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.

Carolina Health Centers, Inc. (NPI 1972636025)

Key Findings

Field	Value
Entity Type	Organization
Organization	Carolina Health Centers, Inc.
Address	113 Liner Dr
City	Greenwood
State	SC
ZIP	29646
Taxonomy	Pediatrics Physician
NPI Enumerated	March 14, 2007

Payer Source	Total Paid
Medicaid	$20.2M
Medicare	$0

CAROLINA HEALTH CENTERS, INC. is effectively a single‑payer Medicaid operation: lifetime Medicaid revenue is $20.2M and there is no Medicare billing on file. This profile indicates the practice’s scale and reimbursement exposure are concentrated in Medicaid rather than split across Medicare and Medicaid.

Revenue is heavily concentrated in a very small set of visit and preventive codes: the precomputed top three Medicaid codes account for 74.9% of the provider’s total Medicaid revenue. Those top three are 99213 ($10.8M, 53.4%), 99214 ($2.6M, 12.7%), and 99391 ($1.8M, 8.7%), showing most dollars derive from routine established‑patient E/M and preventive visits.

The code mix points to a pediatrics primary‑care model focused on high volume office visits and well‑child/preventive services. High‑revenue entries are 99213/99214 (established patient E/M) alongside preventive codes 99391, 99392, 99393 and vaccine administration codes (90460, 90461), which together indicate routine outpatient ambulatory pediatrics with in‑clinic immunizations and screening.

For the dominant E/M code 99213 the provider is a statewide volume leader: 99213 has 60.2K claims for this provider, ranks #29 of 2766 providers in‑state, and is described as an 99th percentile, extreme outlier, far above typical state volume for this code. That rank and label signal a market position in South Carolina where this practice delivers exceptionally high outpatient visit volume for established pediatric patients.

Other top codes show elevated but less extreme standing: 99214 (13.5K claims) ranks #114 of 2483 providers in‑state at the 95th percentile and is labeled typical, unremarkable volume for that code, while 99391 (9.9K claims) ranks #19 of 284 providers at the 94th percentile and is also labeled typical, unremarkable. In addition, testing and infectious‑disease throughput is notable: 87428 (COVID/influenza multiplex testing) has 8.1K claims, $475.6K revenue, and ranks #7 of 142 providers at the 96th percentile, described as notably above typical state volume. These patterns reflect both high routine visit throughput and elevated on‑site testing.

Claim‑level economics emphasize volume over high unit price: 99213 shows an average paid/claim of $179 and 99214 $190, consistent with a practice that generates most revenue through large numbers of mid‑value office visits rather than a few high‑reimbursement procedures. The provider’s 60.2K claims for 99213 and 13.5K claims for 99214 indicate reliance on throughput and frequent follow‑up visits to drive Medicaid revenue.

The NPI was enumerated on 2007-03-14 (~19 years ago), indicating a long tenure in the market that aligns with the cumulative Medicaid revenue and high claim volumes. This longevity likely supports established referral patterns and operational scale needed to sustain the large counts of preventive and E/M visits reported.

From a business and reimbursement planning perspective the provider has high revenue concentration and limited payer diversification: top three Medicaid codes account for 74.9% of Medicaid revenue and there is no Medicare revenue on file. That concentration means changes in Medicaid visit reimbursement, coding policy, or utilization patterns for office E/M and preventive codes could materially affect overall revenue, while the provider’s high rankings for 99213 and elevated testing/vaccination volumes suggest levers that payers or partners could target for care‑management or value‑based arrangements.

Medicaid: Complete Services Breakdown

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

65 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…	60,240	$180	$10.8M
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…	13,500	$190	$2.6M
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…	9,910	$180	$1.8M
T1015	Clinic visit/encounter, all-inclusive	8,680	$190	$1.6M
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…	8,260	$170	$1.4M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,430	$180	$606.4K
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…	8,060	$60	$475.6K
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,…	2,300	$160	$377.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,940	$170	$330.5K
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.	10,880	$10	$97.9K

Showing 1–10 of 65

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

Carolina Health Centers, Inc. — 3 of 25 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

65 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	113	350	3,560	$30	$525.5K
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	280	600	$90	$299K
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…	29	2,770	210	$60	$254.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	575	710	350	$60	$247.2K
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…	114	2,480	350	$80	$246K
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…	26	380	160	$100	$226.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	43	390	100	$100	$148.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	55	340	110	$110	$107.9K
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,…	76	610	190	$50	$98.4K
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.	52	650	140	$30	$98.1K

Showing 1–10 of 65

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Self Regional Healthcare	SC	General Acute Care Hospital	$0	$58.8M
Greenwood Genetic Center Lab	SC	Clinical Medical Laboratory	$0	$31.2M
South Carolina Dept Of Mental Health Accounting Office	SC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$29.1M
Self Medical Group	SC	Emergency Medicine Physician	$0	$6M
Greenwood Treatment Specialists	SC	Methadone Clinic	$75.9K	$3.2M
Self Medical Group	SC	Pediatrics Physician	$0	$3.3M
Greenwood County Ems	SC	Ambulance	$905.9K	$2.2M
Taylor Mader	SC	Rheumatology Physician	$3.1M	$0
Greenwood Obstetrics & Gynecology PA	SC	Obstetrics & Gynecology Physician	$0	$2.7M
Health Related Personnel Services, Inc.	SC	Physical Disabilities Residential Treatment Facility	$0	$2.6M

Carolina Health Centers, Inc. — Billing Profile & Reimbursement Data

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Carolina Health Centers, Inc. — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carolina Health Centers, Inc.	SC	Pediatrics Physician	$0	$7.6M
Carolina Health Centers, Inc.	SC	Federally Qualified Health Center (FQHC)	$0	$3.3M
Melanie Johnson-bailey	SC	Family Medicine Physician	$341.3K	$0