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.

Sandhills Medical Foundation, Inc. (NPI 1487712923)

Sandhills Medical Foundation, Inc. is a federally qualified health center (fqhc) provider located in Lugoff, South Carolina. This profile covers 0 Medicare and 46 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	Sandhills Medical Foundation, Inc.
Address	40 Baldwin Ave.
City	Lugoff
State	SC
ZIP	29078
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	December 5, 2006

Payer Source	Total Paid
Medicaid	$3.2M
Medicare	$0

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

46 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…	6,960	$200	$1.4M
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…	4,490	$190	$857.4K
T1015	Clinic visit/encounter, all-inclusive	5,040	$90	$458.4K
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,…	570	$190	$109.6K
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,…	1,890	$50	$92.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	330	$180	$59.9K
97802	The provider treats medical conditions and related symptoms using specific diet therapy by interacting individually with the patient. This code represents each 15 minutes of the first visit with the…	1,950	$30	$54.6K
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…	250	$180	$44.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	170	$200	$32.2K
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…	130	$180	$24.5K

Showing 1–10 of 46

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

Sandhills Medical Foundation, Inc. — 0 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

46 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…	113	210	320	$130	$707.4K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	188	210	1,470	$60	$615K
T1015	Clinic visit/encounter, all-inclusive	146	350	3,560	$30	$525.5K
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…	227	280	600	$90	$299K
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…	294	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	262	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…	344	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…	197	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.	177	390	100	$100	$148.3K
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…	161	170	500	$50	$128.5K

Showing 1–10 of 46

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Quintella Riley	SC	Nurse Practitioner	$46.4K	$0
Roland Saavedra	SC	Family Medicine Physician	$36.3K	$0
Ayodele Ogunfowora	SC	Psychiatry Physician	$20.7K	$4K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Carolina Ent Allergy & Sleep Medicine PA	SC	Otolaryngology Physician	$0	$16.7M
Lifeline Ambulance	SC	Ambulance	$1.1M	$3.5K
James Kearse	SC	Family Medicine Physician	$327.2K	$870
Anne Blake	SC	Family Nurse Practitioner	$308.9K	$0
Brian Boone	SC	Otolaryngology Physician	$282K	$14.5K
Robert Puchalski	SC	Sleep Medicine (Otolaryngology) Physician	$254.7K	$20.6K
Janaki Emani	SC	Otolaryngology Physician	$196.8K	$17.1K
Jennifer Carter	SC	Medical Physician Assistant	$165.1K	$0
Min Kang	SC	Family Medicine Physician	$143.2K	$1.6K
Julie Taylor	SC	Internal Medicine Physician	$58.3K	$0

Sandhills Medical Foundation, Inc. — Billing Profile & Reimbursement Data

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Sandhills Medical Foundation, 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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