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

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

Medical East Of Decatur Inc (NPI 1659518553)

Key Findings

Field	Value
Entity Type	Organization
Organization	Medical East Of Decatur Inc
Address	2941 Point Mallard Pkwy Se
City	Decatur
State	AL
ZIP	35603
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	January 14, 2009

Payer Source	Total Paid
Medicaid	$10.6M
Medicare	$0

MEDICAL EAST OF DECATUR INC is a Rural Health Clinic/Center in DECATUR, AL with an NPI enumerated on 2009-01-14 (~17 years ago). The provider shows no Medicare billing on file and reports $10.6M in lifetime Medicaid revenue, making its commercial/payer exposure effectively concentrated in Medicaid.

Revenue is highly concentrated around a small set of Medicaid codes: the top 3 Medicaid codes by revenue account for 91.6% of this provider's Medicaid receipts. In particular, T1015 drives the business, generating $9.1M (86.1% of Medicaid revenue), so bundled clinic-visit payments dominate the revenue base.

The code mix points to an operational model focused on bundled clinic encounters plus high-volume point-of-care testing and immunizations. High counts for lab and infectious-disease tests—87880 (18.6K claims, $241.7K, 2.3%), 87426 (7.2K claims, $180.2K, 1.7%), and 87804 (12.9K claims, $168K, 1.6%)—alongside numerous vaccine codes, indicate routine walk-in testing and immunization workflows consistent with a community RHC.

State-level competitive standing is mixed by code: T1015 ranks #18 of 243 (93th percentile; typical, unremarkable volume), while 99211 ranks #5 of 208 (98th percentile; notably above typical state volume) and 87880 ranks #19 of 680 (97th percentile; notably above typical state volume). This pattern suggests the clinic is a major participant for low-level office visits and strep testing within Alabama, even though its bundled clinic-visit volume is similar to many peer RHCs.

Certain utilization patterns are statistical outliers in the state dataset. For example, 99213 shows 55.1K claims and $110.2K revenue (1.0% of Medicaid revenue) and ranks #19 of 1988 (99th percentile; extreme outlier, far above typical state volume), paired with a very low average paid/claim of $2, which signals extremely high-volume, low-reimbursement encounters that may reflect specific clinic workflows or coding practices.

Preventive care and immunizations are a clear operational component: 99211 (3K claims, $337.1K, 3.2%), 99392 (3.2K claims, $19K), and multiple vaccine codes (for example, 90670 at 2.2K claims, $24.5K and 90680 at 1.7K claims, $14.9K) show consistent well-patient and pediatric vaccination activity. These volumes are consistent with a community-facing clinic that handles family care, well-child visits, and routine vaccinations.

Because $10.6M of lifetime revenue is concentrated in Medicaid and dominated by T1015, the provider has limited payer diversification and is exposed to any Medicaid policy or rate shifts affecting bundled clinic-visit reimbursement. Operational levers that change the mix of bundled visits versus discrete billable tests or alter the high-volume low-dollar visit patterns could have outsized effects on overall revenue due to the current concentration.

Medicaid: Complete Services Breakdown

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

66 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	77,480	$120	$9.1M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	2,960	$110	$337.1K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	18,590	$10	$241.7K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	7,210	$30	$180.2K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	12,920	$10	$168K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	640	$210	$134.2K
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…	55,090	$1	$110.2K
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…	870	$50	$40.2K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	3,540	$10	$35.4K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	2,230	$10	$24.5K

Showing 1–10 of 66

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Alabama Distribution

Medical East Of Decatur Inc — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Alabama

Full comparison — all codes billed, vs. Alabama median

66 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	18	240	6,820	$120	$2.9M
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	43	100	470	$130	$1.2M
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	83	90	500	$40	$303.6K
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…	129	1,990	680	$60	$201.7K
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…	19	1,990	560	$40	$185.6K
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.	85	100	480	$20	$165.1K
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…	77	270	1,360	$60	$159.7K
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…	80	300	1,160	$50	$147.8K
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…	49	110	610	$40	$143.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	62	320	640	$50	$98.1K

Showing 1–10 of 66

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Comfort Care Hospice, LLC	AL	Community Based Hospice Care Agency	$0	$1.7M
Marx Optical Inc	AL	Eyewear Supplier	$0	$1.2M
Kids Town Pediatrics, P.C.	AL	Pediatrics Physician	$0	$1.1M
Decatur Surgery Center LP	AL	Ambulatory Surgical Clinic/Center	$544.9K	$15.4K
Adnan Seljuki	AL	Internal Medicine Physician	$412.3K	$0
Decatur Diagnostic Laboratory, Inc.	AL	Clinical Medical Laboratory	$315.8K	$30.7K
Punuru Reddy	AL	Internal Medicine Physician	$298.1K	$0
Manish Arora	AL	Gastroenterology Physician	$189.9K	$0
Amber Whitfield	AL	Family Medicine Physician	$136.2K	$0
David Francis	AL	Family Medicine Physician	$116.1K	$300

Medical East Of Decatur 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