Sumner Physician Practices, LLC
Sumner Physician Practices, LLC was paid $521K by Medicaid between Jan 2018 and Dec 2024, across 30 billing codes. Its largest line is 99214, doctor's office visit, returning patient (more involved) — 75% of everything it billed.
GALLATIN, TN 37066
Next to other Internal Medicine Physician providers in Tennessee
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Paid by month
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 426 | $4K | |
| 2019 | 1,121 | $19K | |
| 2020 | 2,434 | $75K | |
| 2021 | 3,860 | $104K | |
| 2022 | 15,070 | $107K | |
| 2023 | 9,076 | $112K | |
| 2024incomplete | 21,440 | $100K |
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 75% | 16,082 | 11,255 | $389K |
| 99204 | Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | 14% | 1,454 | 1,055 | $74K |
| 64493 | 2.6% | 305 | 127 | $13K | |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 2.5% | 1,178 | 902 | $13K |
| 64635 | 1.2% | 48 | 24 | $6K | |
| 64494 | 1.0% | 275 | 115 | $5K | |
| 99443 | <1% | 253 | 190 | $5K | |
| G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition. (add-on code, list separately in addition to office/outpatient evaluation and management visit, new or established) | <1% | 1,131 | 766 | $4K |
| 64636 | <1% | 50 | 24 | $3K | |
| J1030 | Injection, methylprednisolone acetate, 40 mg | <1% | 741 | 456 | $2K |
| 99203 | Doctor's office visit, new patient (routine)Office or other outpatient visit for the evaluation and management of a new patient, low complexity | <1% | 32 | 31 | $2K |
| 27096 | <1% | 16 | 12 | $2K |
18 more codes
| 99442 | <1% | 85 | $713.77 | |
| 99222 | Initial hospital care, per day, moderate complexity | <1% | 13 | $579.13 |
| J1010 | Injection, methylprednisolone acetate, 1 mg | <1% | 132 | $323.37 |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 23 | $295.06 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | <1% | 490 | $207.90 |
| 99441 | <1% | 18 | $95.08 | |
| 3078F | <1% | 2,457 | $50.02 | |
| 3079F | <1% | 1,367 | $50.00 | |
| 3077F | <1% | 2,315 | $40.02 | |
| 3075F | <1% | 1,063 | $20.00 | |
| 3080F | <1% | 1,162 | $20.00 | |
| 3074F | <1% | 1,572 | $20.00 | |
| 1036F | <1% | 3,139 | $0.02 | |
| 1125F | <1% | 6,076 | $0.02 | |
| 1159F | <1% | 2,806 | $0.02 | |
| 1160F | <1% | 2,807 | $0.02 | |
| 1034F | 0% | 2,728 | $0.00 | |
| 3008F | 0% | 3,609 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
Who's on the registration
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.