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.

Capstone Health Services Foundation PC (NPI 1740397751)

Key Findings

Field	Value
Entity Type	Organization
Organization	Capstone Health Services Foundation PC
Address	850 Peter Bryce Blvd
City	Tuscaloosa
State	AL
ZIP	35401
Taxonomy	Family Medicine Physician
NPI Enumerated	August 24, 2006

Payer Source	Total Paid
Medicaid	$12.5M
Medicare	$0

This provider is effectively a single-payer Medicaid operation: Total Medicare revenue is listed as none while Total Medicaid revenue is $12.5M, and the NPI has been enumerated since 2006-08-24 (~20 years ago), indicating long-standing Medicaid activity and an established presence in the market. The absence of Medicare billing on file suggests payer exposure and contracting will be dominated by Medicaid dynamics rather than Medicare fee schedules or referral flows.

Revenue is highly concentrated in a small set of evaluation-and-management and preventive visit codes: the precomputed top three Medicaid codes (99213, 99214, 99391) together account for 58.9% of total Medicaid revenue. Individually those codes appear as $3.3M (28.4%) for 99213, $2.6M (22.1%) for 99214, and $982.3K (8.4%) for 99391, which signals that routine office E/M and preventive visits drive the bulk of revenue.

The code mix is consistent with a high-volume family medicine/primary care operation that also does substantial pediatric and preventive care: very large claim volumes for 99213 (52.1K claims) and 99214 (31.6K claims) plus high volumes of preventive codes 99391 (14.4K claims) and 99392 (14.6K claims) indicate day-to-day ambulatory management of established patients and systematic delivery of periodic well visits. This pattern supports an operational model focused on frequent, short outpatient encounters and scheduled preventive services rather than specialty procedures.

Several codes show statewide dominance or extreme outlier status, indicating strong competitive standing in Alabama for primary care and pediatric services. For example, 99213 ranks #24 of 1988 providers in-state (99th percentile; extreme outlier), 99214 ranks #36 of 1990 (98th percentile; notably above typical), and 99391 ranks #7 of 270 (98th percentile; notably above typical), which together suggest the provider is a major in-state source for routine E/M and preventive visits.

The practice appears to operate a high-volume pediatric vaccination and preventive screening program: vaccine codes such as 90686 ($235.2K, rank #3 of 363, 99th percentile; extreme outlier), 90670 ($211.1K, rank #7 of 258, 98th percentile; extreme outlier), 90680 ($159.1K, rank #3 of 204, 99th percentile; extreme outlier), and 90697 ($70.8K, rank #1 of 62, 100th percentile; extreme outlier) are all notably above typical statewide volumes. Combined with high volumes of well-child codes 99393 and 99381 and newborn code 99460 ($215.4K), these signals point to substantial pediatric throughput and routine immunization delivery.

Developmental screening activity is an exceptional outlier: 96110 appears with 26.6K claims for $319K in revenue (2.7% of Medicaid revenue) and ranks #1 of 145 providers in-state (100th percentile; extreme outlier). This suggests systematic use of standardized developmental screening in ambulatory workflows and may indicate either a large pediatric panel or programmatic emphasis on early childhood surveillance.

While ambulatory E/M and preventive services dominate, the provider also bills inpatient and newborn care at more typical levels: subsequent inpatient visit codes 99232 and 99233 ($201.7K and $365K respectively) and discharge management 99238 ($224.7K) are present and rank in the 90s percentiles or lower (described as typical, unremarkable volumes). This indicates some hospital-based activity but not at the same dominant scale as ambulatory Medicaid work.

Operational implications for payers and network planners include high patient throughput and concentrated Medicaid risk tied to frequent primary care visits and immunizations; examples include very large claim volumes like 52.1K claims for 99213 and 31.6K claims for 99214. These patterns suggest the provider will be a key Medicaid access point for routine primary and pediatric care, which matters for capacity planning, vaccine supply logistics, and value-based contracting focused on preventive care performance.

Medicaid: Complete Services Breakdown

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

104 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…	52,130	$60	$3.3M
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…	31,650	$80	$2.6M
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…	14,450	$70	$982.3K
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…	14,620	$70	$979.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,320	$70	$411K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	8,110	$50	$365K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	26,590	$10	$319K
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	6,030	$50	$289.2K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	13,070	$20	$235.2K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	3,350	$70	$224.7K

Showing 1–10 of 104

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

Capstone Health Services Foundation PC — 14 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

104 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	41	70	380	$60	$893.8K
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…	50	80	150	$1,540	$787.7K
87661	The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique.	40	40	1,540	$10	$397.4K
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	15	90	500	$40	$303.6K
87481	The lab analyst performs a test for Candida species using amplified nucleic acid probe technique.	22	30	1,190	$30	$272.8K
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…	36	1,990	680	$60	$201.7K
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…	287	330	140	$240	$197.4K
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…	24	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…	7	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…	9	300	1,160	$50	$147.8K

Showing 1–10 of 104

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Capstone Health Services Foundation PC	AL	Multi-Specialty Clinic/Center	$0	$1M
John Warren	AL	Internal Medicine Physician	$356.4K	$0
Mohannad Azzam	AL	Internal Medicine Physician	$282.3K	$0
Abilash Balmuri	AL	Hospitalist Physician	$207.7K	$0
Thomas Patton	AL	Neurology Physician	$128.1K	$0
Brian Hogan	AL	Neurology Physician	$112.4K	$0
Brian Perrin	AL	Neurology Physician	$110.6K	$0
Scott Boyken	AL	Sports Medicine (Family Medicine) Physician	$107.3K	$0
Jennifer Burdette	AL	Family Medicine Physician	$103.6K	$0
David Panting	FL	Psychiatry Physician	$81.9K	$20.8K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Dch Healthcare Authority	AL	General Acute Care Hospital	$0	$16M
Whatley Health Services Inc	AL	Federally Qualified Health Center (FQHC)	$0	$8.8M
Northstar Ems, Inc.	AL	Land Ambulance	$2.1M	$5.6M
Greater Alabama Health Network	AL	Case Management Agency	$0	$5.1M
Relias Emergency Medicine Specialists Of Regional, LLC	AL	Emergency Medicine Physician	$0	$4.4M
Tuscaloosa Neonatal PC	AL	Neonatal-Perinatal Medicine Physician	$0	$2.9M
Dva Healthcare Of Tuscaloosa LLC	AL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.1M
Neonatal Medical Care P.C.	AL	Neonatal-Perinatal Medicine Physician	$0	$1.7M
Greater Alabama Health Network	AL	Exclusive Provider Organization	$0	$1.4M
Samuel Taylor	AL	Retina Specialist (Ophthalmology) Physician	$1.3M	$0

Capstone Health Services Foundation PC — Billing Profile & Reimbursement Data

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Capstone Health Services Foundation PC — 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