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.

Sweetwater Hospital Association (NPI 1558995399)

Sweetwater Hospital Association is a obstetrics & gynecology physician provider located in Sweetwater, Tennessee. This profile covers 0 Medicare and 106 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	Sweetwater Hospital Association
Address	304 Wright St
City	Sweetwater
State	TN
ZIP	37874
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	March 2, 2020

Payer Source	Total Paid
Medicaid	$2.4M
Medicare	$0

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

106 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…	21,700	$40	$889.5K
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…	26,150	$30	$784.5K
99442	N/A	4,070	$30	$110K
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…	4,250	$20	$97.7K
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…	1,680	$50	$79.1K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	640	$110	$72K
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…	630	$70	$42.3K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	2,760	$10	$33.1K
99441	N/A	2,010	$20	$30.1K
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…	550	$50	$28.8K

Showing 1–10 of 106

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

Sweetwater Hospital Association — 5 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

106 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	44	60	1,340	$50	$1.1M
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	66	100	670	$60	$342.9K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	63	170	340	$190	$206.8K
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…	146	3,760	610	$40	$202.3K
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…	225	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…	161	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…	142	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.	202	510	240	$70	$133.7K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	47	80	70	$200	$121.4K
99204	The provider sees a new 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 provider…	550	1,080	120	$80	$90.7K

Showing 1–10 of 106

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sweetwater Hospital Association	TN	General Acute Care Hospital	$0	$12.9M
Laurence James	TN	Internal Medicine Physician	$95.1K	$83.6K
Abdelhamid Alsharif	TN	Pulmonary Disease Physician	$80.8K	$0
Carl Goins	TN	Physician Assistant	$50K	$0
Thomas Vance	TN	Family Nurse Practitioner	$22.4K	$0
Robert Cummings	TN	Physician Assistant	$22.3K	$0
Michelle Davis	TN	Nurse Practitioner	$20.2K	$0
Ivy Massengale	TN	Physician Assistant	$15.9K	$0
Gregory Mckinney	WY	Certified Registered Nurse Anesthetist	$3.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Med-trans Corporation	TN	Air Ambulance	$426.3K	$136.7K
David Norris	TN	Diagnostic Radiology Physician	$22.8K	$66.2K
Tina James	TN	Diagnostic Radiology Physician	$14.9K	$70.8K
Lynda Rogers	TN	Diagnostic Radiology Physician	$30.6K	$0

Sweetwater Hospital Association — Billing Profile & Reimbursement Data

Sign up for Sweetwater Hospital Association — Billing Profile & Reimbursement Data policy alerts

Sweetwater Hospital Association — Billing Profile & Reimbursement Data

Sign up for Sweetwater Hospital Association — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References