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 New Jersey for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Community Medical Center Inc (NPI 1013010917)

Field	Value
Entity Type	Organization
Organization	Community Medical Center Inc
Address	99 Route 37 W
City	Toms River
State	NJ
ZIP	08755
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 6, 2006

Payer Source	Total Paid
Medicaid	$88.3M
Medicare	$0

Key Findings

COMMUNITY MEDICAL CENTER INC is effectively a single‑payer Medicaid hospital in the dataset: it has no Medicare billing on file and reports $88.3M in lifetime Medicaid revenue, indicating its observed public payer footprint for this analysis is concentrated in Medicaid rather than Medicare. The absence of Medicare claims suggests analysts should treat Medicaid as the principal source of counted hospital revenue here.

Revenue concentration is high: the precomputed top three Medicaid codes account for 56.6% of the provider’s total Medicaid revenue, signaling that a majority of Medicaid dollars flow through a very small set of service lines. That concentration suggests financial sensitivity to changes in reimbursement or utilization for those top codes.

The largest single Medicaid revenue driver is G0378 (Hospital observation service, per hour) with $16.6M in revenue (21.9% of total Medicaid revenue). This prominence of observation-hours billing implies substantial use of short‑term inpatient/extended observation pathways and an operational emphasis on emergency/observation throughput rather than elective inpatient procedures.

Emergency department E/M codes (99284, 99283, 99285) collectively account for a large share of the top Medicaid revenues — 99284 contributes $13.2M (17.4%), 99283 $13.1M (17.3%), and 99285 $11.8M (15.6%). This code mix portrays the facility as ED‑and‑observation centric, with high volumes of moderate to high complexity ED visits feeding subsequent observation care.

Competitive standing within New Jersey is mixed but generally shows typical to strong volumes for ED/observation services: G0378 ranks #9 of 78 providers (90th percentile), 99285 ranks #24 of 282 providers (92th percentile), while 99284 and 99283 sit in the middle‑to‑upper range (83th and 82th percentiles respectively). These ranks indicate the hospital is a notable regional player for observation and higher‑acuity ED care, though not a statewide outlier dominating every service line.

Operational breadth beyond ED/observation: the top Medicaid list includes significant diagnostic and procedural services such as 93306 echocardiography ($4.3M, 5.7%), 96413 chemotherapy administration ($1.1M, 1.5%), and 93017 stress testing ($1.2M, 1.6%). That mix indicates the hospital supports cardiology diagnostics and some oncology infusion services in addition to emergency care, reflecting a general acute care hospital service portfolio consistent with its taxonomy.

Volume intensity for routine ancillary services is apparent: very high claim counts for lab and basic imaging codes (e.g., 80053 with 80.2K claims, 36415 with 98.9K claims, and 85025 with 75K claims) combined with low average paid/claim amounts show the hospital processes large numbers of low‑value, high‑frequency services that together contribute materially to Medicaid revenue. Those lines position the facility as a high‑throughput provider for both ED and outpatient testing.

NPI tenure is long: the provider NPI was enumerated on 2006-09-06, meaning roughly 20 years of registration in the NPI system. That longevity supports interpreting observed patterns as established operations rather than a new entrant or transient provider, and it may be relevant when comparing utilization trends over time in more granular analyses.

Medicaid: Complete Services Breakdown

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

353 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0378	Hospital observation service, per hour	23,600	$700	$16.6M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	32,040	$410	$13.2M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	35,810	$370	$13.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	38,930	$300	$11.8M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	4,300	$1,010	$4.3M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	10,230	$240	$2.5M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	80,250	$20	$1.8M
93017	The provider records the electrical activity of the heart to examine for any abnormality in its functioning by obtaining blood pressure and electrocardiograph readings at regular intervals with the…	1,950	$610	$1.2M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	3,380	$340	$1.1M
OP250	N/A	99,660	$10	$1.1M

Showing 1–10 of 353

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other New Jersey providers billing the same CPT/HCPCS codes.

Claims Volume vs. New Jersey Distribution

Community Medical Center Inc — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

353 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	9	80	6,290	$690	$6.6M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	89	130	3,180	$60	$4.2M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	48	260	4,240	$220	$4.1M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	54	320	580	$230	$4M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	24	280	920	$200	$2.6M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	30	150	3,680	$30	$1.5M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	34	140	1,410	$180	$1.3M
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	33	70	4,800	$50	$1M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	59	120	900	$20	$971.9K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	58	120	940	$20	$957.4K

Showing 1–10 of 353

Nearby Providers

Other providers in the same ZIP code as Community Medical Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Preferred Behavioral Health Of Nj	NJ	Community/Behavioral Health Agency	$0	$18.3M
Community Surgical Supply Of Toms River LLC	NJ	Oxygen Equipment & Supplies (DME)	$0	$17M
Spring Oak Of Toms River Alp LLC	NJ	Assisted Living Facility	$0	$10.1M
Magnolia Gardens South LP	NJ	Assisted Living Facility	$0	$8.1M
Jersey Innovative Services LLC	NJ	Community/Behavioral Health Agency	$0	$7.9M
The Residence At Lakeridge LLC	NJ	Assisted Living Facility	$0	$7.6M
Ocean County Eye Associates LLC	NJ	Ambulatory Surgical Clinic/Center	$3.4M	$0
Mohammedyusuf Hajee	NJ	Retina Specialist (Ophthalmology) Physician	$2.6M	$0
Haris Amin	NJ	Retina Specialist (Ophthalmology) Physician	$2.1M	$0
David Dickerson	NJ	Orthopaedic Surgery Physician	$171.5K	$1.7M

Community Medical Center Inc — 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