Loading...
NPI 1013900364 · Sparta, IL · Land Ambulance
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Medstar Ambulance Inc is a land ambulance provider located in Sparta, Illinois. This profile covers 6 Medicare and 11 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Medstar Ambulance Inc |
| Address | 705 Bradbury Ln |
| City | Sparta |
| State | IL |
| ZIP | 62286 |
| Taxonomy | Land Ambulance |
| NPI Enumerated | August 23, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $27.6M |
| Medicare | $2.3M |
This provider is heavily Medicaid-focused: Total Medicare revenue is $2.3M while Total Medicaid revenue is $27.6M, indicating Medicaid accounts for the large majority of billed dollars and the provider operates at scale primarily within the state Medicaid market. The disparity in absolute revenue suggests payer mix and operational emphasis are concentrated on Medicaid patients rather than Medicare beneficiaries.
Medicare revenue is highly concentrated in three ambulance-related codes: the precomputed top 3 Medicare codes account for 91.4% of this provider's total Medicare revenue. The dominant Medicare codes are A0429, A0427, and A0425, which together signal that emergency BLS and ALS transports plus ground mileage drive nearly all Medicare billing for this entity.
Medicaid revenue concentration is even stronger: the precomputed top 3 Medicaid codes account for 95.2% of this provider's total Medicaid revenue. Within Medicaid, A0429 alone represents $15.2M (55.1% of Medicaid revenue), with A0427 contributing $6.8M (24.7%) and A0425 contributing $4.3M (15.5%), showing a very narrow service mix focused on emergency transports and mileage.
The code mix (A0429 – BLS emergency, A0427 – ALS1 emergency, A0425 – ground mileage) describes a core business of ground ambulance emergency response and transport. High volumes of emergency BLS/ALS claims plus substantial mileage billing are consistent with an operation that performs frequent emergency transports across a broad geographic area or with long average trip distances.
State-level competitive standing is dominant for Medicaid emergency BLS: A0429 ranks #3 of 339 providers in-state (99th percentile; extreme outlier, far above typical state volume), and A0427 ranks #5 of 362 (99th percentile). These ranks indicate the provider is a major, possibly market-leading ambulance operator in Illinois for emergency transport services billed to Medicaid.
National competitive standing in Medicare is strong for select codes: A0429 ranks #131 of 7808 providers nationally (98th percentile; notably above typical national volume) and A0425 ranks #275 of 8934 (97th percentile; notably above typical national volume), while A0427 ranks #361 of 6841 (95th percentile; typical, unremarkable volume). This pattern shows high national volume for specific ambulance services even though Medicare revenue is smaller in absolute terms.
Several Medicaid-listed codes appear with claims but $0 avg paid/claim and $0 revenue (for example 93041 with 4.7K claims, $0 avg paid/claim, $0 revenue and 93005 with 2.2K claims, $0 avg paid/claim, $0 revenue). These zero-paid items (including supply codes A0382 and A0398) suggest reporting of technical components or bundled items in the claims file that do not generate separate paid dollars in the dataset, and some of those entries rank at or near the top in-state (e.g., 93041 ranks #1 of 9 in-state, 100th percentile).
The provider’s NPI was enumerated on 2005-08-23 (~21 years ago), indicating long-tenured participation in federal programs. Combined with the very high in-state ranks and concentrated Medicaid volumes, this tenure supports an interpretation of an established ambulance operator with a sustained, Medicaid-focused service footprint.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 2,650 | $320 | $843K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 1,920 | $380 | $730.4K |
| A0425 | Ground mileage, per statute mile | 65,250 | $10 | $522K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 580 | $200 | $117.4K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 250 | $240 | $61K |
| A0433 | Advanced life support, level 2 (als 2) | 30 | $540 | $18.4K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 60,840 | $250 | $15.2M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 29,360 | $230 | $6.8M |
| A0425 | Ground mileage, per statute mile | 99,580 | $40 | $4.3M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 7,650 | $120 | $925.9K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 1,980 | $150 | $293K |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation | 10,270 | $10 | $102.7K |
| A0433 | Advanced life support, level 2 (als 2) | 10 | $150 | $1.8K |
| 93005 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 2,230 | $0 | $0 |
| 93041 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning using a maximum of three leads. This code represents the technical component of the service… | 4,700 | $0 | $0 |
| A0382 | Bls routine disposable supplies | 460 | $0 | $0 |
Showing 1–10 of 11
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
11 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 5 | 360 | 1,340 | $910 | $4M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 3 | 340 | 1,050 | $770 | $2.8M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 19 | 80 | 1,580 | $140 | $1.8M |
| A0425 | Ground mileage, per statute mile | 8 | 450 | 2,450 | $40 | $602.5K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 10 | 60 | 350 | $200 | $269.4K |
| A0433 | Advanced life support, level 2 (als 2) | 11 | 10 | 70 | $190 | $117.5K |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation | 7 | 70 | 800 | $10 | $56.8K |
| 93005 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 10 | 200 | 150 | $10 | $4.3K |
| 93041 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning using a maximum of three leads. This code represents the technical component of the service… | 1 | 10 | 880 | $1 | $280 |
| A0398 | Als routine disposable supplies | 2 | 10 | 410 | $1 | $90 |
Showing 1–10 of 11
Other providers in the same ZIP code as Medstar Ambulance Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Russell Coulter | IL | Family Medicine Physician | $62.1K | $9.4K |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.