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.

Sylacauga Pediatric Clinic, LLC (NPI 1912948373)

Field	Value
Entity Type	Organization
Organization	Sylacauga Pediatric Clinic, LLC
Address	115 W Clay St
City	Sylacauga
State	AL
ZIP	35150
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	June 9, 2006

Payer Source	Total Paid
Medicaid	$7.4M
Medicare	$0

Medicaid: Complete Services Breakdown

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

43 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	98,630	$70	$7M
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.	2,720	$60	$163.1K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	3,860	$10	$27K
90680	This code represents a live pentavalent rotavirus vaccine given by mouth in a three–dose schedule to protect against rotavirus infection.	3,230	$10	$22.6K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,820	$1	$17.5K
90698	This code represents a combination vaccine product administered into the muscle to protect against five diseases: diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and polio.	2,210	$10	$15.5K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	2,190	$10	$15.3K
90633	This code represents a vaccine product administered into a muscle to protect against hepatitis A, a liver infection. This code is specific to a pediatric/adolescent dosage with a two–dose schedule.	2,130	$10	$14.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	4,940	$1	$14.8K
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…	6,150	$1	$12.3K

Showing 1–10 of 43

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

Sylacauga Pediatric Clinic, LLC — 2 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

43 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	14	240	6,820	$120	$2.9M
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…	52	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…	37	1,990	560	$40	$185.6K
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…	50	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…	35	300	1,160	$50	$147.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	22	320	640	$50	$98.1K
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.	166	230	410	$40	$59.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	10	300	330	$50	$56.3K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	43	260	910	$20	$47.2K
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,…	61	500	120	$60	$42.2K

Showing 1–10 of 43

Nearby Providers

Other providers in the same ZIP code as Sylacauga Pediatric Clinic, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pathway Pediatrics, Inc.	AL	Pediatrics Physician	$0	$8.6M
Sylacauga Pediatric Clinic, LLC	AL	Pediatrics Physician	$0	$4.4M
Sylacauga Health Care Authority Inc	AL	Rural Acute Care Hospital	$0	$4.2M
Nes Tennessee Inc	AL	Emergency Medicine Physician	$0	$2.3M
Marble City Pediatric Dentistry	AL	Preferred Provider Organization	$0	$2.2M
Sylacauga Ambulance Service, Inc.	AL	Land Ambulance	$433.6K	$958.7K
Talladega County Health Dept-sylacauga Epsdt Cm	AL	Case Management Agency	$0	$1.2M
Family Eye Care Of Sylacauga LLC	AL	Optometrist	$0	$1.2M
Talladega County Health Dept-sylacauga Fp Clinic	AL	Public Health or Welfare Agency	$0	$951.3K
Hamo Neurology Clinic	AL	Neurology Physician	$0	$943.7K

Sylacauga Pediatric Clinic, LLC — Billing Profile & Reimbursement Data

Sign up for Sylacauga Pediatric Clinic, LLC — Billing Profile & Reimbursement Data policy alerts

Sylacauga Pediatric Clinic, LLC — Billing Profile & Reimbursement Data

Sign up for Sylacauga Pediatric Clinic, LLC — Billing Profile & Reimbursement Data policy alerts

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References