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.

The Valley Foundation (NPI 1952315681)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Valley Foundation
Address	301 Governors Dr Sw
City	Huntsville
State	AL
ZIP	35801
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	July 28, 2006

Payer Source	Total Paid
Medicaid	$11.3M
Medicare	$0

This provider is effectively single-payer in these data: there is no Medicare billing on file while total Medicaid revenue is $11.3M, indicating operational dependence on Medicaid as the primary payer for the reported activity. Analysts should treat Medicaid as the dominant commercial relationship when assessing risk and contracting leverage.

Revenue is highly concentrated in a small set of codes: the precomputed top three Medicaid codes account for 84.2% of the provider's total Medicaid revenue, driven primarily by 99214 ($6M revenue, 54.2K claims, $110 avg paid/claim; 53.4% of Medicaid revenue), 99213 ($2.9M revenue, 38.1K claims, $75 avg paid/claim; 25.6% of Medicaid revenue), and 99391 ($577.4K revenue, 9.2K claims, $63 avg paid/claim; 5.2% of Medicaid revenue). This concentration suggests material exposure if primary-care E/M reimbursement or utilization shifts.

The code mix points to a high-volume outpatient primary care and preventive services operation: 99214 and 99213 are the top revenue drivers (established patient E/M visits), while 99391 and a long list of vaccine codes indicate a strong pediatric/preventive medicine footprint. High counts of claims for vaccines (e.g., 90686, 90670, 90697, 90681) and developmental screening (96110) further support an integrated primary care practice with routine immunizations and well-child services.

For established outpatient visits the provider is a statewide outlier: 99214 ranks #21 of 1990 providers in-state (99th percentile; extreme outlier) and 99213 ranks #46 of 1988 providers (98th percentile; notably above typical state volume). Those ranks indicate market dominance for high-acuity established-patient office visits within Alabama, implying a large patient panel or very high visit throughput relative to peers.

There are notable high-volume specialty/ancillary signals beyond core E/M: developmental screening 96110 has 11.6K claims and ranks #5 of 145 providers in-state (97th percentile; notably above typical state volume), and certain vaccine products such as 90697 (rank #2 of 62; 98th percentile) and 90681 (rank #2 of 38; 97th percentile) are extreme relative outliers in their respective peer sets. These patterns suggest the provider handles substantial pediatric preventive care and immunization activity compared with most in-state peers.

Although outpatient E/M and preventive services dominate, the dataset also shows some inpatient/observation activity at modest levels: 99232 reports 2.7K claims and $130.9K revenue (rank #91 of 396 in-state, 77th percentile) and 99223 reports 416 claims and $64.1K revenue (rank #73 of 237, 69th percentile). This indicates limited hospital-facing work relative to its outpatient volume rather than a major inpatient specialty presence.

Operational throughput is very large on key visit codes: 54.2K claims for 99214 and 38.1K claims for 99213 reflect sustained, high-volume patient-facing encounters across the reporting period. High visit volumes combined with the average paid/claim levels cited ($110 for 99214; $75 for 99213) explain why a small number of codes account for the majority of the $11.3M Medicaid revenue.

The provider has an established tenure in the NPI registry (NPI enumerated 2006-07-28, approximately 20 years ago), which, combined with concentrated Medicaid revenue and sustained high visit volumes, suggests a stable, long-running clinic model focused on outpatient primary care and pediatric preventive services in its regional market.

Medicaid: Complete Services Breakdown

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

79 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…	54,230	$110	$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…	38,100	$80	$2.9M
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…	9,170	$60	$577.4K
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…	7,010	$60	$441.4K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	11,590	$20	$197.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	2,200	$60	$132.1K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	2,670	$50	$130.9K
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…	2,660	$50	$119.7K
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…	5,750	$20	$91.9K
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…	4,800	$20	$76.8K

Showing 1–10 of 79

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

The Valley Foundation — 6 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

79 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	28	120	500	$50	$317.7K
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…	21	1,990	680	$60	$201.7K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	213	330	140	$240	$197.4K
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…	46	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…	19	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…	30	300	1,160	$50	$147.8K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	132	250	420	$50	$133K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	86	320	640	$50	$98.1K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	91	400	470	$30	$97.1K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	54	180	480	$20	$86.2K

Showing 1–10 of 79

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tennessee Valley Neonatology, Inc	AL	Neonatal-Perinatal Medicine Physician	$0	$22.2M
The Health Care Authority Of The City Of Huntsville	AL	General Acute Care Hospital	$0	$17.8M
Happi Health	AL	Federally Qualified Health Center (FQHC)	$0	$17.6M
Emergency Physicians Group	AL	Emergency Medicine Physician	$0	$13.5M
Healthgroup Of Alabama	AL	Contractor	$0	$13.4M
David White	AL	Neurology Physician	$7M	$0
The Children's Hospital Of Alabama	AL	Pediatric Pulmonology Physician	$0	$5.6M
Huntsville Pediatric Associates, LLC	AL	Pediatrics Physician	$0	$4.8M
Dental Associates Of Huntsville, LLC	AL	General Practice Dentistry	$0	$4.7M
Health Group Of Alabama	AL	Contractor	$0	$4.1M

The Valley Foundation — Billing Profile & Reimbursement Data

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The Valley Foundation — 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