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.

Spartanburg & Pelham Ob-gyn,p.a. (NPI 1861447682)

Field	Value
Entity Type	Organization
Organization	Spartanburg & Pelham Ob-gyn,p.a.
Address	250 N Grove Medical Park Dr
City	Spartanburg
State	SC
ZIP	29303
Taxonomy	Obstetrics Physician
NPI Enumerated	May 23, 2006

Payer Source	Total Paid
Medicaid	$2M
Medicare	$0

Medicaid: Complete Services Breakdown

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

24 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…	22,700	$60	$1.3M
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…	2,610	$80	$208.6K
76856	A pelvic ultrasound is a noninvasive procedure used to assess body parts such as the bladder, ovaries, uterus, cervix, and fallopian tubes in females and the bladder, prostate gland, and seminal…	2,100	$80	$170.2K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	850	$80	$70.3K
81002	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dip stick, and shakes off the excess urine. Alternatively, the analyst may place drops of the urine specimen…	16,430	$1	$49.3K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	430	$90	$40.4K
76830	The provider performs a transvaginal ultrasound to assess the reproductive organs, that is, the uterus, fallopian tubes, ovaries, cervix, and vagina in a female patient.	370	$90	$31.5K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	4,400	$10	$30.8K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	860	$30	$24.9K
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.	260	$60	$15.9K

Showing 1–10 of 24

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

Spartanburg & Pelham Ob-gyn,p.a. — 2 of 24 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

24 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	114	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…	520	2,480	350	$80	$246K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	29	100	240	$100	$187.3K
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.	28	70	150	$70	$156.2K
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…	327	410	330	$50	$152.6K
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,…	541	610	190	$50	$98.4K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	205	270	120	$50	$93.2K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	75	380	660	$30	$90K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	42	120	300	$40	$67.1K
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…	186	520	70	$70	$67.1K

Showing 1–10 of 24

Related Providers

Other providers that share a Tax Identification Number (TIN) with Spartanburg & Pelham Ob-gyn,p.a., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ashley Fowler	SC	Obstetrics & Gynecology Physician	$13.4K	$35.9K

Nearby Providers

Other providers in the same ZIP code as Spartanburg & Pelham Ob-gyn,p.a., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spartanburg Medical Center	SC	General Acute Care Hospital	$0	$187.7M
Axcess Healthcare Services, LLC	SC	Nursing Care Agency	$0	$98.5M
South Carolina Dept Of Mental Health Accounting Office	SC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$40M
Spartanburg Medical Center	SC	Emergency Medicine Physician	$0	$17.2M
Spartanburg Medical Center	SC	Family Medicine Physician	$0	$17M
Spartanburg Medical Center	SC	Maternal & Fetal Medicine Physician	$0	$11.5M
Better Beginnings, Inc	SC	Pediatric Occupational Therapist	$0	$6.9M
Whitney Road Dental Health Center, P.C.	SC	General Practice Dentistry	$0	$6.3M
Foothills Pediatric Dentistry, PA	SC	Pediatric Dentistry	$0	$4.9M
Bhg Xxxviii, LLC	SC	Substance Use Disorder Rehabilitation Clinic/Center	$264.8K	$3.5M

Spartanburg & Pelham Ob-gyn,p.a. — Billing Profile & Reimbursement Data

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Spartanburg & Pelham Ob-gyn,p.a. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References