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.

Adventist Health System Georgia Inc (NPI 1699791343)

Key Findings

Field	Value
Entity Type	Organization
Organization	Adventist Health System Georgia Inc
Address	1035 Red Bud Rd Ne
City	Calhoun
State	GA
ZIP	30701
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	July 14, 2006

Payer Source	Total Paid
Medicaid	$9.8M
Medicare	$0

This entity is effectively a single‑payer Medicaid operator: Total Medicaid revenue is $9.8M and there is no Medicare billing on file. The NPI was enumerated 2006-07-14 (~20 years ago), indicating a long-established presence in the market.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes account for 80.0% of this provider's total Medicaid revenue. Those top codes are 99213 ($4M, 42.4%), 99214 ($3M, 31.9%), and 87428 ($540.8K, 5.7%) — together they dominate the revenue profile.

The service mix is consistent with a high‑volume outpatient multi‑specialty clinic focused on evaluation and management visits: 99213 shows 93.2K claims with $43 avg paid/claim and 99214 shows 67K claims with $45 avg paid/claim, together representing the bulk of revenue. The predominance of mid‑level E/M codes (99213/99214) suggests the provider operates a busy clinic workflow seeing large numbers of established patients with a mix of low‑ to moderate‑complexity problems.

Competitive standing in the state is dominant for core office visits: 99213 ranks #9 of 917 providers in-state (99th percentile; extreme outlier) and 99214 ranks #6 of 824 providers in-state (99th percentile; extreme outlier). These ranks indicate this provider is an outlier in Georgia for outpatient visit volume and is among the highest‑volume Medicaid E/M practices statewide.

The provider also runs a high‑volume infectious disease testing operation: 87428 (SARS/flu immunoassay) is $540.8K (5.7% of Medicaid revenue) and ranks #1 of 60 providers in-state (100th percentile; extreme outlier). Additional point‑of‑care testing codes such as 87880 (28.2K claims, $337.8K, ranks #6 of 262; 98th percentile; notably above typical state volume) and 87804/87426/87635 are present, showing a sustained testing service line that supports high outpatient throughput.

Beyond the top codes, the code mix includes routine preventive and diagnostic services at modest levels — for example, 99391 ($188K, 2.0%) and 99392 ($137.7K, 1.5%) preventive visits, and 93010 EKG interpretation (19.6K claims, $97.8K, 1.0%). This breadth indicates the clinic provides general primary care and basic diagnostics alongside its high volume E/M and testing activity rather than being narrowly procedural.

The dependence on a small set of high‑volume E/M and testing codes introduces concentration risk: because the top 3 codes comprise 80.0% of Medicaid revenue, shifts in utilization patterns, Medicaid reimbursement policy, or testing demand could materially affect revenues. Analysts should treat changes in office‑visit or testing utilization as primary drivers of financial variability for this provider.

Taken together — long tenure (NPI enumerated 2006-07-14), dominant in‑state ranks for core E/M codes, and the #1 statewide position on 87428 — the profile is that of an established, high‑throughput Medicaid outpatient clinic in Calhoun, GA with significant market share for routine office visits and infectious disease testing.

Medicaid: Complete Services Breakdown

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

161 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	93,240	$40	$4M
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…	67,040	$50	$3M
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…	10,400	$50	$540.8K
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.	28,150	$10	$337.8K
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…	5,200	$60	$312.2K
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…	3,130	$60	$188K
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…	2,750	$50	$137.7K
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.	7,720	$20	$131.2K
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.	6,180	$20	$123.5K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	19,560	$10	$97.8K

Showing 1–10 of 161

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

Adventist Health System Georgia Inc — 5 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

161 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	183	230	120	$170	$937.5K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	14	20	190	$1,120	$833.4K
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.	217	240	170	$120	$779.3K
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…	9	920	370	$60	$360.6K
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.	41	40	220	$70	$299.7K
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…	6	820	390	$70	$245K
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…	16	20	40	$1,810	$234.1K
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…	51	180	680	$90	$226.7K
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…	45	180	720	$90	$204.2K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	20	60	670	$80	$194.5K

Showing 1–10 of 161

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Robert Styperek	GA	Clinical Cardiac Electrophysiology Physician	$413.7K	$0
Himanshu Patel	GA	Cardiovascular Disease Physician	$302.8K	$0
Charles Jackson	GA	Cardiovascular Disease Physician	$289.8K	$0
Carl Bevill	GA	Family Medicine Physician	$242.2K	$0
Harikrishnan Damodaran Nair	KY	Interventional Cardiology Physician	$234.8K	$0
George Myers	GA	Cardiovascular Disease Physician	$228.3K	$0
Hak Lee	GA	Urology Physician	$214.8K	$0
Daniel Ahn	GA	Ophthalmology Physician	$206.2K	$0
James Merritt	GA	Cardiovascular Disease Physician	$204.4K	$0
Victor Andress	GA	Urology Physician	$182K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Advance Rehabilitation For Kids Of Gordon County, Inc	GA	Rehabilitation Clinic/Center	$0	$9.5M
Gordon Emergency Physicians, LLC	GA	Emergency Medicine Physician	$0	$3.4M
Agc Pediatrics, LLC	GA	Specialist	$0	$2M
Adventist Health System Georgia Inc	GA	Land Ambulance	$644.3K	$0
Med-trans Corporation	GA	Air Ambulance	$341.6K	$0
Ralph Bowers	GA	Family Medicine Physician	$193.1K	$0
Shawn Haggard	GA	Clinical Social Worker	$0	$160.5K
Crossroads Treatment Center Of Calhoun, PC	GA	Methadone Clinic	$125.2K	$0
Charlotte Brooks	GA	Family Nurse Practitioner	$121.2K	$0
Jose Gomez	GA	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	$90.1K	$0

Adventist Health System Georgia Inc — Billing Profile & Reimbursement Data

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Adventist Health System Georgia 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