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.

Colonial Family Practice, LLC (NPI 1518074640)

Colonial Family Practice, LLC is a family medicine physician provider located in Sumter, South Carolina. This profile covers 0 Medicare and 174 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	Colonial Family Practice, LLC
Address	325 Broad St. Ste 100
City	Sumter
State	SC
ZIP	29150
Taxonomy	Family Medicine Physician
NPI Enumerated	August 24, 2006

Payer Source	Total Paid
Medicaid	$9.5M
Medicare	$0

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

174 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…	90,340	$50	$4.7M
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…	52,960	$40	$2.3M
0241U	N/A	3,130	$130	$391.1K
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…	5,170	$40	$222.3K
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…	2,820	$80	$220.2K
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,…	3,960	$40	$170.2K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	3,250	$50	$165.5K
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…	3,220	$40	$132K
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.	5,000	$20	$104.9K
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.	4,320	$20	$103.7K

Showing 1–10 of 174

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

Colonial Family Practice, LLC — 2 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

174 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…	91	210	320	$130	$707.4K
80048	The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood…	36	150	2,500	$50	$324.9K
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…	151	280	600	$90	$299K
0241U	N/A	21	50	1,840	$90	$291.4K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	60	90	730	$60	$275.7K
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…	35	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	46	710	350	$60	$247.2K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	89	100	1,390	$80	$246.6K
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…	9	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…	140	380	160	$100	$226.8K

Showing 1–10 of 174

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
David Whaley	SC	Family Medicine Physician	$595.2K	$0
John Baker	SC	Neurology Physician	$453.6K	$0
Nzeadibenma Uzochukwu	IL	Diagnostic Radiology Physician	$84K	$360.8K
Clayton Lowder	SC	Family Medicine Physician	$340.1K	$0
Monish Merchant	FL	Vascular & Interventional Radiology Physician	$306.8K	$120
Mitchell Grunsky	SC	Family Medicine Physician	$299.1K	$0
Thomas Lucas	SC	Family Medicine Physician	$290.5K	$0
Ike Stewart	SC	Family Medicine Physician	$282.5K	$0
Christopher Mahr	SC	Family Medicine Physician	$228.9K	$0
Joseph Adams	NC	Family Medicine Physician	$219.1K	$3K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health-midlands	SC	General Acute Care Hospital	$0	$28.1M
Sumter Pediatrics, P.A.	SC	Pediatrics Physician	$0	$24.4M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$17.3M
Tandem Health Sc	SC	Federally Qualified Health Center (FQHC)	$0	$7.8M
Prisma Health Tuomey	SC	Emergency Medicine Physician	$0	$6.8M
Wesmark Dental Health Center	SC	General Practice Dentistry	$0	$6.3M
Addus Healthcare (south Carolina), Inc.	SC	In Home Supportive Care Agency	$0	$5.5M
Carolina Children's Dentistry, LLC	SC	Pediatric Dentistry	$0	$5.2M
Sumter School District	SC	Local Education Agency (LEA)	$0	$4.2M
Kool Smiles, PC	SC	General Practice Dentistry	$0	$4.2M

Colonial Family Practice, LLC — Billing Profile & Reimbursement Data

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Colonial Family Practice, LLC — 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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