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.

Gadsden Pediatric Clinic, P.A. (NPI 1801851431)

Key Findings

Field	Value
Entity Type	Organization
Organization	Gadsden Pediatric Clinic, P.A.
Address	501 Bay St
City	Gadsden
State	AL
ZIP	35901
Taxonomy	Pediatrics Physician
NPI Enumerated	April 18, 2006

Payer Source	Total Paid
Medicaid	$11.5M
Medicare	$0

GADSDEN PEDIATRIC CLINIC, P.A. is effectively a Medicaid-focused pediatric practice: there is no Medicare billing on file while reported Medicaid revenue totals $11.5M, indicating the provider’s patient mix and payer exposure are dominated by Medicaid rather than Medicare. The NPI was enumerated in 2006-04-18 (~20 years ago), signaling long tenure in the market which supports accumulated Medicaid volumes and established referral or patient relationships.

Revenue concentration is highly focused: the top three Medicaid codes account for 63.7% of the provider’s total Medicaid revenue, showing the practice depends on a small set of high-volume outpatient E/M and diagnostic services for most of its payments. This concentration suggests business risk if reimbursement or utilization patterns change for those specific codes.

The single largest revenue driver is 99213, which generated $4.9M (44.6% of Medicaid revenue) from 73.9K claims at an average $66 paid/claim. The profile — heavy use of 99213 and substantial volume of 99214 as well — indicates the clinic delivers high-volume established patient office visits and routine outpatient pediatric care rather than procedural or specialty services.

Competitive standing in-state is unusually strong for several common pediatric diagnostics and visits: the provider ranks #14 of 1988 for 99213 (99th percentile, extreme outlier) and #8 of 296 for 87635 (98th percentile, notably above typical state volume). These rankings indicate the clinic is a major local provider for routine E/M visits and high-volume COVID testing, far above typical peer volumes in Alabama.

Beyond E/M codes, the clinic shows elevated volumes for point-of-care and common pediatric testing and vaccines: high rank/percentile placements appear for influenza and rapid strep testing (87804, 87880), specimen collection for SARS-CoV-2 (G2023), and multiple childhood vaccine CPTs (90648, 90716, 90707). This mix reinforces a workflow oriented around well-child visits, immunization, and on-site rapid diagnostic testing, consistent with a primary care pediatric ambulatory model.

Several procedure codes are statistical outliers or notably above typical state volume, reflecting operational scale: 87880 ranks #10 of 680 providers (98th percentile, typical/unremarkable volume wording but very high placement), 87070 ranks #3 of 93 (98th percentile), and 85013 ranks #1 of 6 (100th percentile, notably above typical state volume). These placements suggest the clinic runs a substantial in-office testing program and/or associated lab processing relative to peers.

Although many preventive and vaccine codes (99392, 99391, 99393, 99394, 90670, 90680, 90686) appear at typical to strong percentiles (generally 89th–95th), their individual dollar contributions are modest compared with the dominant E/M code 99213. This pattern implies the clinic’s revenue mix is anchored by high-volume routine visits while preventive care and immunizations are consistent but secondary revenue sources.

Given the absence of Medicare billing, payer mix is effectively single-payer (Medicaid), which concentrates reimbursement risk and positions the clinic’s financial performance to Medicaid policy and enrollment changes. Analysts should treat Medicare-based benchmarks as not applicable here and instead benchmark against state Medicaid peers for utilization and reimbursement trends.

Medicaid: Complete Services Breakdown

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

70 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…	73,930	$70	$4.9M
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…	11,960	$100	$1.2M
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…	21,410	$40	$899.1K
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…	8,720	$60	$540.6K
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.	23,740	$20	$498.4K
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…	8,020	$60	$489.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6,750	$60	$431.7K
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.	27,440	$10	$356.7K
87070	The lab analyst performs the technical lab steps to culture a specimen from any source except urine, blood, or stool. This service involves aerobic culture, which refers to the presence of oxygen.…	23,310	$10	$233.1K
G2023	Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	13,550	$20	$203.2K

Showing 1–10 of 70

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

Gadsden Pediatric Clinic, P.A. — 10 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

70 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	72	100	470	$130	$1.2M
87801	The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique.	51	90	500	$40	$303.6K
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…	131	1,990	680	$60	$201.7K
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…	14	1,990	560	$40	$185.6K
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.	17	100	480	$20	$165.1K
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…	23	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…	20	300	1,160	$50	$147.8K
87634	The lab analyst performs a test for respiratory syncytial virus (RSV) antigen detection using amplified nucleic acid probe technique.	59	60	350	$30	$136.6K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	73	80	220	$70	$103.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	17	320	640	$50	$98.1K

Showing 1–10 of 70

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Quality Of Life Health Services, Inc	AL	Community Health Clinic/Center	$0	$16.8M
Pediatric Dentistry East P.C.	AL	Pediatric Dentistry	$0	$5.4M
Northeast Alabama Pediatrics, P.C.	AL	Pediatrics Physician	$0	$5.3M
Prime Healthcare Services - Gadsden LLC	AL	General Acute Care Hospital	$0	$3.9M
Etowah County Health Dept Fp Clinic	AL	Public Health or Welfare Agency	$0	$2.9M
Pediatric Dental Associates	AL	Pediatric Dentistry	$0	$2.4M
Carr Mental Wellness, LLC	AL	Psychiatry Physician	$0	$2.2M
Alabama Emergency Physician Partners, LLC	AL	Emergency Medicine Physician	$0	$1.9M
George C. Stacey, Jr. D.m.d. Family Denistry P.C.	AL	Dentist	$0	$1.6M
Northeast Alabama Eye Surgery Center	AL	Ambulatory Surgical Clinic/Center	$1.3M	$6.4K

Gadsden Pediatric Clinic, P.A. — Billing Profile & Reimbursement Data

Sign up for Gadsden Pediatric Clinic, P.A. — Billing Profile & Reimbursement Data policy alerts

Gadsden Pediatric Clinic, P.A. — Billing Profile & Reimbursement Data

Sign up for Gadsden Pediatric Clinic, P.A. — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References