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

Why is the Medicaid comparison limited to North 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. North 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.

Thomasville-archdale Pediatrics, PLLC (NPI 1427018894)

Key Findings

Field	Value
Entity Type	Organization
Organization	Thomasville-archdale Pediatrics, PLLC
Address	200 Arthur Dr
City	Thomasville
State	NC
ZIP	27360
Taxonomy	Pediatrics Physician
NPI Enumerated	March 28, 2006

Payer Source	Total Paid
Medicaid	$41.8M
Medicare	$0

This practice is effectively a Medicaid-centric pediatric clinic: there is no Medicare billing on file and lifetime Medicaid revenue is $41.8M, so the provider operates as a single-payer (Medicaid) revenue stream at scale rather than a mixed Medicare/Medicaid model. The NPI was enumerated on 2006-03-28 (~20 years ago), indicating long tenure in the market and sustained Medicaid activity over time.

Revenue is heavily concentrated in a small set of evaluation-and-management and miscellaneous-service codes: the precomputed top three Medicaid codes account for 59.9% of the provider's Medicaid revenue, led by 99213 ($11.8M, 28.7%), 99214 ($7.1M, 17.3%), and 99199 ($5.7M, 13.8%). This concentration implies that routine office visits and 'other medicine services' are the primary drivers of the practice’s financials under Medicaid.

The code mix points to a high-volume primary pediatric care operation focused on well-child and established-patient visits plus broad ancillary services. Preventive and well-visit codes 99392, 99393, 99391, and 99394 collectively generate multimillion-dollar revenues ($2.6M, $2.3M, $2.1M, and $1.4M respectively) and indicate a heavy emphasis on scheduled pediatric preventive care and immunization workflows.

Immunization and vaccine administration are a material service-line: 90471 ($1.8M), 90472 ($1.5M), 90474 ($149.9K) and vaccine product 90651 ($79.7K) together represent sizable revenue and claim volume, corroborating a practice model that delivers on-site vaccinations as a routine part of pediatric visits. High ranks for these codes (for example 90471 ranks #2 of 1570 providers in-state, 100th percentile) reinforce that vaccinations are a core throughput driver.

The provider is a dominant statewide performer on multiple pediatric codes. 99213 ranks #9 of 4130 providers in-state (100th percentile; extreme outlier) and 99214 ranks #23 of 4404 providers in-state (100th percentile; extreme outlier), while 99392 and 99393 also rank in the 99th percentile or higher, indicating the practice operates at volumes far above typical state peers for routine pediatric E/M and preventive visits.

High-volume use of catch‑all and screening codes signals broad office-based services beyond standard visits: 99199 shows very large volume (947.6K claims, $5.7M) and ranks #17 of 2853 providers in-state (99th percentile; extreme outlier), and developmental/behavioral screening codes 96110 (45.4K claims, $453.7K) and 96127 (27.5K claims, $110.1K) rank in the 99th percentile. This pattern suggests routine incorporation of standardized developmental and behavioral screening into visits and frequent reporting of other miscellaneous pediatric services.

Laboratory testing for respiratory infections and strep is a consistent ancillary revenue stream but less dominant than visits and vaccines: multiplex and single-pathogen NAAT codes 87636 ($791.1K), 87635 ($603.3K), and 87651 ($680.4K) are present at varying percentiles (81th, 97th, 99th respectively), and rapid antigen tests 87276 and 87275 each rank #1 of 13 providers in-state. These volumes indicate on-site diagnostic testing is a meaningful operational capability, supporting same‑day evaluation and treatment.

A few service lines outside core pediatrics appear as notable adjuncts: D0145 ($469.4K) and D1206 ($208.7K) show measurable revenue and above-typical state rankings (D0145 rank #8 of 460, 98th percentile; D1206 rank #88 of 1252, 93th percentile), which may reflect provision or coding of supplemental oral health or related preventive supply services within the clinic visit mix. Overall, the profile is of a long-tenured, high-volume Medicaid pediatric practice that dominates state-level volumes for routine visits, preventive services, vaccinations, and select point-of-care diagnostics.

Medicaid: Complete Services Breakdown

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

99 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…	187,870	$60	$11.8M
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…	77,630	$90	$7.1M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	947,580	$10	$5.7M
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…	27,640	$90	$2.6M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	24,810	$90	$2.3M
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…	24,150	$90	$2.1M
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	91,430	$20	$1.8M
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	50,860	$30	$1.5M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	14,630	$100	$1.4M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	5,820	$140	$791.1K

Showing 1–10 of 99

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Thomasville-archdale Pediatrics, PLLC — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

99 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	16	80	750	$120	$449.7K
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	17	2,850	10,910	$10	$330.3K
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…	23	4,400	960	$60	$271.3K
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…	9	520	1,080	$80	$262.1K
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…	6	550	970	$90	$258.9K
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…	9	4,130	670	$50	$219.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4	590	490	$90	$179.8K
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.	56	330	300	$10	$142.3K
A4627	Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler	39	60	190	$40	$118.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3	530	270	$90	$112.8K

Showing 1–10 of 99

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Novant Health Thomasville Medical Center, LLC	NC	General Acute Care Hospital	$0	$15.3M
Usman Khawaja	NC	Interventional Cardiology Physician	$119.3K	$0
Mark Smith	NC	Surgery Physician	$40.2K	$0
Raschid Ghoorahoo	NC	Nurse Practitioner	$21.2K	$0

Thomasville-archdale Pediatrics, PLLC — Billing Profile & Reimbursement Data

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Thomasville-archdale Pediatrics, PLLC — 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