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.

Holston Medical Group PC (NPI 1831110667)

Key Findings

Field	Value
Entity Type	Organization
Organization	Holston Medical Group PC
Address	105 W Stone Dr
City	Kingsport
State	TN
ZIP	37660
Taxonomy	Family Medicine Physician
NPI Enumerated	July 21, 2006

Payer Source	Total Paid
Medicaid	$37M
Medicare	$0

HOLSTON MEDICAL GROUP PC reports $37M in lifetime Medicaid revenue and has no Medicare billing on file, making its operating footprint effectively single-payer Medicaid in scale. The provider’s NPI was enumerated 2006-07-21 (~20 years ago), indicating a long-tenured practice with sustained Medicaid activity rather than a balanced Medicare/Medicaid mix.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes by revenue account for 70.3% of this provider's total Medicaid revenue. Those top three are 99214 ($11.6M, 34.0%), 99213 ($10.7M, 31.3%), and 90460 ($1.7M, 5.1%), showing most dollars derive from established patient E/M visits plus pediatric vaccination services.

The code mix indicates a high-volume family medicine/primary care operation focused on office-based evaluation and management and preventive care. Very large claim counts for 99214 (247.7K claims) and 99213 (261.4K claims), together with substantial preventive visit codes such as 99392 (23.5K claims) and 99391 (27.5K claims), point to a practice model built on frequent longitudinal visits and well-child/adolescent services.

HOLSTON MEDICAL GROUP is a dominant statewide performer on core primary care codes: 99214 ranks #5 of 3759 providers in-state (100th percentile; extreme outlier, far above typical state volume) and 99213 ranks #5 of 4050 providers in-state (100th percentile; extreme outlier). The high ranks for 90460 (rank #15 of 613, 98th percentile; extreme outlier) further underscore market leadership in pediatric immunization delivery.

Preventive and pediatric services are a clear emphasis: 99392 ($1.6M, 4.7%) ranks #12 of 519 providers (98th percentile; extreme outlier) and 99391 ($1.6M, 4.7%) ranks #6 of 482 providers (99th percentile; extreme outlier). Additional established-well patient codes (99393, 99394) also sit at high percentiles, consistent with a practice that delivers large volumes of scheduled well visits.

The practice also provides substantial point-of-care diagnostic and infectious-disease testing alongside its primary care visits. High-volume lab/testing codes include 87502 (10.5K claims, $827.1K, rank #10 of 195, 95th percentile), 87635 (11.7K claims, $516.1K, rank #16 of 377, 96th percentile), 87651 (12.2K claims, $438.6K, rank #16 of 201, 93rd percentile), and 87811 (6.6K claims, $219K, rank #14 of 263, 95th percentile), indicating significant on-site or office-driven testing for respiratory and infectious conditions.

Revenue per-claim on the dominant E/M codes is modest relative to the volumes reported—99214 shows $47 avg paid/claim and 99213 shows $41 avg paid/claim—so overall revenue performance is driven by very high visit volumes rather than high unit reimbursement. Given the provider’s extreme outlier status on those volumes statewide, the practice appears optimized for throughput of routine E/M and preventive encounters.

The combination of ~20 years of enumeration, concentrated Medicaid revenue ($37M) and absence of Medicare claims suggests a stable, Medicaid-focused primary care platform that is a major statewide player for routine office visits, immunizations, and office-based testing. Analysts should treat this entity as a high-volume, Medicaid-centric family medicine provider when evaluating network capacity, access for pediatric/preventive care, or negotiations tied to visit-based reimbursement.

Medicaid: Complete Services Breakdown

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

236 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…	247,670	$50	$11.6M
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…	261,450	$40	$10.7M
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.	49,810	$40	$1.7M
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…	23,510	$70	$1.6M
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…	27,450	$60	$1.6M
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…	10,470	$80	$827.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10,950	$70	$744.9K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	22,640	$30	$701.8K
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…	11,440	$50	$537.6K
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…	11,730	$40	$516.1K

Showing 1–10 of 236

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

Holston Medical Group PC — 15 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

236 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	46	70	160	$500	$421.5K
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.	39	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…	37	40	1,860	$70	$294.9K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	85	150	390	$60	$220.9K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	29	170	340	$190	$206.8K
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.	15	610	1,220	$40	$206K
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…	5	3,760	610	$40	$202.3K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	41	70	130	$140	$193.9K
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…	12	520	470	$70	$187K
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…	5	4,050	620	$30	$183.9K

Showing 1–10 of 236

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
James Louthan	TN	Internal Medicine Physician	$735.7K	$0
Edward Fore	TN	Family Medicine Physician	$637K	$0
Rick Whiles	TN	Internal Medicine Physician	$634.1K	$0
Alison Whitman	VA	Family Medicine Physician	$386.8K	$0
Song Zang	MO	Rheumatology Physician	$341.3K	$0
Cynthia Partain	TN	Family Medicine Physician	$262.5K	$0
Charlotte Townsend	VA	Family Medicine Physician	$227.2K	$33.9K
Nicholas Harman	TN	Family Medicine Physician	$232.4K	$10.3K
Mary Francisco	TN	Pediatric Gastroenterology Physician	$182.5K	$38.4K
William Rogers	TN	Urology Physician	$198K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wellmont Medical Associates Inc	TN	Pulmonary Disease Physician	$0	$27.8M
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
Blue Ridge Medical Management Corporation	TN	Pediatrics Physician	$0	$2.9M

Holston Medical Group 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