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.

Carrollton Emergency Physicians, PC (NPI 1790724672)

Key Findings

Field	Value
Entity Type	Organization
Organization	Carrollton Emergency Physicians, PC
Address	705 Dixie St
City	Carrollton
State	GA
ZIP	30117
Taxonomy	Emergency Medicine Physician
NPI Enumerated	June 6, 2006

Payer Source	Total Paid
Medicaid	$11M
Medicare	$0

CARROLLTON EMERGENCY PHYSICIANS, PC shows effectively single‑payer activity: there is no Medicare billing on file and its reported lifetime Medicaid revenue is $11M, indicating the organization's billed patient mix and revenue stream are dominated by Medicaid payers. This concentration in a single public payer should be considered when evaluating reimbursement risk and contracting leverage.

Revenue is highly concentrated in three emergency department E/M codes: 99284 ($5M revenue, 45.7%), 99285 ($3.3M revenue, 29.7%), and 99283 ($2.1M revenue, 19.3%); the top three codes together account for 94.6% of the provider's total Medicaid revenue. Those three codes alone drive almost the entire Medicaid topline for this entity, so changes in ED visit volumes or reimbursement for these codes would disproportionately affect overall revenue.

The code mix is consistent with an ED‑centric practice: the largest revenue drivers are ED evaluation and management codes (99284, 99285, 99283), which aligns with the listed taxonomy of Emergency Medicine Physician. The presence of small volumes of critical care (99291 — 79 claims, $8.1K revenue) and routine ECG interpretation (93010 — 12.8K claims, $63.8K revenue) supports a clinical model focused on emergency department throughput with intermittent higher‑acuity or diagnostic services.

CARROLLTON is an outlier on state ED volume for certain codes: 99284 ranks #6 of 231 providers in‑state (98th percentile; extreme outlier), indicating an unusually high statewide volume for moderately complex ED visits. That rank and percentile position CARROLLTON as a dominant provider in Georgia for 99284 relative to peers, suggesting either large ED coverage, high ED visit counts, or an operational focus that generates this specific code mix.

The provider is also notably above typical state volume for the other high‑acuity ED codes: 99285 ranks #9 of 139 (94th percentile; notably above typical state volume) and 99283 ranks #11 of 237 (96th percentile; notably above typical state volume). Together these ranks show the practice is a major regional participant for both moderate and high‑level ED E/M services rather than a marginal or low‑volume ED group.

Lower‑revenue ancillary and outpatient codes are present but represent small shares: 99213 generated $250.1K (2.3% of Medicaid revenue) and ranks #184 of 917 in‑state (80th percentile; typical, unremarkable volume), while testing codes such as 87428 produced $104.9K (1.0%) and rank in typical ranges. This pattern reinforces that the business is ED‑focused rather than driven by office‑based continuity care or high ancillary revenue streams.

There are billing patterns worth noting for further operational review: the file shows 99053 with 2.8K claims and $0 avg paid/claim (0.0% of Medicaid revenue) and ranks #3 of 48 in‑state (96th percentile). High claim counts with reported $0 paid/claim for certain administrative/overnight facility codes may reflect billing/reporting practices or contractual reimbursement arrangements and should be interpreted in the context of payment rules and local Medicaid policies rather than as an automatic revenue source.

The provider has a long tenure in the NPI registry (enumerated 2006-06-06, ~20 years ago), which supports the view that the current high ED volumes and ranking positions are produced by an established operation rather than a short‑term surge. Given the tenure and the concentrated Medicaid revenue profile, analyses of network contracting, capacity, and Medicaid rate sensitivity will be especially relevant for payer/provider decision‑making.

Medicaid: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	72,490	$70	$5M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	36,530	$90	$3.3M
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.	44,030	$50	$2.1M
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…	4,170	$60	$250.1K
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…	1,460	$70	$104.9K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	12,760	$10	$63.8K
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…	700	$90	$59.8K
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.	2,420	$20	$38.7K
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…	270	$100	$28.1K
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,…	540	$40	$18.9K

Showing 1–10 of 23

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

Carrollton Emergency Physicians, PC — 2 of 17 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

23 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	9	140	200	$280	$1.9M
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.	6	230	120	$170	$937.5K
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.	11	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…	184	920	370	$60	$360.6K
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…	446	820	390	$70	$245K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	30	50	180	$220	$177.6K
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,…	204	360	370	$50	$153.6K
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…	64	310	90	$90	$136.3K
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…	15	60	180	$50	$76.4K
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…	112	130	480	$20	$59.9K

Showing 1–10 of 23

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tanner Medical Group Inc	GA	Cardiovascular Disease Physician	$0	$17.9M
Carrollton Ear, Nose And Throat, P.C.	GA	Otolaryngology Physician	$0	$2M
Apogee Medical Group Georgia	GA	Internal Medicine Physician	$0	$1.2M
West Georgia Ambulance Inc	GA	Ambulance	$1.1M	$0
Georgia Cataract And Eye Specialty Center LLC	GA	Ambulatory Surgical Clinic/Center	$1M	$0
Air Evac Ems, Inc.	GA	Air Ambulance	$511.6K	$0
John Arnold	GA	Nuclear Radiology Physician	$464.8K	$0
Charlie Rouse	GA	Cardiovascular Disease Physician	$412.2K	$0
Garland Berry	GA	Ophthalmology Physician	$336.5K	$0
Ho Lin	GA	Diagnostic Radiology Physician	$307.3K	$0

Carrollton Emergency Physicians, 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