Established Internal Medicine Practice, 32-Year North Carolina Clinic With Real Estate

$1.9M

Revenue

$1.3M

SDE

Subscribe Free

Read the full deal writeup

Get Free Access

Already a member? Sign in

Full Editorial Writeup

This is a 32-year-old internal medicine practice in Eden, North Carolina, bundled with the medical real estate it operates from. The practice delivers office-based internal medicine, preventive exams, annual wellness visits, and chronic care management to a stable panel of local patients. Reported 2025 figures show $1,872,729 in gross revenue, $1,325,943 in seller-reported SDE, and $1,023,669 in EBITDA, a roughly 55 percent EBITDA margin that is unusually strong for a single-physician primary care clinic.

Operations sit in a purpose-built 3,800 square foot facility constructed in 2013, with eight exam rooms, two physician offices, two nurse stations, and 36 parking spaces. The layout was built with excess capacity, leaving room to add a second physician or an advanced practice provider without taking on new real estate. The payer mix spans commercial, Medicare, Medicare Advantage, and Medicaid plans, and the clinic is still actively accepting roughly 30 new patients per month.

The catch is structural: the seller requires the practice and the real estate to be bought together by the same buyer with concurrent closings. Neither is available alone, and the property is listed separately by a partnering real estate broker. That means the true all-in purchase price and the real estate valuation are both undisclosed, and the headline SDE multiple cannot be assessed until those numbers surface under NDA.

Why we like it

Earnings quality is the standout here: $1.87m revenue converting to $1.02m EBITDA and $1.33m SDE implies margins north of 50 percent, which is rare and reflects a mature single-provider practice with low overhead. Internal medicine revenue is recurring in nature because chronic care management and annual wellness visits bring the same patient panel back year after year.
Durability is reinforced by a 32-year local footprint and continued intake of roughly 30 new patients monthly, meaning the panel is growing rather than aging out. Primary care is among the stickiest healthcare relationships, and switching costs for patients with established chronic care histories are high.
Demographic and payer tailwinds favor this clinic: an aging population drives steady demand for internal medicine and chronic care management, and Medicare plus Medicare Advantage payers are a durable, government-backed reimbursement base. Chronic care management codes are an underutilized recurring revenue stream the industry is actively expanding.
The operator advantage is clear capacity: eight exam rooms and a facility built for two providers, but currently run by one physician. A buyer who recruits a second physician or an advanced practice provider can materially lift revenue against a largely fixed cost base and already-paid-for real estate.

How to improve it

Recruit an advanced practice provider (NP or PA) into the existing open exam rooms within the first 90 days of scoping. The facility was built for two providers, so incremental patient volume flows against mostly fixed overhead and should expand margin, not just revenue.
Audit and expand chronic care management enrollment, which the seller already flags as underutilized. CCM codes generate recurring monthly per-patient revenue for Medicare patients, and systematically enrolling the eligible panel can add a high-margin income layer with minimal added cost.
Review all payer contracts and renegotiate commercial reimbursement rates, since a long-tenured solo practice often has not refreshed fee schedules in years. Even modest rate improvements on the commercial book drop almost entirely to the bottom line.
Tighten billing, coding, and collections processes to reduce leakage, which the listing itself names as an improvement area. Bringing in a billing specialist or outsourced RCM partner can recover revenue that a solo-owner practice frequently leaves on the table.
Increase annual wellness and preventive visit utilization across the existing panel through proactive outreach and scheduling. These visits are reimbursable, recurring, and also surface additional chronic conditions that drive downstream CCM and follow-up revenue.
Extend scheduling capacity and provider coverage to improve patient access, reducing wait times that cap new patient conversion. With 30 new patients already arriving monthly, better throughput directly grows the panel.
Separate the real estate economics by financing the building to understand true occupancy cost versus market rent. Owning the property at a reasonable basis converts rent into equity, but the buyer must model it so the real estate does not artificially inflate the blended multiple.

Diligence notes

The combined-sale structure is the central issue: practice and real estate must be bought together with no standalone option, yet neither the asking price nor the real estate value is disclosed. Get both figures under NDA immediately and model the operating multiple separately from the real estate so you are not overpaying a blended number.
Verify the seller-reported SDE and EBITDA against tax returns and the general ledger, because 50-plus percent margins on a solo practice warrant scrutiny. Confirm how much of SDE is physician compensation that a buyer must replace if the selling doctor is leaving.
Assess physician transition and succession risk, since the owner is exiting and much of the patient relationship and referral base may attach to that specific doctor. Clarify whether the seller will stay through a credentialing and handover period and how long payer re-credentialing for a new owner will take.
Examine the payer mix and reimbursement concentration across commercial, Medicare, Medicare Advantage, and Medicaid plans. Medicaid-heavy or single-payer-dependent revenue can be lower-margin and more volatile, so confirm the actual revenue split before trusting the margin profile.
Confirm what equipment and assets are actually included, which the listing explicitly states is subject to confirmation. Also validate the 2013-built facility's condition, remaining useful life, and any deferred maintenance given the real estate is a mandatory part of the purchase.

Source

Originally listed on BizBuySell. View original listing →