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.

Carolina Health Centers, Inc. (NPI 1518238690)

Field	Value
Entity Type	Organization
Organization	Carolina Health Centers, Inc.
Address	23265 Highway 76 E
City	Clinton
State	SC
ZIP	29325
Taxonomy	Pediatrics Physician
NPI Enumerated	January 20, 2012

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

Medicaid: Complete Services Breakdown

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

47 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…	15,240	$180	$2.7M
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…	14,510	$190	$2.7M
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…	4,370	$170	$734.3K
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…	2,860	$180	$502.8K
T1015	Clinic visit/encounter, all-inclusive	1,930	$190	$375K
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…	4,240	$60	$254.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,130	$190	$214.9K
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.	3,600	$10	$39.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	180	$160	$29.7K
G9153	Mapcp demonstration - physician incentive pool	890	$30	$29.2K

Showing 1–10 of 47

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

Carolina Health Centers, Inc. — 1 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

47 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…	209	210	320	$130	$707.4K
T1015	Clinic visit/encounter, all-inclusive	233	350	3,560	$30	$525.5K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	641	650	800	$120	$413.8K
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…	49	280	600	$90	$299K
90832	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…	125	160	270	$70	$268.1K
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…	164	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	639	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…	106	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…	71	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.	96	390	100	$100	$148.3K

Showing 1–10 of 47

Related Providers

Other providers that share a Tax Identification Number (TIN) with Carolina Health Centers, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carolina Health Centers, Inc.	SC	Pediatrics Physician	$0	$20.2M
Carolina Health Centers, Inc.	SC	Federally Qualified Health Center (FQHC)	$0	$3.3M
Melanie Johnson-bailey	SC	Family Medicine Physician	$341.3K	$0

Nearby Providers

Other providers in the same ZIP code as Carolina Health Centers, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prisma Health-upstate	SC	General Acute Care Hospital	$0	$13.1M
Piedmont Pediatrics LLC	SC	Pediatrics Physician	$0	$8.4M
Laurens School District 56	SC	Local Education Agency (LEA)	$0	$3.1M
Lifesource Of North Carolina	SC	General Practice Physician	$0	$3.1M
Hospice Of Laurens County Inc	SC	Community Based Hospice Care Agency	$0	$2.6M
Surgery & Laser Center At Professional Park LLC	SC	Ambulatory Surgical Clinic/Center	$1.3M	$49.8K
James Loging	SC	Orthopaedic Surgery Physician	$779.6K	$0
Harvard Riddle	SC	Ophthalmology Physician	$547K	$0
Samuel Montgomery	SC	Ophthalmology Physician	$543.3K	$1.5K
Giridhar Gundu	SC	Physical Medicine & Rehabilitation Physician	$240.1K	$0

Carolina Health Centers, Inc. — Billing Profile & Reimbursement Data

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Carolina Health Centers, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References