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.

Heritage Medical Associates PC (NPI 1548284060)

Heritage Medical Associates PC is a internal medicine physician provider located in Nashville, Tennessee. This profile covers 0 Medicare and 68 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	Heritage Medical Associates PC
Address	222 22nd Ave N
City	Nashville
State	TN
ZIP	37203
Taxonomy	Internal Medicine Physician
NPI Enumerated	July 27, 2006

Payer Source	Total Paid
Medicaid	$5.6M
Medicare	$0

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

68 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…	48,930	$40	$1.9M
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.	17,700	$40	$743.4K
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…	9,850	$60	$541.6K
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…	6,210	$70	$428.4K
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…	13,570	$30	$420.7K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	3,260	$110	$372K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,390	$70	$298.2K
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…	3,620	$60	$220.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,320	$70	$97.7K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	1,980	$50	$93.2K

Showing 1–10 of 68

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

Heritage Medical Associates PC — 2 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

68 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	37	50	140	$850	$541.1K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	47	70	160	$500	$421.5K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	41	80	330	$170	$342.3K
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.	47	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…	332	3,760	610	$40	$202.3K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	16	70	130	$140	$193.9K
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…	57	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…	86	4,050	620	$30	$183.9K
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…	88	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.	56	510	240	$70	$133.7K

Showing 1–10 of 68

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Victor Byrd	TN	Rheumatology Physician	$1.3M	$0
Christian Rhea	TN	Rheumatology Physician	$1.3M	$0
Elizabeth Lyons	TN	Rheumatology Physician	$1.2M	$0
Brent Moody	TN	MOHS-Micrographic Surgery Physician	$428.6K	$0
Susan Harwell	TN	Rheumatology Physician	$323.5K	$0
Morgan Parker	TN	Ophthalmology Physician	$270.6K	$0
Sean Ryan	TN	Internal Medicine Physician	$260.9K	$0
Seth Banks	TN	Internal Medicine Physician	$181.6K	$0
Subir Prasad	TN	Neurology Physician	$171.9K	$0
Obinna Umunakwe	TN	Ophthalmology Physician	$144.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hca Health Services Of Tennessee, Inc.	TN	General Acute Care Hospital	$0	$45.9M
Pediatrix Medical Group Of Tennessee, P.C.	TN	Neonatal-Perinatal Medicine Physician	$0	$32.3M
Saint Thomas Medical Partners	TN	Internal Medicine Physician	$0	$21.9M
Radiology Alliance PC	TN	Diagnostic Radiology Physician	$0	$13.2M
Emergency Medicine Services Of Tn, PC	TN	Emergency Medicine Physician	$0	$12.9M
Tennessee Maternal-fetal Medicine LLC	TN	Specialist	$0	$12.5M
The Next Door, Inc.	TN	Substance Abuse Rehabilitation Facility	$0	$8.6M
Tennessee Oncology PLLC	TN	Hematology & Oncology Physician	$0	$8.5M
Vcphcs Ix, LLC	TN	Substance Use Disorder Rehabilitation Clinic/Center	$257.7K	$6.6M
Tennessee Retina PC	TN	Retina Specialist (Ophthalmology) Physician	$0	$6M

Heritage Medical Associates PC — Billing Profile & Reimbursement Data

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Heritage Medical Associates PC — 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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