Internal Medicine & Cardiology Practice, 22-Year Northeast Florida Clinic

$1.8M

Revenue

$591K

SDE

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Full Editorial Writeup

This is a 22-year-old internal medicine and cardiology practice in Saint Augustine, Florida, generating roughly $1.75 million in gross revenue and $591,000 in seller's discretionary earnings in 2025. The practice combines primary care, internal medicine, and cardiology under one roof, with integrated in-office diagnostics that include echocardiography, nuclear medicine, stress testing, vascular ultrasound, and EKG. That diagnostic stack is the profit engine here: it keeps high-margin testing in-house rather than referring it out, which is exactly what separates this from a plain primary-care office.

The practice runs from a single 6,000-square-foot facility with 11 exam and treatment rooms, which is meaningfully more capacity than the current provider load appears to use. Payer mix is a balanced roughly 50% Medicare and 50% commercial, and revenue grew from about $1.61 million in 2024 to $1.75 million in 2025. The Medicare-heavy demographic of Northeast Florida is a structural tailwind for a cardiology-focused adult medicine practice.

The listing frames the buyer profile as a physician seeking ownership, an established group expanding, or a strategic healthcare organization building density in the market. The facility is seller-owned but its treatment in a transaction has not been determined, so real estate is not confirmed as included in any price. With only cash flow disclosed and no asking price, the valuation and deal structure are entirely to be negotiated.

Why we like it

Earnings quality is strong: $591k SDE on $1.75m revenue is roughly a 34% margin, which is excellent for a medical practice and signals the in-house diagnostics are carrying real profit rather than referral fees. The mix of internal medicine plus cardiology plus imaging creates multiple complementary revenue streams instead of a single billing line.
The moat is a returning patient panel and a diagnostic platform. Cardiology patients with chronic conditions come back for recurring stress tests, echos, and monitoring, and the balanced 50/50 Medicare and commercial payer mix protects against single-payer reimbursement shocks. Twenty-two years of operating history means an established referral network that is hard for a new entrant to replicate.
Market tailwinds are unusually clean here. Northeast Florida is growing fast with a heavy retiree and Medicare demographic, which is exactly the population that consumes cardiology and chronic disease management. Demand for adult primary and cardiovascular care holds up in any economic environment.
Operator advantage is obvious: 11 exam rooms in a 6,000-square-foot facility with what looks like meaningful unused capacity. Adding one physician or an advanced practice provider drops largely to the bottom line because the fixed cost of space and diagnostic equipment is already paid for.

How to improve it

Recruit an advanced practice provider (NP or PA) within the first 90 days to fill unused exam rooms. This is the fastest incremental profit lever because the space, equipment, and front-office overhead are already sunk, so most new patient revenue flows through.
Audit diagnostic equipment utilization and push in-house imaging capture rates. Every echo, nuclear scan, or vascular ultrasound that currently gets referred out is high-margin revenue leaking to a competitor, so tightening referral discipline directly increases per-patient yield.
Renegotiate commercial payer contracts, which make up half of revenue. Practices that have not repriced their fee schedules in years often leave 5 to 15% of collections on the table, and a Medicare-heavy panel gives leverage to demand better commercial rates.
Build structured chronic disease management and preventive care programs to increase visit frequency per patient. Cardiovascular and metabolic patients justify recurring monitoring visits, which raises recurring revenue per panel member without acquiring new patients.
Strengthen inbound referral relationships with area primary care physicians who lack in-house cardiology diagnostics. Positioning the practice as the local imaging and cardiology destination converts competitors into a referral funnel.
Modernize scheduling and revenue cycle management to reduce no-shows and shorten days in AR. Even modest gains in throughput and collections on a $1.75m base compound quickly given the fixed cost structure.
Evaluate adding complementary service lines such as remote patient monitoring or in-office lab draws. These leverage the existing Medicare panel and diagnostic infrastructure to add billable touchpoints.

Diligence notes

Confirm exactly how the seller's discretionary earnings were calculated and how many physicians the $591k supports. A single physician-owner generating that SDE means a buyer must either be a physician or hire a replacement doctor whose salary would materially reduce true owner cash flow.
Clarify the real estate. The facility is seller-owned but the listing says the treatment of the real estate in a transaction has not been determined, so model both a leased and a purchase scenario and pin down the lease rate before assuming the SDE is clean of a market rent adjustment.
Scrutinize the diagnostic revenue and billing compliance for nuclear medicine and imaging. These service lines carry heavy Medicare regulatory and coding scrutiny, so verify accreditation, supervision requirements, and that no billing practices create clawback or Stark/anti-kickback exposure.
Test provider continuity risk. If the departing owner is the primary cardiologist, patient retention depends on securing a credentialed replacement before close, and payer contracts plus hospital privileges may need re-credentialing under new ownership.
Verify the 2024 to 2025 revenue growth is organic and repeatable rather than a one-time coding or volume bump. Request monthly revenue, visit counts, and diagnostic volumes to confirm the trend and understand seasonality in a retiree-heavy market.

Source

Originally listed on BizBuySell. View original listing →