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.

Summit Medical Group, PLLC (NPI 1548349186)

Key Findings

Field	Value
Entity Type	Organization
Organization	Summit Medical Group, PLLC
Address	1275 Dick Lonas Rd Unit 101
City	Knoxville
State	TN
ZIP	37909
Taxonomy	Internal Medicine Physician
NPI Enumerated	November 3, 2006

Payer Source	Total Paid
Medicaid	$44.5M
Medicare	$0

This provider has effectively no Medicare footprint — “none below” indicates no Medicare billing on file — and is therefore functionally a single-payer Medicaid operator with $44.5M in lifetime Medicaid revenue. The absence of Medicare claims means Medicaid patterns dominate any payer-mix or competitive analysis for this NPI.

Revenue is highly concentrated: the top three Medicaid codes (99213, 99214, 90460) together account for 62.6% of the provider’s total Medicaid revenue. In dollar terms those top codes include 99213 at $15.5M (36.5% of Medicaid revenue), 99214 at $7.6M (17.9%), and 90460 at $3.4M (8.1%), indicating a small number of services drive the majority of payments.

The top codes indicate a primary care, high-volume ambulatory practice model: 99213 and 99214 are established-patient office/outpatient E/M visits, and 90460 is vaccine administration for patients up to 18 years of age. Combined with high-volume preventive medicine codes (99392, 99391, 99393, 99394), the mix suggests the operation delivers routine chronic and preventive care and runs an active immunization program, particularly for children and adolescents.

Competitive standing in-state is dominant for several high-revenue services: 99213 ranks #2 of 4050 providers in Tennessee (100th percentile; extreme outlier) and 99214 ranks #13 of 3759 (100th percentile; extreme outlier), showing this provider is far above typical state volume for core E/M visits. Vaccine and preventive codes are also extreme outliers (for example, 90460 ranks #8 of 613, 99392 ranks #4 of 519, and 99391 ranks #4 of 482 at the 99th–100th percentiles), indicating market leadership in well-child and vaccination workflows.

Diagnostic and infectious-disease testing is another material service line: 87651 (Strep A NAAT) generated $1.8M and ranks #1 of 201 providers in-state (100th percentile; extreme outlier), and 87502 (influenza multiplex) produced $1.7M and ranks #2 of 195 (99th percentile; extreme outlier). High volumes in 87635 (SARS–CoV‑2 testing), 87428, U0003, and 87636 further show extensive respiratory-pathogen testing activity alongside the clinical visit volume.

The provider reports substantial preventive screening and behavioral/developmental assessments at scale: 96110 (developmental screening) produced $778.2K and ranks in the 96th percentile, 96161 (caregiver risk questionnaire) produced $163.7K and ranks #4 of 230 (99th percentile; extreme outlier), and 96127 generated $149.3K (99th percentile). These data imply standardized screening workflows are embedded in visits and contribute meaningfully to revenue.

Reliance on a narrow set of high-volume codes represents concentration risk: with 62.6% of Medicaid revenue tied to 99213/99214/90460, changes in Medicaid policy, reimbursement, vaccination demand, or visit patterns could disproportionately affect revenue. Operational and payer-negotiation strategies should account for this concentration when modeling downside scenarios.

The NPI has been enumerated since 2006-11-03 (~20 years ago), indicating a long-tenured presence in the market. Combined with the provider’s dominant statewide ranks on multiple codes, the tenure supports a profile of an established practice with sustained, high-volume Medicaid activity across primary care, preventive pediatrics, and outpatient infectious-disease testing.

Medicaid: Complete Services Breakdown

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

212 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…	369,210	$40	$15.5M
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…	158,660	$50	$7.6M
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.	65,950	$50	$3.4M
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…	33,750	$80	$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…	31,630	$70	$2.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	23,190	$80	$1.8M
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.	46,160	$40	$1.8M
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…	17,880	$100	$1.7M
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…	23,030	$50	$1.1M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	9,330	$90	$811.6K

Showing 1–10 of 212

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

Summit Medical Group, PLLC — 20 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

212 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	20	100	400	$60	$524.7K
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…	138	360	350	$50	$414.4K
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…	305	440	530	$70	$282.3K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	8	40	200	$20	$234.7K
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…	182	300	480	$30	$221.2K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	68	70	250	$20	$215.6K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	69	70	270	$20	$215.5K
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.	8	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…	13	3,760	610	$40	$202.3K
0241U	N/A	22	70	870	$90	$197.2K

Showing 1–10 of 212

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Knoxville Pediatric Associates, P.C.	TN	Pediatrics Physician	$0	$6.1M
Michael Watterson	NC	Rheumatology Physician	$669.3K	$2.6K
Nila Alsheik	IL	Diagnostic Radiology Physician	$332.8K	$300.3K
Jeffrey Summers	TN	Internal Medicine Physician	$624.1K	$0
David Szczesniak	OH	Diagnostic Radiology Physician	$588.2K	$0
Joshua Kellerman	NJ	Diagnostic Radiology Physician	$525K	$0
Matthew Lowrance	TN	Retina Specialist (Ophthalmology) Physician	$502.4K	$0
John D'souza	OH	Diagnostic Radiology Physician	$470.9K	$0
Nzeadibenma Uzochukwu	IL	Diagnostic Radiology Physician	$84K	$360.8K
Fred Sammons	TN	Internal Medicine Physician	$415.2K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Omni Community Health, Inc.	TN	Community/Behavioral Health Agency	$0	$77.7M
Allergy Associates, P.A.	TN	Specialist	$0	$26.5M
Knoxville Pediatric Dentistry, PLLC	TN	General Practice Dentistry	$0	$11.2M
The Florence Crittenton Agency Inc	TN	Community/Behavioral Health Agency	$0	$10.7M
Bsp Enterprises, LLC	TN	In Home Supportive Care Agency	$0	$8M
Associated Pain Specialists, PC	TN	Pain Medicine Physician	$0	$6.8M
Jeremiah Bivins	TN	Allergy & Immunology Physician	$419.4K	$4.6M
Westbrook Medical Center, PLLC	TN	Family Medicine Physician	$0	$4M
James Miller	TN	Retina Specialist (Ophthalmology) Physician	$3.9M	$0
Nicholas Anderson	TN	Retina Specialist (Ophthalmology) Physician	$3M	$0

Summit Medical Group, PLLC — 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