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.

Knoxville Hma Physician Management, LLC (NPI 1629356969)

Knoxville Hma Physician Management, LLC is a pulmonary disease physician provider located in Knoxville, Tennessee. This profile covers 0 Medicare and 163 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	Knoxville Hma Physician Management, LLC
Address	4711 Centerline Dr Ste 100
City	Knoxville
State	TN
ZIP	37917
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	August 3, 2011

Payer Source	Total Paid
Medicaid	$8.7M
Medicare	$0

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

163 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…	100,170	$30	$2.9M
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…	76,920	$30	$1.9M
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…	13,340	$60	$800.5K
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.	9,670	$60	$599.7K
99203	The provider sees a new 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 provider…	7,110	$40	$284.2K
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.	3,560	$40	$156.5K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	2,750	$50	$148.3K
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…	3,150	$50	$144.8K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	1,870	$70	$127.4K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	3,190	$40	$121.1K

Showing 1–10 of 163

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

Knoxville Hma Physician Management, LLC — 8 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

163 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	53	80	100	$1,260	$405.3K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	26	60	320	$140	$346.9K
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.	23	100	670	$60	$342.9K
76820	The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when…	10	50	490	$50	$333.3K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	33	150	390	$60	$220.9K
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.	2	170	340	$190	$206.8K
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.	295	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…	25	3,760	610	$40	$202.3K
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…	49	4,050	620	$30	$183.9K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	105	130	370	$50	$183.3K

Showing 1–10 of 163

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cocke County Hma, LLC	TN	General Acute Care Hospital	$0	$18.4M
William Thetford	FL	Foot & Ankle Surgery Podiatrist	$481.5K	$0
Adam Shrewsberry	TN	Urology Physician	$476.7K	$0
Nilesh Patel	TN	Radiation Oncology Physician	$329.6K	$0
Srinivas Boppana	TN	Radiation Oncology Physician	$324.8K	$0
Sean Delair	TN	Urology Physician	$208.9K	$0
Harold Silver	TN	Gastroenterology Physician	$199.2K	$100
Joseph Veys	GA	Urology Physician	$178.3K	$0
David Harrison	TN	Foot & Ankle Surgery Podiatrist	$149.8K	$0
Mancel Wakham	TN	Family Medicine Physician	$69.8K	$77.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Helen Ross Mcnabb Center	TN	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$198.7M
University Of Tn Medical Center Home Care Services, LLC	TN	Community Based Hospice Care Agency	$0	$7.8M
Sertoma Center, Inc.	TN	Developmentally Disabled Services Day Training Agency	$0	$7.4M
Knox County Goverment	TN	Public Health or Welfare Agency	$0	$2.6M
Michael Chavin	TN	Pain Medicine (Anesthesiology) Physician	$38.9K	$1.1M
Douglas Luttrell	TN	Nurse Practitioner	$145.3K	$0
Robert Hancock	TN	Podiatrist	$129.5K	$0
Heather Sandberg	TN	Podiatrist	$128.7K	$0
David Sandberg	TN	Podiatrist	$88.1K	$0
Melody Stump	TN	Family Nurse Practitioner	$83K	$0

Knoxville Hma Physician Management, LLC — Billing Profile & Reimbursement Data

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Knoxville Hma Physician Management, LLC — 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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