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 North Carolina for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Gaston Memorial Hospital, Incorporated (NPI 1013918960)

Key Findings

Field	Value
Entity Type	Organization
Organization	Gaston Memorial Hospital, Incorporated
Address	2525 Court Dr
City	Gastonia
State	NC
ZIP	28054
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 2, 2005

Payer Source	Total Paid
Medicaid	$49.2M
Medicare	$0

GASTON MEMORIAL HOSPITAL reports no Medicare billing on file and $49.2M in lifetime Medicaid revenue, making its publicly visible reimbursement footprint effectively single-payer (Medicaid) in scale. The absence of Medicare claims suggests analyses of payer mix and reimbursement strategy should be framed around Medicaid volumes and state-level competition rather than Medicare comparisons.

Revenue is heavily concentrated in emergency department evaluation-and-management codes: the top 3 Medicaid codes (99285, 99283, 99284) together account for 78.4% of this provider's total Medicaid revenue. Those three codes individually represent $16.6M (34.9%), $11.9M (25.1%), and $8.7M (18.4%) of Medicaid revenue respectively, indicating major dependence on ED encounters for Medicaid reimbursement.

The code mix and claim volumes point to a high-throughput emergency department as the core operating service line. GASTON MEMORIAL records 65K claims for 99285, 88.2K claims for 99283, and 38.8K claims for 99284, consistent with a facility that sees large numbers of low-, moderate-, and high-acuity ED visits rather than a practice mix dominated by elective inpatient or ambulatory specialty procedures.

Competitive standings for the ED codes show the hospital is a market leader for many visit types within North Carolina. 99285 ranks #12 of 281 providers in-state (96th percentile) and 99283 ranks #11 of 316 (97th percentile), both described as notably above typical state volume, while 99284 ranks #46 of 325 (86th percentile), a more typical statewide volume for that moderate-acuity code.

GASTON MEMORIAL is an extreme outlier in several diagnostic testing codes, driving materially higher state volumes for specific assays. 87635 (SARS–COV–2 NAAT) has 23.2K claims and $1.3M revenue and ranks #3 of 487 providers in-state (100th percentile; extreme outlier), while 87430 (group A strep immunoassay) has 15.1K claims and $240.9K revenue and ranks #1 of 79 providers (100th percentile; extreme outlier), indicating exceptionally high throughput for respiratory and infectious-disease testing relative to peers.

Beyond ED E/M and infectious testing, the provider shows broad high-volume use of common hospital diagnostics and acute care interventions. Examples include 71045 (34.4K claims, $1.1M; 90th percentile), 80053 (73.4K claims, $734.3K; 95th percentile), 85025 (81.2K claims, $568.4K; 98th percentile), and procedural/admin codes such as 96374 (26.2K claims, $733.8K; 95th percentile) and 96361 (20.1K claims, $422.6K; 97th percentile), which together reflect typical hospital-based imaging, lab, and IV/medication administration activity.

The provider's NPI was enumerated on 2005-08-02 (~21 years ago), indicating long tenure in the market. Combined with its concentrated Medicaid revenue and high statewide rankings for key ED and testing codes, this tenure suggests an established regional role focused on high-volume emergency and acute diagnostic services for Medicaid patients.

Medicaid: Complete Services Breakdown

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

124 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	65,000	$260	$16.6M
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.	88,220	$140	$11.9M
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.	38,800	$230	$8.7M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	23,210	$60	$1.3M
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	34,440	$30	$1.1M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	950	$1,070	$1M
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.	73,430	$10	$734.3K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	26,210	$30	$733.8K
87400	The lab analyst performs the technical lab test to detect antigens of influenza A or B using an immunoassay technique, such as EIA. This analysis will distinguish if a patient has influenza A or B.	46,800	$10	$655.1K
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…	25,440	$20	$585.2K

Showing 1–10 of 124

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Gaston Memorial Hospital, Incorporated — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

124 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	46	330	6,130	$130	$2.7M
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.	11	320	6,160	$120	$2.1M
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.	12	280	2,690	$130	$1.6M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	11	40	420	$1,080	$841K
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.	136	360	1,830	$40	$819.8K
87536	A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load.	13	30	470	$50	$640.6K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	100	190	530	$20	$635.1K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	101	190	560	$20	$609.8K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	37	150	860	$50	$586.6K
87389	The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an…	81	100	400	$10	$440.2K

Showing 1–10 of 124

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Comprehab LLC	NC	Physical Therapist	$0	$129.7M
Hughes Behavioral And Mental Health Services Inc.	NC	Developmentally Disabled Services Day Training Agency	$0	$59.8M
Carolina Therapeutic Services, Inc	NC	Community/Behavioral Health Agency	$0	$46.7M
Partners Behavioral Health Management	NC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$43.7M
Center For Emotional Health	NC	Addiction Psychiatry Physician	$0	$40.1M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$32.9M
Support Incorporated	NC	Community/Behavioral Health Agency	$0	$19.1M
Gastonia Physician Services, PLLC	NC	Emergency Medicine Physician	$0	$15.8M
Gaston Adolescent Center, Inc.	NC	Community/Behavioral Health Agency	$0	$14.4M
Touchpoint Healthcare Services Inc	NC	In Home Supportive Care Agency	$0	$11.1M

Gaston Memorial Hospital, Incorporated — 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