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

Why is the Medicaid comparison limited to Georgia 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. Georgia (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.

Primary Pediatrics, PC (NPI 1477638575)

Key Findings

Field	Value
Entity Type	Organization
Organization	Primary Pediatrics, PC
Address	5300 Bowman Rd
City	Macon
State	GA
ZIP	31210
Taxonomy	Specialist
NPI Enumerated	October 26, 2006

Payer Source	Total Paid
Medicaid	$32.9M
Medicare	$0

PRIMARY PEDIATRICS, PC reports no Medicare billing on file and $32.9M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid) practice for the recorded period. Absence of Medicare claims prevents any national Medicare peer comparisons, so competitive analysis should focus on in-state Medicaid performance and volumes.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 62.6% of the provider's total Medicaid revenue. Those top drivers are 99213 ($14.4M, 44.1% of Medicaid revenue), 99392 ($3.1M, 9.4%), and 90460 ($2.9M, 9.0%), indicating a small set of services generate the majority of billing.

The payor-and-service mix points to a high-volume pediatric primary care operation: heavy use of 99213 (218.8K claims) alongside preventive medicine codes 99392, 99391, 99393, and 99394 shows routine sick and well-child visits dominate clinical activity. Large counts of vaccine administration (90460, 55.5K claims) and developmental screening (96110, 11.3K claims) further signal bundled preventive care and immunization workflows typical of pediatric clinics.

Competitive standing within Georgia is dominant for core pediatric services: 99213 ranks #2 of 917 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), while 99392 and 90460 each rank #1 in their respective peer groups (100th percentile; extreme outlier, far above typical state volume). Several other well-care and vaccine-related codes (99391, 99393, 99394, 99050) also appear at the 100th percentile, indicating market-leading volume for pediatric preventive and immunization services.

Operational profile implied by ancillary codes: very high volumes of point-of-care testing and vaccines—87804 (55.6K claims, $834K) and 87880/87807/87426—combined with after-hours/extended-hours codes 99050 (42.8K claims) and 99051 (28.9K claims) suggest the practice runs high-throughput immunization clinics and offers services outside standard hours. The statistical labels for these codes include “extreme outlier” and “notably above typical,” supporting an interpretation of unusually large throughput rather than isolated billing for rare procedures.

Clinical acuity appears weighted toward low- and moderate-complexity outpatient visits: high volume of 99213 (established patient, low complexity) and meaningful counts of 99212 (22.4K claims) contrast with relatively modest use of higher-complexity new-patient and extended E/M codes (for example 99203 and 99204 are much smaller contributors). Where present, mid-level E/M codes such as 99214 (7.6K claims) rank at more typical levels (90th percentile; described as typical, unremarkable), consistent with a practice focused on routine follow-up and preventive care.

Tenure and taxonomy support an established pediatric practice: NPI enumerated 2006-10-26 (~20 years ago) and the listed Taxonomy is Specialist, consistent with a long-standing pediatric-focused operation that has scaled Medicaid volumes over time. Analysts should interpret volumes in the context of an established clinic rather than a recently opened or transient provider.

Implications for payers and network strategists: because 62.6% of Medicaid revenue is concentrated in three pediatric-focused codes and the provider is a clear statewide volume leader on those services, contracting, capacity planning, and quality-monitoring efforts should prioritize well-child visits, vaccine administration, and high-frequency established-patient E/M workflows. The lack of Medicare activity simplifies payer mix analysis but creates reliance risk on Medicaid reimbursement and utilization patterns for overall revenue stability.

Medicaid: Complete Services Breakdown

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

85 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…	218,810	$70	$14.4M
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…	30,250	$100	$3.1M
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.	55,520	$50	$2.9M
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…	27,960	$100	$2.7M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	21,480	$100	$2.2M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	12,460	$110	$1.4M
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,…	22,380	$40	$939.8K
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.	55,600	$20	$834K
99050	In this procedure, the provider renders services to a patient in his office at a time when that office would otherwise be closed.	42,810	$20	$770.6K
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…	7,630	$100	$748.1K

Showing 1–10 of 85

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Primary Pediatrics, PC — 15 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

85 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	105	140	200	$280	$1.9M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	147	230	120	$170	$937.5K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	55	240	170	$120	$779.3K
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…	21	20	190	$140	$407.6K
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…	2	920	370	$60	$360.6K
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…	85	820	390	$70	$245K
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…	1	180	680	$90	$226.7K
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…	1	180	720	$90	$204.2K
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	250	660	$40	$172.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1	170	500	$100	$170.6K

Showing 1–10 of 85

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jennifer Tucker	FL	Orthopaedic Hand Surgery Physician	$292.2K	$0
Chelsea Rizkalla	GA	Acute Care Nurse Practitioner	$28.3K	$0

Primary Pediatrics, PC — Billing Profile & Reimbursement Data

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Primary Pediatrics, PC — 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
Cogent Healthcare Of Georgia PC	GA	Internal Medicine Physician	$0	$4.6M
Bradley Sumrall	GA	Medical Oncology Physician	$3.1M	$0
Harry Moore	GA	Medical Oncology Physician	$2.9M	$0
Tara Adams	GA	Nurse Practitioner	$2.9M	$0
Macon Outpatient Surgery, LLC	GA	Ambulatory Surgical Clinic/Center	$2.2M	$0
Georgia Em-i Medical Services PC	GA	Physician Assistant	$0	$1.9M
Steven Allee	GA	Ophthalmology Physician	$1.7M	$0
Norman Nelson	GA	Ophthalmology Physician	$1.5M	$0
Central Georgia Cancer Care	GA	Specialist	$0	$1.2M
Arpan Bachhawat	GA	Retina Specialist (Ophthalmology) Physician	$1.2M	$0