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.

Central Pediatrics Inc. (NPI 1467639534)

Central Pediatrics Inc. is a preferred provider organization provider located in Athens, Alabama. This profile covers 0 Medicare and 38 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Central Pediatrics Inc.
Address	707 Us Highway 31 S
City	Athens
State	AL
ZIP	35611
Taxonomy	Preferred Provider Organization
NPI Enumerated	January 30, 2008

Payer Source	Total Paid
Medicaid	$4.1M
Medicare	$0

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

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	40,480	$90	$3.6M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	990	$90	$87.5K
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…	1,420	$50	$65.1K
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.	4,010	$10	$52.1K
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.	1,230	$20	$25.7K
90648	This code represents a Haemophilus influenzae type b (Hib) vaccine product administered into the muscle to protect against Hib disease. This formulation uses a PRP–T conjugate and follows a four–dose…	3,140	$10	$25.1K
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…	21,960	$1	$22K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	2,710	$10	$21.7K
90723	The provider administers a combination inactivated vaccine intramuscularly to prevent multiple diseases, including diphtheria, tetanus, acellular pertussis, hepatitis B, and polio.	2,440	$10	$19.5K
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…	4,110	$1	$16.4K

Showing 1–10 of 38

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

Central Pediatrics Inc. — 1 of 25 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

38 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	41	240	6,820	$120	$2.9M
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…	708	1,990	680	$60	$201.7K
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…	100	1,990	560	$40	$185.6K
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…	55	270	1,360	$60	$159.7K
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…	64	300	1,160	$50	$147.8K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	51	80	220	$70	$103.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	61	320	640	$50	$98.1K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	283	300	210	$40	$77.9K
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…	126	200	170	$50	$60.5K
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.	91	230	410	$40	$59.2K

Showing 1–10 of 38

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Advantage Dental Oral Health And Vision Center Of Alabama, P.C.	AL	Pediatric Dentistry	$0	$6.3M
Hh Health System - Athens Limestone, LLC	AL	General Acute Care Hospital	$0	$2.7M
Athens Limestone Health Services, LLC	AL	Ambulance	$1M	$1.2M
Athens-limestone Er Physicians	AL	Emergency Medicine Physician	$0	$1.7M
Pathways Speech Therapy, Inc.	AL	Speech-Language Pathologist	$0	$985.9K
Limestone County Health Dept Fp Clinic	AL	Public Health or Welfare Agency	$0	$936.3K
R Hill	AL	Specialist	$333.6K	$0
Cassidy Koonce	AL	Surgery Physician	$281K	$0
Nauman Qureshi	AL	Specialist	$263K	$0
Crystal Walker	AL	Cardiovascular Disease Physician	$194.6K	$0

Central Pediatrics Inc. — Billing Profile & Reimbursement Data

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Central Pediatrics Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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