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 Georgia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Georgia 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. Georgia (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.

Southern Crescent Pediatrics PC (NPI 1972595999)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southern Crescent Pediatrics PC
Address	150 Medical Blvd
City	Stockbridge
State	GA
ZIP	30281
Taxonomy	Pediatrics Physician
NPI Enumerated	August 16, 2005

Payer Source	Total Paid
Medicaid	$9.6M
Medicare	$0

This provider is effectively single-payer in the available data: there is no Medicare billing on file and all recorded lifetime revenue comes from Medicaid, totaling $9.6M. The absence of Medicare claims indicates this practice operates almost exclusively within the pediatric Medicaid market rather than serving a mixed Medicare/Medicaid population.

Revenue is highly concentrated in a small set of outpatient and preventive pediatric services: the precomputed top three Medicaid codes account for 62.4% of total Medicaid revenue. The single largest contributor is 99213 with $3.7M (38.6% of Medicaid revenue), followed by 90460 at $1.3M (13.5%) and 99394 at $999.9K (10.4%).

The code mix indicates a high-volume, office-based pediatric primary care practice focused on routine evaluation/management and preventive care. High volumes for E/M code 99213 (53.2K claims, $70 avg paid/claim) together with adolescent and child well visit codes 99394 (9K claims, $111 avg paid/claim) and 99393 (9.8K claims, $101 avg paid/claim) reflect ongoing longitudinal primary care and scheduled well-child services as core operations.

Vaccination delivery is a major operational component but shows mixed reimbursement patterns: 90460 has large paid volume (28.9K claims, $45 avg paid/claim, $1.3M revenue) and is labeled an extreme outlier (ranks #6 of 246, 98th percentile), while multiple vaccine product codes (90670 and 90686) show high claim counts (6.5K and 5.9K claims, respectively) but $0 avg paid/claim and $0 revenue. This pattern suggests the practice both administers many vaccines and participates in billing pathways or programs where product reimbursement may be captured differently from administration fees.

Competitive standing within the state is strong for core pediatric services: 99213 ranks #20 of 917 providers in-state (98th percentile; notably above typical state volume), 99394 ranks #3 of 157 (99th percentile; extreme outlier), and 99393 ranks #6 of 173 (97th percentile; notably above typical). Together these ranks position the practice as a major Medicaid provider for well visits and routine pediatric E/M in Georgia.

The practice shows elevated use of standardized screening and brief developmental assessment codes, underlining preventive and developmental emphasis: 96110 has 8K claims and $72.4K revenue and ranks #5 of 151 providers in-state (97th percentile; extreme outlier), while 96127 is also used regularly (3K claims, $11.8K revenue). High use of these screening codes aligns with a practice model that prioritizes developmental surveillance during well visits.

Point-of-care testing and respiratory diagnostics appear as frequent ancillary services: 87880 (strep test) has 12.4K claims and $186.2K revenue (ranks #12 of 262, 96th percentile; typical, unremarkable volume) and 87804 (influenza test) shows 5K claims and $70.4K revenue (ranks #28 of 252, 89th percentile). These volumes support a workflow that integrates rapid testing into same-day outpatient visits.

The provider has an established operational tenure in the market: the NPI was enumerated on 2005-08-16 (~21 years ago), indicating long-standing engagement in pediatric Medicaid care that likely supports the high cumulative volumes observed across well visits, immunizations, and screening services.

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
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…	53,230	$70	$3.7M
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.	28,900	$50	$1.3M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	9,010	$110	$999.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	9,800	$100	$990.2K
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…	10,020	$90	$911.9K
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,…	14,830	$40	$608.1K
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…	6,550	$90	$596K
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.	12,410	$20	$186.2K
99429	Use 99429 to report a preventive medicine service that does not have a specific code.	9,050	$10	$81.5K
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…	8,040	$10	$72.4K

Showing 1–10 of 43

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Georgia providers billing the same CPT/HCPCS codes.

Claims Volume vs. Georgia Distribution

Southern Crescent Pediatrics PC — 8 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia median

43 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…	20	920	370	$60	$360.6K
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…	444	820	390	$70	$245K
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…	11	180	680	$90	$226.7K
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…	15	180	720	$90	$204.2K
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.	6	250	660	$40	$172.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	6	170	500	$100	$170.6K
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,…	16	360	370	$50	$153.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3	160	190	$110	$129.7K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	37	140	940	$1	$82.1K
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	40	80	190	$30	$49.9K

Showing 1–10 of 43

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Apex Family Healthcare Services, LLC	GA	Community/Behavioral Health Agency	$0	$19M
Pacific Health Systems LLC	GA	Home Health Agency	$0	$9.9M
Healthsource Agency Inc	GA	Home Health Agency	$0	$5.8M
Piedmont Hospitalist Physicians LLC	GA	Family Medicine Physician	$0	$3.6M
National Premier Laboratories Inc	GA	Clinical Medical Laboratory	$0	$3.4M
Covenant Care Pediatrics PC	GA	Pediatrics Physician	$0	$3M
Stockbridge Pediatrics	GA	Pediatrics Physician	$0	$2.6M
Surgical Center For Urology LLC	GA	Ambulatory Surgical Clinic/Center	$805.2K	$0
Regenerative Orthopaedics Surgery Center, LLC	GA	Ambulatory Surgical Clinic/Center	$622K	$0
Tambrea Ellison	GA	Physical Medicine & Rehabilitation Physician	$509.4K	$0

Southern Crescent Pediatrics PC — Billing Profile & Reimbursement Data

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Southern Crescent Pediatrics 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

Nearby Providers

Frequently Asked Questions

References