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

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

The Mercy Hospital Inc (NPI 1043204316)

Field	Value
Entity Type	Organization
Organization	The Mercy Hospital Inc
Address	271 Carew St
City	Springfield
State	MA
ZIP	01104
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 1, 2005

Payer Source	Total Paid
Medicaid	$98.9M
Medicare	$0

Key Findings

THE MERCY HOSPITAL INC is effectively a single-payer Medicare/Medicaid operation on file: it reports no Medicare revenue and $98.9M in total Medicaid revenue, so Medicaid is the dominant and sole public-payer revenue stream visible in this dataset. That concentration means the provider’s public-revenue profile and any utilization trends will be driven almost entirely by Medicaid reimbursement and utilization patterns.

Revenue at THE MERCY HOSPITAL is highly concentrated in a small set of emergency and infusion codes: the top three Medicaid codes (99283, 99285, 96361) together account for 49.0% of the provider’s total Medicaid revenue, with 99283 ($13.5M, 17.7%), 99285 ($13M, 17.0%), and 96361 ($10.9M, 14.3%) listed as the top contributors. This degree of concentration around ED evaluation-and-management and IV-fluid/infusion codes indicates that a large share of Medicaid dollars flow from acute, ED-driven care and short-duration infusion services.

The code mix points to a high-volume emergency department with substantial acuity range: THE MERCY reported 90.2K claims for 99283 and 78.6K claims for 99285, plus 61K claims for 99284 and 11.5K claims for 99282. Those volumes, combined with the top-revenue concentration noted above, suggest the hospital operates a busy ED treating both low- and high-acuity Medicaid patients and generating significant ED-driven revenue.

Infusion and dehydration-management services are a clear secondary service line; 96361 appears as a top-3 revenue driver (30.8K claims, $354 avg paid/claim, $10.9M revenue, described as typical, unremarkable volume) and related infusion codes 96365, 96360, and 96366 also appear in the top 25. This pattern is consistent with frequent IV fluid administration and short infusions in the ED or observation setting, reinforcing that many Medicaid clinical encounters are acute and require parenteral therapy.

THE MERCY ranks as a regional outlier on several ED and testing codes: 99283 ranks #10 of 547 providers in-state (98th percentile; extreme outlier, far above typical state volume for this code) and 99285 ranks #13 of 521 providers in-state (98th percentile; notably above typical state volume for this code). The hospital therefore holds a leading statewide position for high-volume ED evaluation-and-management activity, indicating market dominance in Medicaid ED throughput for these service lines.

Beyond ED and infusion services, THE MERCY shows robust diagnostic and procedural capacity: colonoscopy code 45378 ($2.8M), upper endoscopy biopsy 43239 ($2.2M), CT and ultrasound codes such as 74177 ($2.5M) and 70450 ($2.1M) appear in the top 25, and 74176 ranks #7 of 121 providers in-state (95th percentile; notably above typical state volume). These procedure and imaging volumes signal that the hospital supports procedural, endoscopy, and cross-sectional imaging service lines at scale for its Medicaid population.

COVID-era testing volumes include very large counts for molecular antigen/NAAT codes: 87635 shows 21.1K claims, $36 avg paid/claim, $759.9K revenue and ranks #10 of 717 providers in-state (99th percentile; extreme outlier, far above typical state volume for this code), while U0003 also appears with 12.6K claims. The extremely high relative position on 87635 indicates the hospital was a major site of SARS‑CoV‑2 testing activity for Medicaid enrollees during the period covered by these claims.

Tenure and institutional stability are visible: THE MERCY’s NPI was enumerated 2005-09-01 (~21 years ago), indicating two decades of billing activity under this identifier. Combined with the hospital’s leading ranks on multiple Medicaid codes and the $98.9M in Medicaid revenue, this tenure supports the interpretation of an established acute-care provider with sustained Medicaid-facing service lines and market presence.

Medicaid: Complete Services Breakdown

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

343 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	90,210	$150	$13.5M
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.	78,600	$170	$13M
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.	30,780	$350	$10.9M
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.	61,050	$150	$9.3M
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	2,710	$1,050	$2.8M
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…	31,470	$80	$2.6M
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.	16,260	$160	$2.5M
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.	3,580	$620	$2.2M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	16,850	$130	$2.1M
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.	11,540	$150	$1.7M

Showing 1–10 of 343

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

The Mercy Hospital Inc — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

343 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	29	40	26,400	$10	$9.7M
J9271	Injection, pembrolizumab, 1 mg	9	10	210	$5,200	$5.5M
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.	9	90	7,560	$350	$4.2M
J2350	Injection, ocrelizumab, 1 mg	4	10	130	$7,900	$3.9M
S9485	Crisis intervention mental health services, per diem	73	110	1,250	$540	$3.2M
J2505	Injection, pegfilgrastim, 6 mg	7	10	650	$1,880	$1.8M
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…	11	50	1,870	$210	$1.4M
G0378	Hospital observation service, per hour	23	70	7,250	$100	$1.3M
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.	18	80	4,380	$140	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	48	110	5,660	$30	$1.1M

Showing 1–10 of 343

Related Providers

Other providers that share a Tax Identification Number (TIN) with The Mercy Hospital Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Holyoke Capital Jv, LLC	MA	Psychiatric Hospital	$645.1K	$11.5M
The Mercy Hospital Inc	MA	Psychiatric Hospital	$0	$11M
The Mercy Hospital Inc	MA	Rehabilitation Hospital Unit	$0	$7.4M

Nearby Providers

Other providers in the same ZIP code as The Mercy Hospital Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Behavioral Health Network Inc	MA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$238.6M
Gandara Mental Health Center Inc	MA	Mental Health Counselor	$0	$133.1M
Behavioral Health Network, Inc	MA	Methadone Clinic	$1.3M	$108.4M
Behavioral Health Network, Inc	MA	Adult Day Care Clinic/Center	$0	$76.5M
American Medical Response Of Massachusetts Inc	MA	Ambulance	$8.7M	$51.7M
Greater Springfield Senior Services, Inc.	MA	Case Management Agency	$0	$55.1M
Viability, Inc.	MA	Adult Care Home Facility	$0	$46.8M
Riverbend Medical Group, Inc.	MA	Internal Medicine Physician	$0	$38.8M
International Health Solutions,inc	MA	Home Health Agency	$0	$27.3M
Greater Springfield Senior Services, Inc.	MA	Case Management Agency	$0	$25.4M

The Mercy Hospital Inc — Billing Profile & Reimbursement Data

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The Mercy 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