

The code mix and dollar drivers point to a specialized, hospital/NICU–focused neonatal-perinatal operation: the top codes are 99469 (subsequent neonatal critical care), 99479/99480 (direction of care for recovering low birth weight infants), and significant volume in newborn evaluation and discharge management codes. This pattern is consistent with a practice that provides high-volume NICU coverage and directed management of hospitalized neonates rather than outpatient-only well-child pediatrics.

On in-state competitive standing, the practice is a dominant provider for its highest-revenue codes: 99469 ranks #1 of 13 providers in-state (100th percentile; notably above typical state volume), 99479 ranks #1 of 14 providers in-state (100th percentile; notably above typical state volume), and 99480 ranks #1 of 11 providers in-state (100th percentile; notably above typical state volume). Those #1 rankings and 100th-percentile placements indicate a statewide market leadership position for these specific neonatal service lines.

Several additional Medicaid codes show extreme outlier volumes that reinforce the hospital-based, high-throughput profile: 99460 (31K claims, $806.9K; ranks #1 of 82 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code)), 99238 (34.9K claims, $767.1K; ranks #1 of 203 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code)), and 99381 (28.4K claims, $340.5K; ranks #1 of 49 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code)). These extreme-volume signals reinforce that the provider performs many immediate-postnatal and discharge-related encounters.

The practice also performs a spectrum of neonatal critical care, initial and follow-up intensive services, and routine newborn care: for example, 99468 (initial neonatal critical care) produced $960.2K and ranks #2 of 10 providers in-state (89th percentile; typical, unremarkable volume), 99472 (follow-up care of critically ill infant 29 days–24 months) produced $2.1M and ranks #3 of 12 providers in-state (82th percentile; typical, unremarkable volume), and 99477 (initial intensive day) produced $58.5K and ranks #1 of 2 providers in-state (100th percentile; typical, unremarkable volume). Together these entries show both high-volume routine newborn work and sustained engagement in higher-acuity neonatal care.

The provider’s NPI was enumerated on 2011-07-20 (~15 years ago), indicating a long-tenured presence in the market; combined with the concentrated high volumes and top-rank placements, this suggests an established operating footprint in the Huntsville region. Longevity plus sustained high volumes in select neonatal codes are consistent with an embedded NICU coverage role rather than a recent entrant.

Because 75.6% of Medicaid revenue is tied to three neonatal codes (99469, 99479, 99480) and there is no Medicare revenue, the practice faces concentrated operational and reimbursement risk: changes to reimbursement, coding policy, or hospital referral patterns that affect those specific neonatal codes could materially impact revenue. For contract strategy and risk management, analysts should prioritize monitoring reimbursement trends and state policy for these high-impact neonatal codes.

Medicaid: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	48,650	$170	$8.4M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	93,940	$60	$5.2M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	56,820	$60	$3.3M
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.	12,970	$170	$2.1M
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	3,410	$280	$960.2K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	31,030	$30	$806.9K
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…	34,870	$20	$767.1K
99381	The provider performs a well–baby visit for a child under the age of one.	28,370	$10	$340.5K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	3,050	$50	$143.2K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	9,830	$10	$98.3K

Showing 1–10 of 15

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

Tennessee Valley Neonatology, Inc — 9 of 15 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

15 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	140	$480	$4.8M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	1	10	1,820	$350	$3.2M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	10	3,160	$110	$1.7M
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	2	10	240	$850	$851.2K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	1	10	3,260	$80	$701.3K
99478	The provider directs the care of a recovering low birthweight infant, whose current weight is less than 1500 grams.	2	10	1,420	$140	$254.3K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	1	80	220	$70	$103.1K
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…	1	200	170	$50	$60.5K
54150	The provider performs a circumcision, a surgical procedure that removes the foreskin of the penis, using a clamp or other device and regional anesthesia consisting of a dorsal penile or ring block.	30	50	60	$140	$42.6K
99462	The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.	2	60	220	$40	$39.3K

Showing 1–10 of 15

Related Providers

Other providers that share a Tax Identification Number (TIN) with Tennessee Valley Neonatology, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charles Potter	GA	Neonatal-Perinatal Medicine Physician	$0	$275.9K

Nearby Providers

Other providers in the same ZIP code as Tennessee Valley Neonatology, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Health Care Authority Of The City Of Huntsville	AL	General Acute Care Hospital	$0	$17.8M
Happi Health	AL	Federally Qualified Health Center (FQHC)	$0	$17.6M
Emergency Physicians Group	AL	Emergency Medicine Physician	$0	$13.5M
Healthgroup Of Alabama	AL	Contractor	$0	$13.4M
The Valley Foundation	AL	Multi-Specialty Clinic/Center	$0	$11.3M
David White	AL	Neurology Physician	$7M	$0
The Children's Hospital Of Alabama	AL	Pediatric Pulmonology Physician	$0	$5.6M
Huntsville Pediatric Associates, LLC	AL	Pediatrics Physician	$0	$4.8M
Dental Associates Of Huntsville, LLC	AL	General Practice Dentistry	$0	$4.7M
Health Group Of Alabama	AL	Contractor	$0	$4.1M

Tennessee Valley Neonatology, Inc — Billing Profile & Reimbursement Data

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Tennessee Valley Neonatology, Inc — 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