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

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

Vip Midsouth, LLC (NPI 1487737912)

Key Findings

Field	Value
Entity Type	Organization
Organization	Vip Midsouth, LLC
Address	648 Hartsville Pike
City	Gallatin
State	TN
ZIP	37066
Taxonomy	Pediatrics Physician
NPI Enumerated	October 20, 2006

Payer Source	Total Paid
Medicaid	$30.4M
Medicare	$0

This provider is effectively a single‑payer Medicaid practice: there is no Medicare billing on file and lifetime Medicaid revenue on record is $30.4M, indicating the organization’s entire reported Medicare/Medicaid footprint is concentrated in Medicaid. The absence of Medicare activity means comparative national Medicare analyses are not applicable for this entity.

Revenue is highly concentrated in a small set of pediatric outpatient codes: the top three Medicaid codes (99213, 90460, 99391) account for 64.7% of the provider’s total Medicaid revenue. Those three codes individually are 99213: $12.6M (41.9%), 90460: $4M (13.1%), and 99391: $2.9M (9.7%), showing most dollars come from routine office visits, vaccine administration, and preventive well visits.

The code mix points to a high‑volume pediatric primary care and preventive services operation: heavy billing for 99213 (established E/M visits), multiple well‑child codes (99391, 99392, 99393, 99394), and vaccine administration codes (90460, 90471, 90670, 90686) indicates the practice focuses on routine follow‑up, well visits, and immunizations for children. These patterns are consistent with a clinic that prioritizes preventive care, childhood vaccination programs, and frequent short outpatient encounters.

For its top revenue drivers the provider is a dominant statewide performer: 99213 ranks #8 of 4050 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), 90460 ranks #4 of 613 providers in-state (100th percentile; extreme outlier), and 99391 ranks #3 of 482 providers in-state (100th percentile; extreme outlier). Those rankings indicate this practice is an outlier in Tennessee for high volumes of established visits, vaccine administration, and preventive well visits relative to peers.

Beyond the top three, the provider shows unusually high volumes of point‑of‑care and lab testing and vaccine administration that support a high‑throughput ambulatory model: codes such as 87880 (45.8K claims, ranks #6 of 995, 99th percentile; notably above typical state volume), 87804 (26.1K claims, 99th percentile), 87635 (8.5K claims, 94th percentile), and vaccine product codes 90686 (31.4K claims, ranks #1 of 889, 100th percentile; extreme outlier) and 90670 (19.2K claims, 99th percentile; extreme outlier) show breadth in rapid testing and immunization services. This mix suggests the clinic combines routine pediatric visits with onsite testing and high-volume vaccine delivery.

Claim‑level economics reinforce the operational picture without implying clinical complexity: 99213 has 233.8K claims with an average paid/claim of $54, while immunization code 90460 has 80.8K claims at $49 avg paid/claim and 99391 has 36.2K claims at $81 avg paid/claim. The large claim counts with modest per‑claim payments are consistent with a high‑volume ambulatory pediatric model that relies on throughput rather than high‑acuity, high‑reimbursement encounters.

Tenure is long enough to support an established referral and patient flow: the NPI was enumerated on 2006-10-20 (~20 years ago), indicating a multi‑year presence in the market that aligns with the high cumulative Medicaid volumes observed. Long enumeration plus extreme volume rankings implies sustained high utilization of pediatric preventive and immunization services.

Concentration of revenue in a few service lines presents both operational strengths and potential financial sensitivity: because 64.7% of Medicaid revenue is tied to 99213, 90460, and 99391, reimbursement changes, vaccine supply disruptions, or shifts in well‑child visit utilization could materially affect total revenue. From a payer or partner perspective, this pattern highlights where negotiation, quality monitoring, or capacity planning would have the greatest impact on the provider’s finances.

Medicaid: Complete Services Breakdown

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

80 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…	233,850	$50	$12.6M
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.	80,840	$50	$4M
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…	36,200	$80	$2.9M
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…	32,860	$90	$2.9M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	19,920	$90	$1.7M
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…	18,680	$80	$1.5M
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	21,050	$30	$610.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	6,430	$90	$604.8K
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.	45,770	$10	$595K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	8,240	$70	$593.3K

Showing 1–10 of 80

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Vip Midsouth, LLC — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

80 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	4	610	1,220	$40	$206K
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	3,760	610	$40	$202.3K
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…	6	520	470	$70	$187K
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…	8	4,050	620	$30	$183.9K
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…	47	130	370	$50	$183.3K
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	480	580	$60	$174.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	7	510	240	$70	$133.7K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	14	200	300	$60	$106K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	67	620	740	$20	$88.8K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	14	420	150	$80	$81.8K

Showing 1–10 of 80

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Group Effort Of Tennessee, LLC.	TN	Developmental Disabilities Clinic/Center	$0	$31.4M
Sumner Regional Medical Center LLC	TN	General Acute Care Hospital	$0	$11.8M
21st Century Rehabilitation Services	TN	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$9.5M
County Of Sumner	TN	Land Ambulance	$1.6M	$4.5M
Trinity Pediatrics, P.C.	TN	Pediatrics Physician	$0	$5.8M
Children's Dentistry Of Gallatin	TN	Pediatric Dentistry	$0	$5.4M
Emergency Physicians At Sumner PLLC	TN	Emergency Medical Services (Emergency Medicine) Physician	$0	$3.4M
Tamjeed Ahmed	TN	Hematology & Oncology Physician	$913.2K	$0
Dianna Shipley	TN	Medical Oncology Physician	$636.7K	$0
Anne Hensley	TN	Nurse Practitioner	$410.9K	$0

Vip Midsouth, 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