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NPI 1043250350 · Winston Salem, NC · Ambulance
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Forsyth County is a ambulance provider located in Winston Salem, North Carolina. This profile covers 5 Medicare and 5 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 | Forsyth County |
| Address | 911 E 5th St |
| City | Winston Salem |
| State | NC |
| ZIP | 27101 |
| Taxonomy | Ambulance |
| NPI Enumerated | June 7, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $11.5M |
| Medicare | $2.1M |
Operational profile: Billing mix is consistent with a high-volume ambulance provider focused on emergency advanced life support (ALS) transport. The dominant code in both payers is A0427 (ALS 1 - emergency), which alone generated $1.5M on Medicare (3.9K claims, $378 avg paid/claim) and $9.2M on Medicaid (72.1K claims, $128 avg paid/claim), indicating core operational emphasis on emergency ALS services rather than non-emergency transports.
Revenue concentration (Medicare): Revenue is highly concentrated among a small set of transport and mileage codes, with the precomputed top 3 Medicare codes accounting for 97.0% of the provider's total Medicare revenue. Those top three — A0427 (69.7%), A0429 (16.6%), and A0425 (10.7%) — dominate Medicare receipts, signaling limited diversification in Medicare service lines.
Revenue concentration (Medicaid): Medicaid revenue is even more concentrated, with the precomputed top 3 Medicaid codes accounting for 99.7% of total Medicaid revenue. A0427 alone contributes 80.3% of Medicaid revenue, followed by A0429 at 16.6% and 99199 at 2.8%, so Medicaid dollars are overwhelmingly driven by emergency transport activity.
Payer mix and scale: This provider is effectively Medicaid-dominant by dollars: Medicaid revenue ($11.5M) substantially exceeds Medicare revenue ($2.1M), so payers and contracts with state Medicaid programs will have outsized influence on overall topline performance and utilization patterns. Analysts should treat the entity as primarily a Medicaid-funded ambulance operator in economic scale.
Competitive standing (Medicare): For Medicare-level ALS emergency transports (A0427) the provider ranks #170 of 6841 nationally (98th percentile) and is described as "notably above typical national volume," so it is a high-volume national outlier for that specific code. Other Medicare codes—A0429 (rank #451 of 7808, 94th percentile) and A0425 (rank #650 of 8934, 93th percentile)—are in higher percentiles but characterized as typical or unremarkable volume relative to peers.
Competitive standing (Medicaid): The provider is a dominant statewide player for A0427 on Medicaid, ranking #5 of 168 in-state (98th percentile) and labeled an "extreme outlier, far above typical state volume." A0429 is also comparatively large in-state (rank #13 of 144, 92th percentile) but described as typical in volume, confirming that the provider's market position in Medicaid is driven overwhelmingly by emergency ALS transports.
Coding and reimbursement oddities: The Medicaid record shows 32.6K claims for A0425 (ground mileage) with $0 avg paid/claim and $0 revenue, a pattern that merits follow-up in data validation or contract interpretation since mileage appears to be billed but not reimbursed in the Medicaid dataset. Additionally, 99199 appears on Medicaid with 65.4K claims and $327K revenue (2.8%), indicating frequent use of unspecified/other procedure reporting in the state data.
Tenure and operational stability: The NPI was enumerated on 2006-06-07 (~20 years ago), indicating long-term presence in the market. Given the sustained, high-volume A0427 activity across payers and the long tenure, this facility appears to be an established ambulance provider whose strategic relevance to Medicaid programs is particularly pronounced.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 3,930 | $380 | $1.5M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 1,110 | $320 | $353K |
| A0425 | Ground mileage, per statute mile | 32,480 | $10 | $227.4K |
| A0433 | Advanced life support, level 2 (als 2) | 70 | $550 | $37.1K |
| A0434 | Specialty care transport (sct) | 40 | $650 | $26.8K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 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.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 72,080 | $130 | $9.2M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 17,330 | $110 | $1.9M |
| 99199 | Use this code to report other medicine services or procedures for which there is no specific code available. | 65,410 | $10 | $327K |
| A0433 | Advanced life support, level 2 (als 2) | 260 | $130 | $32.3K |
| A0425 | Ground mileage, per statute mile | 32,600 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. North Carolina median
5 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 | 170 | 2,470 | $140 | $1.2M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 13 | 140 | 2,410 | $110 | $686.8K |
| 99199 | Use this code to report other medicine services or procedures for which there is no specific code available. | 511 | 2,850 | 10,910 | $10 | $330.3K |
| A0433 | Advanced life support, level 2 (als 2) | 15 | 30 | 280 | $140 | $100K |
| A0425 | Ground mileage, per statute mile | 12 | 220 | 3,930 | $10 | $86.1K |
Other providers in the same ZIP code as Forsyth County, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Perry L. Jeffries Dds, PA | NC | Pediatric Dentistry | $0 | $17.2M |
| The Enrichment Center-an Affiliated Chapter Of The Arc | NC | Community/Behavioral Health Agency | $0 | $11.4M |
| Lifestar Emergency Services LLC | NC | Ambulance | $1.2M | $1.8M |
| Maggie Foster | NC | Physician Assistant | $35.6K | $0 |
| Floyd Strupe | NC | Chiropractor | $11.1K | $0 |
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