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.

Sweetgrass Pediatrics (NPI 1437168135)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sweetgrass Pediatrics
Address	2713 Dantzler Dr
City	North Charleston
State	SC
ZIP	29406
Taxonomy	Pediatrics Physician
NPI Enumerated	August 5, 2006

Payer Source	Total Paid
Medicaid	$37.1M
Medicare	$0

SWEETGRASS PEDIATRICS is effectively a Medicaid-focused practice with no Medicare billing on file; lifetime Medicaid revenue is $37.1M and total Medicare revenue is listed as none, indicating the organization's clinical volume and payer mix are overwhelmingly concentrated in the Medicaid program rather than Medicare. This single-payer emphasis should shape contracting, care-management and reporting priorities toward pediatric Medicaid populations.

Revenue concentration is high: the top three Medicaid codes by revenue account for 58.9% of this provider’s total Medicaid revenue. The largest single-code contributor is 99213 ($12.7M, 34.4% of Medicaid revenue), followed by 99214 ($5.3M, 14.5%) and 99392 ($3.7M, 10.0%); this combination shows most income derives from established primary-care visits and preventive pediatrics.

The code mix (99213, 99214, 99392 and other well-child codes like 99391/99393/99394) indicates SWEETGRASS operates primarily as a high-volume outpatient pediatric primary care and preventive services practice. Heavy use of office E/M and preventive medicine CPTs plus high vaccine administration codes (90460, 90461) suggests routine well-child visits and immunization delivery are central service lines.

Competitive standing in-state is dominant for many pediatric and preventive-service codes: the practice ranks in the 99th–100th percentile or near the very top for several high-volume codes (99213 ranks #5 of 2766 providers at 100th percentile; 99392 and 99391 both rank #3 in their respective peer pools). These ranks and the platform’s labeling of those volumes as “extreme outlier” or “far above typical state volume” indicate SWEETGRASS is a major pediatric care provider in South Carolina for those services.

Operational footprint and throughput are implied by several unusually large claim counts for low-acuity outpatient items: e.g., 99213 (189.2K claims), 90460 (94K claims), and 96161/96127 (33.4K and 26.5K claims respectively). The presence of high-volume brief screening and caregiver questionnaire codes alongside routine E/Ms suggests integration of standardized developmental and behavioral screening into frequent visits.

Clinical support services and testing are also provided at scale: high ranks and volumes for point-of-care and lab codes such as 87880 (25.7K claims, 99th percentile), 87426 (12K claims, 97th percentile), and lead testing 83655 (9.6K claims, 98th percentile) show the practice delivers on-site or closely coordinated diagnostic testing for common pediatric presentations. These ancillary services likely contribute meaningfully to clinic workflow and revenue beyond pure E/M and vaccine codes.

Tenure is long-standing: the NPI was enumerated ~20 years ago (2006-08-05), indicating established presence in the market. This longevity, combined with very high volumes and top-percentile ranks, supports that the practice has built sustained demand and operational capacity for pediatric Medicaid care.

Several codes are flagged as extreme outliers within state peer groups (multiple 99th–100th percentile and rank-top placements). That pattern — concentrated revenue in routine pediatric E/M, preventive visits and vaccinations paired with unusually high diagnostic and screening volumes — signals a specialized, high-throughput Medicaid pediatric clinic rather than a general multi-specialty practice.

Medicaid: Complete Services Breakdown

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

70 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…	189,210	$70	$12.7M
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…	56,800	$90	$5.3M
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…	37,270	$100	$3.7M
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…	37,480	$90	$3.5M
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.	94,050	$30	$3M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	22,710	$100	$2.2M
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	32,800	$40	$1.2M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	10,220	$110	$1.1M
G9153	Mapcp demonstration - physician incentive pool	18,970	$40	$815.9K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	11,950	$50	$573.7K

Showing 1–10 of 70

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

Sweetgrass Pediatrics — 17 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

70 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	25	210	320	$130	$707.4K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	611	650	800	$120	$413.8K
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…	3	280	600	$90	$299K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	108	160	270	$70	$268.1K
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…	5	2,770	210	$60	$254.5K
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…	14	2,480	350	$80	$246K
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…	3	380	160	$100	$226.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5	390	100	$100	$148.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5	340	110	$110	$107.9K
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,…	448	610	190	$50	$98.4K

Showing 1–10 of 70

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Trident Medical Center, LLC	SC	General Acute Care Hospital	$0	$55.8M
Trident Ambulatory Surgery Center, L.P.	SC	Ambulatory Surgical Clinic/Center	$1M	$10.9M
Palmetto Pediatrics, PA	SC	Pediatrics Physician	$0	$9M
Taylor Consultants, LLC	SC	Case Manager/Care Coordinator	$0	$7.5M
Charleston Children's Therapy Center, LLC	SC	Pediatric Physical Therapist	$0	$5.7M
Trident Medical Center, LLC	SC	General Acute Care Hospital	$0	$4.1M
Med-trans Corporation	SC	Air Ambulance	$292K	$3.6M
Oral Surgery Of South Carolina LLC	SC	Oral and Maxillofacial Surgery (Dentist)	$0	$3.8M
Crossroads Treatment Center Of Charleston, PC	SC	Substance Use Disorder Rehabilitation Clinic/Center	$153.1K	$3.2M
Gaslite Dental Health PC	SC	Dental Clinic/Center	$0	$3.2M

Sweetgrass Pediatrics — Billing Profile & Reimbursement Data

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Sweetgrass Pediatrics — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southern Medical Management, LLC	SC	Pediatrics Physician	$0	$43.9M
Inlet Pediatrics PA	SC	Pediatrics Physician	$0	$5.3M