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.

Medcare Express - North Charleston LLC (NPI 1457579617)

Key Findings

Field	Value
Entity Type	Organization
Organization	Medcare Express - North Charleston LLC
Address	1850 Sam Rittenberg Blvd
City	Charleston
State	SC
ZIP	29407
Taxonomy	Urgent Care Clinic/Center
NPI Enumerated	April 23, 2007

Payer Source	Total Paid
Medicaid	$34.8M
Medicare	$0

This provider is effectively single-payer with respect to fee-for-service claims: there is no Medicare billing on file and all reported lifetime revenue is from Medicaid totaling $34.8M. The NPI was enumerated 2007-04-23 (~19 years ago), indicating long-standing enrollment that supports a mature outpatient operation.

Revenue is highly concentrated in a small number of evaluation-and-management codes: the precomputed top-3 Medicaid codes account for 61.1% of this provider's total Medicaid revenue. The top three are 99214 (171K claims, $74 avg paid/claim, $12.7M revenue, 36.4%), 99213 (88.2K claims, $52 avg paid/claim, $4.6M revenue, 13.2%), and 99203 (54.9K claims, $73 avg paid/claim, $4M revenue, 11.5%), which together form the bulk of Medicaid receipts.

The CPT mix and volumes point to a high-throughput urgent care model that depends on brief E/M encounters and rapid diagnostics: large volumes of 99214, 99213, 99203 and presence of the urgent-care global code S9083 (2.4K claims, $137 avg paid/claim, $333K revenue) indicate routine office/outpatient visits as the primary service line. The E/M average paid per claim figures ($74 for 99214, $52 for 99213, $73 for 99203) combined with the very large claim counts suggest visit-centered revenue rather than procedure- or inpatient-focused revenue streams.

Diagnostic and point-of-care infectious disease testing is a clear secondary revenue engine: 87804 (216.5K claims, $12 avg paid/claim, $2.6M revenue, 7.5%), 87811 (65.4K claims, $36 avg paid/claim, $2.4M revenue, 6.8%), U0002 (40.7K claims, $50 avg paid/claim, $2M revenue, 5.8%), and 87426 (24.1K claims, $47 avg paid/claim, $1.1M revenue, 3.3%) together show large-scale flu and SARS–CoV–2 testing throughput consistent with urgent-care operations. Many of these lab codes are flagged as state-level extreme outliers, indicating testing volume far above typical peers.

State-level competitive standing is dominant for the provider's core codes: 99214 ranks #4 of 2483 providers in-state (100th percentile; extreme outlier), 99203 ranks #2 of 522 providers in-state (100th percentile; extreme outlier), and 99204 ranks #1 of 487 providers in-state (100th percentile; extreme outlier). Testing codes show similar leadership — 87804 ranks #1 of 536 providers in-state (100th percentile; extreme outlier) and U0002 ranks #1 of 53 providers in-state (100th percentile; extreme outlier) — together these ranks characterize the provider as a major statewide player for urgent visits and rapid infectious testing.

Several ancillary, low-reimbursement services contribute meaningfully to visit throughput: high-volume low-dollar items such as 81003 (48.8K claims, $2 avg paid/claim, $97.6K revenue) and 81025 (26.1K claims, $6 avg paid/claim, $156.8K revenue) reflect routine pregnancy and urinalysis testing frequently paired with E/M encounters. The presence of injection codes (96372: 21.3K claims, $5 avg paid/claim, $106.6K revenue) and common medication J-codes reinforces a walk-in treatment model that provides same-day therapeutic interventions.

Operational sensitivity is concentrated to Medicaid policy and payer behavior because Medicare billing is absent; any changes to Medicaid reimbursement, lab testing coverage, or visit-authorization rules could materially affect this provider given the $34.8M Medicaid-only revenue base. Given the heavy reliance on high-volume E/M and testing codes, shifts in reimbursement per claim or utilization controls for codes like 99214, 87804, and U0002 would have outsized budgetary impact.

The overall pattern — long-tenured enrollment, extreme outlier volumes for core visit and testing codes, and 61.1% of Medicaid revenue coming from the top three E/M codes — supports classifying this entity as a high-volume, Medicaid-focused urgent care operator that is a dominant in-state provider for both office visits and point-of-care infectious disease testing. Analysts should treat its Medicaid portfolio as the primary lens for competitive and policy impact analysis rather than Medicare-based comparisons.

Medicaid: Complete Services Breakdown

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

60 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	170,980	$70	$12.7M
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…	88,210	$50	$4.6M
99203	The provider sees a new 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 provider…	54,860	$70	$4M
99204	The provider sees a new 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 provider…	29,990	$110	$3.3M
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.	216,530	$10	$2.6M
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	65,410	$40	$2.4M
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	40,670	$50	$2M
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,…	24,150	$50	$1.1M
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	78,040	$10	$936.5K
S9083	Global fee urgent care centers	2,430	$140	$333K

Showing 1–10 of 60

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

Medcare Express - North Charleston LLC — 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

60 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J8499	Prescription drug, oral, non chemotherapeutic, nos	7	10	940	$50	$475.5K
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…	15	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	223	710	350	$60	$247.2K
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…	4	2,480	350	$80	$246K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	15	410	330	$50	$152.6K
81001	Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other…	177	180	1,360	$20	$152.1K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	1	50	340	$80	$129.4K
S9083	Global fee urgent care centers	1	10	460	$130	$110.4K
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,…	42	610	190	$50	$98.4K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	3	380	660	$30	$90K

Showing 1–10 of 60

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kalpesh Purohit	SC	Family Medicine Physician	$2.1M	$0
Jeffrey Herman	SC	Internal Medicine Physician	$291.5K	$2.8K
Michael Smith	SC	Family Medicine Physician	$199K	$0
Edmond Jordan	SC	Family Medicine Physician	$178.2K	$0
Caitlin Wilburn	SC	Physician Assistant	$163.7K	$0
Robert Kimpton	SC	Family Medicine Physician	$92.3K	$23K
Wendy Griffith	SC	Medical Physician Assistant	$113.7K	$0
Lachin Hatemi	SC	General Practice Physician	$103.4K	$0
Mark Martin	SC	Family Medicine Physician	$99.5K	$0
Lori Cook	SC	Internal Medicine Physician	$77.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dentistry For Children Of South Carolina, PC	SC	Pediatric Dentistry	$0	$68.4M
Justiceworks Behavioral Care	SC	Community/Behavioral Health Agency	$0	$18.6M
Carolina Health Force	SC	Nursing Care Agency	$0	$8.8M
Plantation Pediatrics, LLC	SC	Pediatrics Physician	$0	$8.2M
Southern Home Care Services, Inc.	SC	In Home Supportive Care Agency	$0	$5.8M
Charleston Pediatric Rehabilitation LLC	SC	Speech-Language Pathologist	$0	$3.8M
Charleston Ent Associates, LLC	SC	Ambulatory Surgical Clinic/Center	$482K	$2.8M
Charleston Ot LLC	SC	Occupational Therapist	$0	$3.2M
Active Sc One, Inc.	SC	Adult Day Care Clinic/Center	$0	$3.2M
Personal Care, Inc.	SC	Land Ambulance	$2.7M	$234.3K

Medcare Express - North Charleston LLC — Billing Profile & Reimbursement Data

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Medcare Express - North Charleston LLC — 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