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

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

Partners In Pediatrics, LLC (NPI 1528233103)

Key Findings

Field	Value
Entity Type	Organization
Organization	Partners In Pediatrics, LLC
Address	8160 Seaton Pl
City	Montgomery
State	AL
ZIP	36116
Taxonomy	Primary Care Clinic/Center
NPI Enumerated	April 24, 2008

Payer Source	Total Paid
Medicaid	$14M
Medicare	$0

PARTNERS IN PEDIATRICS, LLC is effectively a single‑payer Medicaid practice: there is no Medicare billing on file and the provider reports $14M in lifetime Medicaid revenue. The NPI was enumerated on 2008-04-24 (~18 years ago), indicating an established presence in Montgomery, AL.

Revenue is highly concentrated in a few evaluation-and-management and preventive codes: the top 3 Medicaid codes by revenue account for 61.8% of this provider's total Medicaid revenue. Those codes are 99214 ($4.1M, 30.3%), 99213 ($3.1M, 22.5%), and 99391 ($1.2M, 9.0%), which together drive the majority of Medicaid receipts.

The claims mix and taxonomy (Primary Care Clinic/Center) indicate a pediatric primary-care model focused on high-volume office visits and well-child care: 99214 and 99213 are the largest revenue generators and 99391/99392 represent routine preventive visits and immunization encounters. This pattern is consistent with a practice organized around recurring outpatient follow-up and scheduled preventive care.

PARTNERS IN PEDIATRICS is a dominant statewide provider for routine E/M visits: 99214 is ranked #23 of 1990 providers in-state and 99213 is ranked #21 of 1988 providers in-state, both at the 99th percentile and labeled "extreme outlier." These ranks indicate volumes far above typical state peers for established-patient office visits.

Preventive and well-child services are also unusually concentrated: 99391 ranks #5 of 270 providers (99th percentile, "extreme outlier") and 99392 ranks #6 of 299 providers (98th percentile, "extreme outlier"). This reinforces that well-visits are a central operational focus rather than episodic, problem-based care.

Immunization and vaccine administration are a substantial secondary revenue stream and operational emphasis. High-volume vaccine and administration codes include 90460 (32.9K claims, $461.2K revenue, rank #1 of 225, 100th percentile, "extreme outlier"), 90461 (23.2K claims, $255K revenue, rank #1 of 161, 100th percentile, "extreme outlier"), 90670 (11.8K claims, $542.9K revenue, rank #4 of 258, 99th percentile, "extreme outlier"), 90723 (9K claims, $279.7K revenue, rank #3 of 131, 98th percentile), and 90680 (8.5K claims, $272.2K revenue, rank #5 of 204, 98th percentile).

The practice performs high-throughput point-of-care testing consistent with outpatient pediatrics: 87880 (27.3K claims, $328.2K revenue, rank #12 of 680, 98th percentile, "notably above typical"), 87804 (14.4K claims, $201.8K revenue, rank #29 of 793, 96th percentile, "typical, unremarkable"), and 87426 (3.5K claims, $83.4K revenue, rank #39 of 406, 91st percentile, "typical, unremarkable"). These volumes support on-site testing workflows for acute infections and respiratory surveillance.

Taken together, the code mix and percentile ranks portray PARTNERS IN PEDIATRICS as a major Medicaid pediatric provider in Alabama with concentrated revenue from established-patient E/M and preventive/vaccine services. Its pattern of extreme outlier volume across multiple pediatric visit and vaccination codes, combined with ~18 years of enumeration, suggests an entrenched, high-capacity primary-care pediatric operation serving Medicaid patients.

Medicaid: Complete Services Breakdown

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

58 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…	45,030	$90	$4.1M
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…	54,120	$60	$3.1M
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…	17,320	$70	$1.2M
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…	17,280	$70	$1.2M
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	11,800	$50	$542.9K
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.	32,950	$10	$461.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,480	$70	$405.4K
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.	27,350	$10	$328.2K
90723	The provider administers a combination inactivated vaccine intramuscularly to prevent multiple diseases, including diphtheria, tetanus, acellular pertussis, hepatitis B, and polio.	9,020	$30	$279.7K
90680	This code represents a live pentavalent rotavirus vaccine given by mouth in a three–dose schedule to protect against rotavirus infection.	8,510	$30	$272.2K

Showing 1–10 of 58

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

Partners In Pediatrics, LLC — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

58 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	23	1,990	680	$60	$201.7K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	252	330	140	$240	$197.4K
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…	21	1,990	560	$40	$185.6K
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…	5	270	1,360	$60	$159.7K
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	300	1,160	$50	$147.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	26	320	640	$50	$98.1K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	49	370	1,540	$10	$65K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	21	60	240	$100	$62.9K
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.	1	230	410	$40	$59.2K
87086	Culture, bacterial; quantitative, colony count, urine.	64	100	400	$10	$57.9K

Showing 1–10 of 58

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alabama Dept. Of Rehabilitation Services	AL	Case Management Agency	$0	$58.2M
Rehab Early Intervention	AL	Speech-Language Pathologist	$0	$39.3M
Health Care Authority For Baptist Health, An Affiliate Of Uabhs	AL	General Acute Care Hospital	$0	$16.7M
The Center For Pain Of Montgomery LLC	AL	Interventional Pain Medicine Physician	$0	$5.9M
Behavioral Medicine LLC	AL	Mental Health Counselor	$0	$5.9M
Alabama Smiles	AL	General Practice Dentistry	$0	$5.5M
Alabama Department Of Rehabilitation Services	AL	Multi-Specialty Clinic/Center	$0	$3.9M
Easter Seals Central Alabama	AL	Speech-Language Pathologist	$0	$2.2M
Excel Rehabilitation, LLC.	AL	Pediatric Occupational Therapist	$0	$1.9M
Farragut Dialysis, LLC	AL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.1M

Partners In Pediatrics, LLC — Billing Profile & Reimbursement Data

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Partners In Pediatrics, 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

Nearby Providers

Frequently Asked Questions

References