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.

Springville Pediatrics LLC (NPI 1689187080)

Key Findings

Field	Value
Entity Type	Organization
Organization	Springville Pediatrics LLC
Address	350 Springville Station Blvd
City	Springville
State	AL
ZIP	35146
Taxonomy	Pediatrics Physician
NPI Enumerated	November 8, 2017

Payer Source	Total Paid
Medicaid	$10.4M
Medicare	$0

Payer mix is effectively single‑payer: Medicare billing is listed as none while Medicaid accounts for $10.4M of lifetime revenue, so the practice’s revenue profile is overwhelmingly Medicaid‑dependent. This concentration means any changes in state Medicaid policy or reimbursement could have outsized impact on overall revenue.

Revenue is extremely concentrated in a single encounter code: the precomputed top‑3 Medicaid codes account for 95.6% of this provider’s Medicaid revenue, and T1015 alone represents $9.8M (93.9% of Medicaid revenue) from 53K claims at $185 avg paid/claim. That level of dependence on one all‑inclusive clinic/encounter code signals a business model built around billed clinic encounters rather than a diversified set of higher‑value procedures.

Clinical/service‑line mix points to a high‑volume pediatric primary care and vaccination operation: the dominant T1015 (Clinic visit/encounter, all‑inclusive) plus numerous vaccine codes (for example, 90460 with 1.5K claims, $54 avg paid/claim, $82.1K revenue and 90700 with 3.5K claims, $9 avg paid/claim, $31.2K revenue) and respiratory/viral testing codes (for example, 87811 and 87804) indicate routine preventive visits, immunization delivery, and point‑of‑care infectious disease testing are core services. This profile is consistent with an office‑based pediatric practice that captures most patient contact through bundled clinic encounter billing.

Operational reimbursement pattern shows high volumes but low per‑claim Medicaid payments for E/M services: for example 99213 appears with 22.8K claims at $1 avg paid/claim for $22.8K total and 99214 has 7.5K claims at $1 avg paid/claim for $7.5K total. These low per‑claim payments alongside the large T1015 payments suggest the practice bills the all‑inclusive clinic encounter (T1015) for most visits while traditional E/M codes contribute limited Medicaid revenue.

Competitive standing within Alabama is mixed but not outlier: T1015 ranks #28 of 243 providers in‑state (89th percentile) and is annotated as typical, unremarkable volume, which indicates the practice is a high‑volume but not exceptional provider for that code statewide. Several vaccine and testing codes also sit in the upper percentiles (for example, 87811 at rank #29 of 303, 91th percentile; 87804 at rank #115 of 793, 86th percentile), signaling consistent above‑typical provision of vaccinations and point‑of‑care testing compared with in‑state peers rather than dominance concentrated across many service lines.

Tenure indicates an established local presence: the NPI was enumerated 2017-11-08 (~9 years ago), implying the entity has been operating long enough to build steady Medicaid volumes and claims patterns. That tenure supports interpretation of the current code mix as an operational norm rather than an early startup pattern.

Preventive and diagnostic testing comprise routine ancillary revenue but are small relative to T1015: codes such as 87633 (496 claims, $205 avg paid/claim, $101.7K revenue), 87804 (3.9K claims, $21 avg paid/claim, $82.4K revenue), and 87811 (2.9K claims, $27 avg paid/claim, $79.1K revenue) together reflect regular lab testing for respiratory pathogens and contribute operationally important, though numerically modest, revenue streams. These testing and immunization services support a typical pediatric clinic workflow and likely drive visit volume that is captured primarily under the all‑inclusive encounter code.

Medicaid: Complete Services Breakdown

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

46 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	52,980	$190	$9.8M
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…	500	$210	$101.7K
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.	3,920	$20	$82.4K
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.	1,520	$50	$82.1K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	2,930	$30	$79.1K
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.	3,790	$10	$49.2K
90700	This code represents a DTaP vaccine product administered into the muscle to protect against diphtheria, tetanus, and pertussis (whooping cough). It is used for children younger than 7 years of age.	3,470	$10	$31.2K
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…	22,780	$1	$22.8K
90713	This code represents an IPV vaccine product administered beneath the skin or into the muscle to protect against poliomyelitis (polio). This is an inactivated, or killed, virus vaccine.	2,480	$10	$22.3K
90648	This code represents a Haemophilus influenzae type b (Hib) vaccine product administered into the muscle to protect against Hib disease. This formulation uses a PRP–T conjugate and follows a four–dose…	2,650	$10	$21.2K

Showing 1–10 of 46

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

Springville Pediatrics LLC — 1 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

46 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	28	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…	47	100	470	$130	$1.2M
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…	204	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…	96	1,990	560	$40	$185.6K
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…	85	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…	82	300	1,160	$50	$147.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	125	320	640	$50	$98.1K
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.	53	230	410	$40	$59.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	113	300	330	$50	$56.3K
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…	85	260	910	$20	$47.2K

Showing 1–10 of 46

Springville Pediatrics LLC — Billing Profile & Reimbursement Data

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Springville Pediatrics LLC — 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

Frequently Asked Questions

References