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

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

Wellmont Medical Associates Inc (NPI 1780986257)

Key Findings

Field	Value
Entity Type	Organization
Organization	Wellmont Medical Associates Inc
Address	105 W Stone Dr
City	Kingsport
State	TN
ZIP	37660
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	December 3, 2010

Payer Source	Total Paid
Medicaid	$27.8M
Medicare	$0

WELLMONT MEDICAL ASSOCIATES INC reports no Medicare billing on file while recording $27.8M in lifetime Medicaid revenue, making its Medicaid business effectively the sole payer relationship visible in these data. This single-payer profile concentrates payerside exposure and makes Medicaid reimbursement patterns the primary driver of the provider's financial footprint in our dataset.

Revenue concentration is heavily focused in a small set of Medicaid codes: 99214 ($8.1M, 194K claims, 31.4%), 99213 ($7.6M, 217.6K claims, 29.3%), and 0241U ($2.4M, 21.3K claims, 9.4%), which together account for 70.1% of the provider's total Medicaid revenue. This precomputed top-3 share indicates that a few service lines dominate overall Medicaid receipts and therefore operational and payer risk.

The code mix points to a high-volume outpatient pulmonary practice with substantial diagnostic testing capacity: large volumes of office E/M visits (99214 and 99213) dominate revenue while respiratory and infectious-disease testing codes (87651, 87635, 87502, 87804, 87880) together produce meaningful Medicaid revenue and claim volumes. The presence of sleep study code 95810 and procedural/inpatient codes suggests the practice also supports ancillary services beyond routine clinic visits, consistent with a multi-setting pulmonary specialty operation.

For statewide competitive standing, the provider is an outlier on key codes: 99214 ranks #10 of 3759 providers in-state (100th percentile; extreme outlier) and 99213 ranks #9 of 4050 (100th percentile; extreme outlier), while 0241U ranks #1 of 68 providers in-state (100th percentile; extreme outlier). These ranks indicate dominance for those services within Tennessee and imply material market share for routine pulmonary E/M and the specific 0241U service.

Operational throughput is very high: 217.6K Medicaid claims for 99213 and 194K claims for 99214 reflect sustained, large-volume office visit activity, while the average paid per claim is relatively modest ($35 for 99213 and $42 for 99214). This combination of very high claim counts with low-to-moderate per-claim payments indicates revenue generated primarily through volume rather than high reimbursement per encounter.

The provider runs a substantial diagnostic/testing footprint for respiratory pathogens: 87651 (34.2K claims, $32 avg paid/claim, $1.1M), 87635 (25.7K claims, $41 avg paid/claim, $1.1M), and 87502 (10.8K claims, $78 avg paid/claim, $843.4K) are all well above typical state volumes by rank and percentile. Multiple testing codes are labeled as extreme outliers or notably above typical state volume, signaling that testing services are a major operational line and a likely referral/throughput hub.

Inpatient and higher-acuity services are also part of the mix: 99232 (47.3K claims, $20 avg paid/claim, $946K), 99233 (12.6K claims, $24 avg paid/claim, $301.8K), and 99291 (1K claims, $81 avg paid/claim, $84.2K) indicate billing across observation/hospital subsequent visits and critical care. These data suggest the provider is active across outpatient and hospital settings, likely supporting both ambulatory pulmonary care and inpatient follow-up or critical-care episodes.

The provider's NPI was enumerated on 2010-12-03 (~16 years ago), indicating an established presence in the market. Coupled with sustained high volumes and top-state ranks on several codes, this tenure and scale suggest WELLMONT MEDICAL ASSOCIATES is an entrenched regional provider whose Medicaid utilization patterns and test volumes will be material considerations for payer network management and utilization monitoring.

Medicaid: Complete Services Breakdown

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

199 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…	194,010	$40	$8.1M
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…	217,630	$40	$7.6M
0241U	N/A	21,250	$120	$2.4M
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.	34,190	$30	$1.1M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	25,660	$40	$1.1M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	47,300	$20	$946K
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…	10,810	$80	$843.4K
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…	12,970	$60	$713.1K
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.	43,340	$10	$520.1K
99204	The provider sees a new 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 provider…	5,740	$70	$373.2K

Showing 1–10 of 199

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Wellmont Medical Associates Inc — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

199 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	146	360	350	$50	$414.4K
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.	42	100	670	$60	$342.9K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	24	40	1,860	$70	$294.9K
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…	168	440	530	$70	$282.3K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	222	240	840	$20	$259.2K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	138	180	480	$90	$245.5K
80050	The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the…	13	40	200	$20	$234.7K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	257	300	480	$30	$221.2K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	77	150	390	$60	$220.9K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	60	70	250	$20	$215.6K

Showing 1–10 of 199

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wellmont Medical Associates Inc	VA	Family Medicine Physician	$0	$24.6M
Takoma Regional Hospital Inc	TN	General Acute Care Hospital	$0	$20.1M
Blue Ridge Medical Management Corporation	TN	Family Nurse Practitioner	$0	$8M
Blue Ridge Medical Management Corporation	TN	Pediatrics Physician	$0	$2.9M
Blue Ridge Medical Management Corporation	TN	Internal Medicine Physician	$0	$2.8M
Blue Ridge Medical Managgement Corporation	TN	Internal Medicine Physician	$0	$2.2M
Sos Nalghranyan	FL	Hematology & Oncology Physician	$1.1M	$0
Harsha Vardhana	TN	Medical Oncology Physician	$941.1K	$66.6K
James Louthan	TN	Internal Medicine Physician	$735.7K	$0
Matthew Gestaut	TN	Radiation Oncology Physician	$446.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Holston Medical Group PC	TN	Family Medicine Physician	$0	$37M
Wellmont Health System	TN	General Acute Care Hospital	$0	$17.6M
Mountain States Health Alliance	TN	General Acute Care Hospital	$0	$15.5M
Watauga Dental Center, PLLC	TN	General Practice Dentistry	$0	$8M
Lovinginhomecareinc	TN	In Home Supportive Care Agency	$0	$5.3M
Harville Orthodontics PLLC	TN	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$4.7M
Sbh-kingsport	TN	Psychiatric Hospital	$0	$4M
Thompson Delivery Services LLC	TN	Non-emergency Medical Transport (VAN)	$0	$3.2M
Wellmont Cardiology Services	TN	Cardiovascular Disease Physician	$0	$3.1M
Courtney Pendergraft	TN	Family Nurse Practitioner	$2.8M	$0

Wellmont Medical Associates 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