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

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

Phoebe Sumter Medical Center, Inc. (NPI 1609001312)

Key Findings

Field	Value
Entity Type	Organization
Organization	Phoebe Sumter Medical Center, Inc.
Address	126 Hwy 280 W
City	Americus
State	GA
ZIP	31719
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 26, 2009

Payer Source	Total Paid
Medicaid	$16.5M
Medicare	$0

PHOEBE SUMTER MEDICAL CENTER is effectively a Medicaid-focused provider: it has no Medicare billing on file and reports $16.5M in lifetime Medicaid revenue. The absence of any Medicare revenue makes the facility functionally single‑payer at scale in our dataset, which concentrates its financial exposure and competitive positioning within the Medicaid market rather than across both Medicare and Medicaid.

Revenue concentration is high: the precomputed top three Medicaid codes account for 43.5% of the provider’s total Medicaid revenue. Those top three contributors are 99284 ($2.8M, 33.7K claims), 99283 ($1.6M, 23.8K claims), and 74177 ($1.3M, 3K claims), which together drive nearly half of reported Medicaid receipts and point to concentrated service lines.

The code mix indicates an emergency-department and acute-imaging orientation: 99284 and 99283 are the two largest single-code revenue drivers and describe moderate- and low-level ED E/M visits respectively, while 74177 (CT abdomen/pelvis with contrast) is the third largest code. This combination—very high ED E/M claim counts alongside high-revenue CT imaging—suggests core operational emphasis on emergency care with on-site diagnostic imaging capacity to support ED throughput.

Competitive standing within Georgia is strong on several ED and procedural codes. 99284 ranks #14 of 231 providers in-state (94th percentile) and is explicitly described as “notably above typical state volume for this code,” indicating PHOEBE SUMTER is a comparatively high-volume provider for moderate-complexity ED visits; 99283 ranks #19 of 237 (92th percentile) but is labeled “typical, unremarkable volume,” so high claim counts coexist with a more ordinary statewide presence for that lower-severity ED code.

Several ancillary and procedure codes show elevated statewide presence reflecting throughput beyond raw ED visits: 96372 (therapeutic/prophylactic/subcutaneous or intramuscular injections) is at the 96th percentile and labeled “notably above typical state volume,” and CMP (80053) and CBC (85025) rank in the 90s percentiles, indicating heavy on-site lab utilization that supports frequent acute and observation care. These lab and injection volumes align with a high-volume ED/observation workflow rather than a low-utilization or outpatient clinic model.

Observation and infusion activity are material parts of the billing mix: G0378 (hospital observation, per hour) appears with 3.9K claims and $302.8K revenue (2.3% of Medicaid revenue), and multiple infusion/IV administration codes (96365, 96361, 96375, 96374, 96366) collectively appear across the top codes list. The presence of both per-hour observation billing and numerous IV administration codes supports an operational profile that manages short-term observation stays and frequent IV therapies as part of ED and observation care pathways.

Imaging breadth is notable beyond abdominal CT: 70450 (head CT without contrast) and 71260 (CT thorax with contrast) and multiple chest x‑ray codes (71045/71046) all show significant claim counts and revenue, which reinforces the profile of an ED-centric hospital with on-site radiology services handling a range of acute diagnostic needs. These imaging volumes, combined with high CT abdomen/pelvis revenue, suggest investment in cross-sectional imaging that likely supports regional emergency and trauma workflows.

Tenure is long enough to establish local presence: the NPI was enumerated on 2009-05-26 (~17 years ago), indicating an established facility rather than a recent entrant. In sum, the provider presents as an established, Medicaid-dependent acute-care hospital with above‑typical statewide volumes in moderate-complexity ED visits and supporting labs, injections, and CT imaging, making it a meaningful regional ED/imaging participant within Georgia Medicaid networks.

Medicaid: Complete Services Breakdown

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

248 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	33,710	$80	$2.8M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	23,770	$70	$1.6M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	3,020	$420	$1.3M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	6,110	$130	$781.6K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	3,970	$170	$678.9K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	7,230	$80	$549.6K
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	7,360	$70	$515.3K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	10,720	$40	$471.8K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	1,610	$290	$470.4K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	7,640	$60	$420.4K

Showing 1–10 of 248

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Phoebe Sumter Medical Center, Inc. — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

248 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	24	140	200	$280	$1.9M
97150	In this procedure, the provider supervises and directs therapeutic procedures like exercise therapy for a group of patients.	3	10	840	$90	$1.5M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	5	10	1,280	$270	$1.1M
G0378	Hospital observation service, per hour	9	20	2,070	$160	$1.1M
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…	21	40	850	$70	$983K
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	14	230	120	$170	$937.5K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	21	20	310	$900	$893.2K
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	19	240	170	$120	$779.3K
P9016	Red blood cells, leukocytes reduced, each unit	9	10	560	$550	$612K
87799	The lab analyst performs a test to quantify infection with an infectious agent, not otherwise specified in another code, using a nucleic acid probe technique. Use this code if you know the laboratory…	8	10	710	$30	$506K

Showing 1–10 of 248

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ramesh Donepudi	FL	Critical Care Medicine (Internal Medicine) Physician	$135.5K	$2.1K
Wael Azer	NJ	Emergency Medicine Physician	$78.9K	$0
Nathan Smith	SC	Surgery Physician	$52.1K	$0
Frank Vandy	SD	Vascular Surgery Physician	$38.5K	$0
Michael Pruitt	GA	Emergency Medicine Physician	$38.3K	$0
Toks Macarthy	WI	Hospitalist Physician	$35K	$1.5K
Faith Murray	GA	Psychiatric/Mental Health Nurse Practitioner	$25.2K	$0
James Black	GA	Emergency Medicine Physician	$24.9K	$0
Larry Medley	GA	Emergency Medicine Physician	$17.7K	$0

Phoebe Sumter Medical Center, Inc. — Billing Profile & Reimbursement Data

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Phoebe Sumter Medical Center, Inc. — 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