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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Coastal Pediatric Associates, P.A. (NPI 1770700759)

Key Findings

Field	Value
Entity Type	Organization
Organization	Coastal Pediatric Associates, P.A.
Address	2067 Charlie Hall Blvd
City	Charleston
State	SC
ZIP	29414
Taxonomy	Pediatrics Physician
NPI Enumerated	April 19, 2007

Payer Source	Total Paid
Medicaid	$25M
Medicare	$0

This provider is effectively single‑payer in the available data: Medicare billing is absent (no Medicare billing on file) while total Medicaid revenue is $25M, indicating the practice’s commercial and Medicare exposure is either minimal or not represented here. Analyses and payer-contracted strategies should therefore treat Medicaid as the operating baseline for this entity.

Revenue is heavily concentrated in a very small set of evaluation-and-management and preventive visit codes: the top three Medicaid codes (99214, 99213, 99392) account for 61.8% of the provider’s total Medicaid revenue. Those three codes alone represent $7.9M (99214), $4.9M (99213), and $2.4M (99392) of the $25M Medicaid total, so any reimbursement or utilization shifts for office E/M or preventive visit codes would disproportionately affect overall revenue.

The code mix indicates a high-volume pediatric primary care operation focused on established patient visits and well-child/preventive services. High-volume E/M codes 99214 (85.5K claims, $93 avg paid/claim) and 99213 (76.5K claims, $64 avg paid/claim) together with preventive codes 99392 (24.3K claims, $98 avg paid/claim), 99391, 99393 and 99394, and large vaccine administration counts (90460, 90461) point to a clinic model that prioritizes routine outpatient visits, scheduled well visits, and in‑office immunizations.

Coastal Pediatric Associates is a dominant statewide performer on core pediatric visit codes: 99214 ranks #10 of 2483 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code) and 99213 ranks #19 of 2766 providers in-state (99th percentile; extreme outlier, far above typical state volume for this code). Preventive code 99392 also ranks at the top of peers (#6 of 377; 99th percentile; extreme outlier, far above typical state volume for this code), signaling the practice is a major player in pediatric outpatient volume across South Carolina.

The practice delivers high volumes of ancillary pediatric services in addition to visits: 90460 shows 65.7K claims generating $2.2M (rank #5 of 652; 99th percentile; extreme outlier, far above typical state volume for this code), and testing codes such as 87426 (8.1K claims, $423.2K; ranks #12 of 236; 95th percentile; notably above typical state volume for this code) and U0002 (2K claims, $107.9K; ranks #8 of 53; 87th percentile; typical, unremarkable volume for this code) indicate in-office vaccination and infectious-disease testing capabilities. These service lines support a full-service pediatric outpatient footprint rather than a narrowly specialized clinic.

Operational scale and longevity support the observed volumes: the NPI was enumerated 2007-04-19 (~19 years ago), consistent with an established practice capable of sustaining very large claim volumes (for example, 85.5K claims for 99214 and 76.5K claims for 99213). That tenure and throughput imply mature workflows and capacity for high patient throughput, important context for network contracting or capacity assessments.

Because top visit codes are so central to revenue, the practice has concentrated exposure to policy or payment changes affecting E/M and preventive visit reimbursement; the top three codes make up 61.8% of Medicaid revenue, so payer negotiations, coding policy updates, or utilization-management efforts targeting those codes would have outsized budgetary impact. Given the provider’s extreme outlier status on key E/M codes, any audit, reimbursement change, or network strategy should explicitly model effects on 99214 and 99213 volumes.

Medicaid: Complete Services Breakdown

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

77 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…	85,480	$90	$7.9M
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…	76,500	$60	$4.9M
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…	24,310	$100	$2.4M
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…	25,780	$90	$2.3M
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.	65,750	$30	$2.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	11,570	$100	$1.1M
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	20,340	$20	$488.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3,980	$110	$426.1K
G9153	Mapcp demonstration - physician incentive pool	8,320	$50	$424.5K
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,…	8,140	$50	$423.2K

Showing 1–10 of 77

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Coastal Pediatric Associates, P.A. — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

77 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	568	650	800	$120	$413.8K
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…	8	280	600	$90	$299K
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	2,770	210	$60	$254.5K
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…	10	2,480	350	$80	$246K
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…	6	380	160	$100	$226.8K
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…	245	410	330	$50	$152.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8	390	100	$100	$148.3K
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	8	50	340	$80	$129.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	18	340	110	$110	$107.9K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	164	610	190	$50	$98.4K

Showing 1–10 of 77

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Carolina Dept Of Mental Health Accounting Office	SC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$65.9M
Bon Secours St. Francis Xavier Hospital Inc.	SC	General Acute Care Hospital	$0	$35.9M
Eric Jablon	SC	Ophthalmology Physician	$8.9M	$0
Charleston Ent Associates, LLC	SC	Otolaryngology Physician	$0	$7.1M
John Kerrison	SC	Ophthalmology Physician	$5M	$0
Charleston Neurosciences Institute	SC	Ophthalmology Physician	$0	$4.2M
Physicians Eye Surgery Center LLC	SC	Ambulatory Surgical Clinic/Center	$3.9M	$70.1K
Daniel Alfaro	SC	Ophthalmology Physician	$3.6M	$0
Michael Johnson	SC	Ophthalmology Physician	$3M	$0
Bon Secours St Francis Xavier Hospital, Inc.	SC	Emergency Medicine Physician	$0	$2.3M

Coastal Pediatric Associates, P.A. — Billing Profile & Reimbursement Data

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Coastal Pediatric Associates, P.A. — 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

Nearby Providers

Frequently Asked Questions

References