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.

Pediatric Rural Health Clinics, Inc (NPI 1992742860)

Pediatric Rural Health Clinics, Inc is a pediatric nurse practitioner provider located in Greenville, Alabama. This profile covers 0 Medicare and 57 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Pediatric Rural Health Clinics, Inc
Address	46 L V Stabler Dr
City	Greenville
State	AL
ZIP	36037
Taxonomy	Pediatric Nurse Practitioner
NPI Enumerated	June 1, 2006

Payer Source	Total Paid
Medicaid	$8M
Medicare	$0

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	82,490	$80	$6.7M
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	13,540	$20	$270.9K
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.	15,940	$10	$191.3K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	6,110	$30	$152.8K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	4,700	$30	$117.5K
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.	2,750	$40	$96.1K
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…	52,660	$1	$52.7K
87807	The lab analyst performs the technical lab test to analyze for the presence of respiratory syncytial virus (RSV) in a specimen by immunoassay using direct optical, meaning visual, observation.	4,490	$10	$44.9K
90651	This code represents a nonavalent human papillomavirus (HPV) vaccine product administered into the muscle to protect against HPV infection. The vaccine protects against nine HPV types (6, 11, 16, 18,…	1,290	$30	$40K
90710	This code represents an MMRV vaccine product administered beneath the skin to protect against measles, mumps, rubella (German measles), and varicella (chickenpox).	1,520	$30	$39.5K

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

Pediatric Rural Health Clinics, Inc — 5 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	15	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…	346	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…	23	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…	58	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…	55	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.	44	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.	124	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.	35	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…	71	260	910	$20	$47.2K
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…	81	170	210	$40	$39.3K

Showing 1–10 of 57

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southerncare, Inc.	AL	Community Based Hospice Care Agency	$0	$3.7M
Rmcca Clinic A LLC	AL	Clinic/Center	$0	$2.1M
Butler County Health Dept-greenville Fp Clinic	AL	Public Health or Welfare Agency	$0	$1.2M
The Pope Stanley Group, P.C.	AL	General Practice Dentistry	$0	$1.1M
The Health Care Authority Of The City Of Greenville - Lv Stabler Hospi	AL	General Acute Care Hospital	$0	$1.1M
Pro-med, P.C.	AL	Family Medicine Physician	$0	$1M
Garlock Enterprises	AL	Land Ambulance	$253.8K	$648.6K
Brandon Slagley	AL	Family Medicine Physician	$117.4K	$0
Kanu Patel	AL	Internal Medicine Physician	$73.8K	$0
Lashonda Moore	AL	Primary Podiatric Medicine Podiatrist	$56.1K	$0

Pediatric Rural Health Clinics, Inc — Billing Profile & Reimbursement Data

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Pediatric Rural Health Clinics, Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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