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.

Smart Start Pediatrics LLC (NPI 1982020756)

Field	Value
Entity Type	Organization
Organization	Smart Start Pediatrics LLC
Address	460 Al Highway 75 N
City	Albertville
State	AL
ZIP	35951
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	March 17, 2014

Payer Source	Total Paid
Medicaid	$11.2M
Medicare	$0

Key Findings

SMART START PEDIATRICS LLC is effectively a single-payer Medicaid practice: it has no Medicare billing on file and reports $11.2M in lifetime Medicaid revenue, indicating its clinical operations and reimbursement volume are concentrated entirely within Medicaid. The absence of Medicare activity suggests the clinic focuses on pediatric and family services that predominantly serve the Medicaid population rather than older adult care.

Revenue concentration is extremely high: the top three Medicaid codes by revenue account for 93.3% of the provider's total Medicaid revenue, signaling that a very small set of service lines generates almost all billed revenue. This concentration increases the business importance of those codes to the clinic’s financial performance and operational planning.

T1015 (Clinic visit/encounter, all-inclusive) is the dominant revenue driver, producing $10M and representing 89.2% of the provider’s Medicaid revenue. That code’s scale implies the clinic operates primarily as a general ambulatory pediatric/rural health clinic with high volumes of bundled clinic visits rather than revenue coming from many discrete procedures or higher-level E/M codes.

The code mix (T1015 plus a range of vaccine and point-of-care testing codes such as 90700, 90670, 90680, 90633, 90648 and rapid-test codes 87804, 87880, 87428) indicates a preventive pediatric and outpatient primary-care emphasis, with routine immunization programs and on-site infectious disease testing forming a steady share of service delivery. High claim counts for vaccines and rapid tests are consistent with a pediatric rural clinic providing well-child visits and immunization series.

SMART START’s competitive standing on key codes is mixed within Alabama: for its largest code T1015 it ranks #21 of 243 providers and sits in the 92nd percentile, which indicates above-average statewide volume but not an extreme outlier; several vaccine codes (for example 90700) and COVID testing (87428) rank in the 97th–98th percentiles or similarly high positions, reflecting notably above-typical state volume for those specific services and signaling relative local strength in immunizations and testing.

Several codes are explicitly flagged as "notably above typical" or high-percentile outliers in-state: 87428 ranks #6 of 166 providers (97th percentile) and 90700 ranks #3 of 132 providers (98th percentile). These rankings suggest the clinic is a local leader in on-site infectious disease testing during the relevant period and in delivering DTaP vaccine volumes compared with peers statewide.

Operational implications of the billing profile include heavy reliance on bundled clinic visit reimbursement (T1015) which may limit reimbursement diversification and make revenue sensitive to visit volume and state Medicaid policies governing clinic encounter payments. The sizeable volumes of immunization and point-of-care testing services imply operational capacity for vaccine delivery and rapid diagnostics, supporting a preventive-care and acute respiratory illness testing role in the community.

The practice has established tenure: the NPI was enumerated on 2014-03-17 (approximately 12 years ago), indicating a sustained presence in the local market. That longevity combined with high-volume standing on several pediatric vaccine and testing codes suggests an entrenched role in routine child health services in Albertville, AL.

Medicaid: Complete Services Breakdown

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

57 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	67,930	$150	$10M
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…	5,630	$50	$270.3K
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.	1,370	$130	$183.4K
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.	6,650	$10	$86.5K
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…	4,570	$20	$82.2K
90700	This code represents a DTaP vaccine product administered into the muscle to protect against diphtheria, tetanus, and pertussis (whooping cough). It is used for children younger than 7 years of age.	6,410	$10	$57.7K
90680	This code represents a live pentavalent rotavirus vaccine given by mouth in a three–dose schedule to protect against rotavirus infection.	4,160	$10	$50K
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.	850	$60	$49.3K
90713	This code represents an IPV vaccine product administered beneath the skin or into the muscle to protect against poliomyelitis (polio). This is an inactivated, or killed, virus vaccine.	4,520	$10	$45.2K
90716	The provider administers a live vaccine subcutaneously to protect against varicella infection.	1,910	$20	$44K

Showing 1–10 of 57

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

Smart Start Pediatrics 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

57 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	21	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…	163	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…	70	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…	29	270	1,360	$60	$159.7K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	35	50	380	$90	$157.3K
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…	29	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.	58	320	640	$50	$98.1K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	20	60	240	$100	$62.9K
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.	83	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.	95	300	330	$50	$56.3K

Showing 1–10 of 57

Nearby Providers

Other providers in the same ZIP code as Smart Start Pediatrics LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Compass Pediatrics, P.C.	AL	Pediatrics Physician	$0	$1.3M
J Watts	AL	Neurology Physician	$161.4K	$0
John Groves	AL	Surgery Physician	$50.2K	$0
Kathryn Mccurdy	AL	Optometrist	$37.8K	$0
Hilary Looney	AL	Family Nurse Practitioner	$32K	$0
Audrey Carson	AL	Family Nurse Practitioner	$29.9K	$0

Smart Start Pediatrics LLC — Billing Profile & Reimbursement Data

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Smart Start Pediatrics LLC — 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