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.

Goldsboro Pediatrics PA (NPI 1427125269)

Key Findings

Field	Value
Entity Type	Organization
Organization	Goldsboro Pediatrics PA
Address	2706 Medical Office Place
City	Goldsboro
State	NC
ZIP	27534
Taxonomy	Pediatrics Physician
NPI Enumerated	November 29, 2006

Payer Source	Total Paid
Medicaid	$61.3M
Medicare	$0

GOLDSBORO PEDIATRICS PA reports no Medicare billing on file and $61.3M in Medicaid revenue, making its commercial/Medicare exposure effectively nil in this dataset and its operations overwhelmingly Medicaid-focused. Analysts should treat this profile as a single-payer (Medicaid) practice when assessing market impact and network contracting opportunities.

Revenue for this provider is highly concentrated: the precomputed top 3 Medicaid codes account for 51.0% of total Medicaid revenue, with 99213 generating $14.8M (24.8%), 99199 generating $9M (15.0%), and 99214 generating $6.6M (11.1%). These three codes together drive a majority of revenue and indicate that office-based evaluation-and-management and a broadly coded “other medicine services” category are the primary revenue engines.

The code mix and volumes point to a high-volume pediatric primary care operation focused on established office visits and routine care: 99213 has 238.2K claims and 99214 has 70.5K claims, both described as established-patient E/M visits. Substantial claims for well-child and preventive codes (99391, 99392, 99393, 99394) and developmental screening (96110) further reinforce that the practice’s core service line is pediatric preventive and longitudinal primary care.

Preventive medicine and immunizations are a distinct revenue stream for this provider: 90460 contributes $4.7M (7.8%) and ranks #1 of 383 in-state, while 90472 and 90471 together add meaningful revenue and are far above typical state volumes. The combination of top-ranked immunization codes and high-ranking preventive visit codes (99391, 99392 rank at or near the top statewide) signals an operational emphasis on scheduled well visits and vaccine administration.

The provider also reports very high throughput for point-of-care testing and screenings: 87428 (SARS/flu immunoassay) accounts for $1.7M (2.8%) and ranks #1 of 211, 87426 contributes $849.3K (1.4%) and ranks #5 of 443, and 96110 (developmental screening) shows 97.2K claims for $875K (1.5%) and ranks #1 of 651. These patterns are consistent with in-office testing and screening workflows that support rapid diagnosis and preventive care within the practice.

Competitive standing within North Carolina is dominant for many core pediatric codes: multiple codes are listed as 100th percentile and “extreme outlier” (for example, 99213 ranks #7 of 4130, 90460 ranks #1 of 383, 99391 ranks #2 of 521), indicating this provider is a major statewide volume leader for pediatric visits, immunizations, and screenings. At the same time, some ancillary services (85025, 90834, 99460) appear at typical or unremarkable volumes, suggesting the dominance is focused on core pediatric primary-care activities rather than every ancillary service line.

Operationally, the very large volume of 99199—1.5M claims producing $9M (15.0%) and ranking #11 of 2853 in-state as a 100th percentile, extreme outlier—deserves attention: 99199 is an unspecified “other medicine services” code, so its scale implies substantial use of a broadly categorized billing code that aggregates many minor or miscellaneous services. Analysts should treat 99199 as a major revenue driver that likely represents a mix of low-dollar, high-count services rather than a single discrete procedure.

The NPI enumeration date of 2006-11-29 (~20 years ago) indicates an established presence in the market; combined with the large Medicaid volumes and repeated top-state rankings, this tenure supports the interpretation that the practice has long-standing pediatric capacity and an entrenched Medicaid patient base. For payer strategy, this suggests stability of service volumes and a reliable partner for pediatric Medicaid access in the GOLDSBORO area.

Medicaid: Complete Services Breakdown

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

105 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…	238,150	$60	$14.8M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	1,492,790	$10	$9M
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…	70,470	$90	$6.6M
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.	88,060	$50	$4.7M
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…	48,010	$90	$4.2M
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…	44,990	$90	$4M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	32,650	$90	$3M
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	28,560	$60	$1.7M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	16,980	$100	$1.7M
99401	At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient’s age, family history, and areas of concern. The subjects…	44,020	$30	$1.5M

Showing 1–10 of 105

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

Goldsboro Pediatrics PA — 22 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

105 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	11	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…	28	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…	2	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…	2	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…	7	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.	1	590	490	$90	$179.8K
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.	1	380	460	$40	$173.1K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	401	510	480	$40	$166.3K
A4627	Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler	10	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.	2	530	270	$90	$112.8K

Showing 1–10 of 105

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wayne Memorial Hospital Inc	NC	General Acute Care Hospital	$0	$37.8M
Waynesboro Family Clinic	NC	Mental Health Counselor	$0	$32.8M
Crossroads Support Services, Inc	NC	Home Health Agency	$0	$13.5M
Simmons Early Intervention Therapy, LLC	NC	Developmental Therapist	$0	$12.9M
Howell Support Services	NC	Community/Behavioral Health Agency	$0	$11.5M
Clientfirst Of Nc, LLC	NC	Community/Behavioral Health Agency	$0	$10M
Personal Homecare Solutions, Inc.	NC	Personal Care Attendant	$0	$9.5M
Omni Family Of Services North Carolina Inc.	NC	Community/Behavioral Health Agency	$0	$8.5M
Goldsboro Emergency Medical Specialists, Inc.	NC	Emergency Medicine Physician	$0	$8.2M
Triangle Comprehensive Health Services, Inc	NC	Community/Behavioral Health Agency	$0	$8M

Goldsboro Pediatrics 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

Nearby Providers

Frequently Asked Questions

References