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

Why is the Medicaid comparison limited to Connecticut 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. Connecticut (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.

Windham Community Memorial Hospital, Inc. (NPI 1023191467)

Key Findings

Field	Value
Entity Type	Organization
Organization	Windham Community Memorial Hospital, Inc.
Address	112 Mansfield Ave
City	Willimantic
State	CT
ZIP	06226
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 21, 2006

Payer Source	Total Paid
Medicaid	$69.5M
Medicare	$0

This provider is effectively single‑payer in the available data: there is no Medicare billing on file while total Medicaid revenue is reported as $69.5M. The NPI was enumerated on 2006-10-21 (approximately 20 years ago), indicating an established presence in the market but with Medicaid capturing the entirety of observed federal payer revenue.

Revenue is highly concentrated in emergency department evaluation-and-management codes: the top three Medicaid codes 99285, 99284, and 99283 together account for 64.0% of the provider's total Medicaid revenue. Individually those codes generate $16.4M (27.2%), $13.7M (22.7%), and $8.5M (14.1%) respectively, signaling that ED visits are the dominant revenue driver for this hospital.

The code mix points to an ED‑focused acute care operation consistent with its taxonomy as a General Acute Care Hospital: very high claim counts for ED E/M codes (30.3K claims for 99285, 46.1K for 99284, 39.8K for 99283) plus substantial IV/infusion activity (96374, 96360, 96361) and observation/clinic visits (G0463). This pattern suggests the hospital’s revenue and throughput depend on emergency and short‑stay acute care rather than elective, high‑margin inpatient procedures.

Despite high absolute revenue from ED codes, the provider is not a statewide dominant outlier for those services: 99285, 99284, and 99283 are ranked around #28–#30 in the state and are explicitly labeled as "typical, unremarkable volume for this code." In other words, the hospital runs a large ED in absolute terms but its per‑code volumes sit within common state ranges rather than at extreme percentiles.

Other service lines provide secondary revenue but at much smaller shares: physical therapy 97110 accounts for $2.4M (4.0% of Medicaid revenue) with 56.4K claims and is ranked #20 of 348 providers (95th percentile) yet described as "typical, unremarkable volume for this code." Endoscopy (45380, $1.9M, 3.1%) and cross‑sectional imaging (74177, $1.6M, 2.7%) also appear in the top codes, indicating an outpatient procedural footprint beyond the ED.

There is evidence the hospital manages higher‑acuity presentations: 99291 (critical care) appears in the top 25 with 919 claims and $492.6K revenue (0.8%), and 93306 and 78452 (cardiac imaging/studies) each contribute meaningful revenue. These codes are labeled as "typical, unremarkable volume for this code," but their presence confirms available capability to deliver critical care and diagnostic cardiology services in addition to ED throughput.

From a competitive standpoint the provider’s highest‑revenue codes largely sit in middle percentiles statewide (many entries note "typical, unremarkable volume for this code"), so while the hospital is a significant local Medicaid revenue generator ($69.5M) it does not appear to be a specialty market leader on the examined codes. Analysts should therefore view the hospital as a high‑volume, broadly typical acute care provider whose scale is driven by ED visits rather than by a niche specialty dominance.

Operationally, the hospital’s heavy dependence on ED E/M codes (the three ED codes alone are 64.0% of Medicaid revenue) creates sensitivity to shifts in emergency department utilization patterns or Medicaid outpatient payment policy. Any contractual or policy changes affecting ED reimbursement or visit volumes could disproportionately affect this provider’s revenue given the concentration in a few ED codes.

Medicaid: Complete Services Breakdown

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

350 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.	30,280	$540	$16.4M
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.	46,130	$300	$13.7M
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.	39,770	$210	$8.5M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	22,350	$150	$3.3M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	56,410	$40	$2.4M
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	2,450	$760	$1.9M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	8,460	$200	$1.6M
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	2,810	$400	$1.1M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	19,690	$50	$964.8K
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…	14,220	$70	$952.8K

Showing 1–10 of 350

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Windham Community Memorial Hospital, Inc. — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

350 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	25	40	21,520	$90	$8M
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.	30	130	520	$330	$5.9M
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.	28	130	690	$180	$4.7M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	21	40	23,540	$140	$3.7M
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.	30	110	1,520	$140	$3.4M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	16	30	17,770	$50	$1.1M
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…	26	40	1,910	$190	$1.1M
96360	The provider introduces a catheter intravenously for supplementation of fluid and electrolytes for 31 minutes to one hour to treat severe cases of dehydration.	19	30	7,070	$130	$1.1M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	21	40	5,360	$120	$1M
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…	19	50	3,340	$60	$1M

Showing 1–10 of 350

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hartford Hospital	CT	Surgery Physician	$0	$27.5M
Raj Parikh	CT	Pulmonary Disease Physician	$134.6K	$0
Pampana Gowd	CA	Cardiovascular Disease Physician	$132.5K	$0
James Pope	CT	Pulmonary Disease Physician	$127K	$0
Natalya Thorevska	CT	Pulmonary Disease Physician	$121.1K	$0
Jeffrey Nascimento	CT	Pulmonary Disease Physician	$112.9K	$0
Patrick Troy	CT	Pulmonary Disease Physician	$104.6K	$0
Jordan Powner	CT	Pulmonary Disease Physician	$98.5K	$0
Gregory Haman	CT	Internal Medicine Physician	$96.2K	$0
Michael Perkins	CT	Pulmonary Disease Physician	$91.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Generations Family Health Center, Inc.	CT	Federally Qualified Health Center (FQHC)	$0	$61.8M
Northeast Emergency Medicine Specialists, LLC	CT	Emergency Medicine Physician	$0	$11.4M
Perception Programs Inc	CT	Substance Abuse Rehabilitation Facility	$0	$8.9M
Para-pharm Inc	CT	Durable Medical Equipment & Medical Supplies	$0	$5.3M
Abi Resources LLC	CT	Developmentally Disabled Services Day Training Agency	$0	$3.3M
Town Of Windham	CT	Land Ambulance	$276.2K	$2.6M
Town Of Windham Board Of Education	CT	Local Education Agency (LEA)	$0	$2.8M
Tricounty Vision Associates, L.L.C.	CT	Optometrist	$0	$1.9M
Radianz Dental PC	CT	General Practice Dentistry	$0	$1.4M
Mark Pollack	CT	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$1.2M

Windham Community Memorial Hospital, Inc. — Billing Profile & Reimbursement Data

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Windham Community Memorial Hospital, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References