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.

East Carolina University (NPI 1043260474)

Key Findings

Field	Value
Entity Type	Organization
Organization	East Carolina University
Address	Brody Outpatient Center
City	Greenville
State	NC
ZIP	27858
Taxonomy	Internal Medicine Physician
NPI Enumerated	May 10, 2006

Payer Source	Total Paid
Medicaid	$53.7M
Medicare	$0

This NPI is effectively single‑payer in scope: there is no Medicare billing on file while total Medicaid revenue is $53.7M, so the provider’s billed footprint at this enumeration is dominated by Medicaid receipts rather than a dual Medicare/Medicaid mix. Analysts should treat this profile as a Medicaid-centric revenue stream when comparing payer strategies or patient mix.

Revenue concentration is high: the precomputed top three Medicaid codes (99284, 99214, 99469) account for 46.7% of the provider’s total Medicaid revenue, with those codes generating $10.3M, $6.8M, and $6.3M respectively. This concentration means a relatively small set of services drives nearly half of the $53.7M Medicaid portfolio and should be prioritized for utilization and rate analyses.

The code mix points to a large emergency department operation: 99284 ($10.3M, 139.3K claims; ranks #8 of 325 in‑state, 98th percentile, notably above typical state volume), 99283 ($4.4M; ranks #10 of 316, 97th percentile), and 99285 ($3.7M; ranks #17 of 281, 94th percentile) are among the top revenue drivers. High claim counts and elevated in‑state ranks for multiple ED E/M codes indicate substantial ED throughput and should be considered when modeling acute care capacity or partner network needs.

There is a clear neonatal/critical‑care service line: 99469 (subsequent neonatal critical care) brings $6.3M and ranks #1 of 16 providers in‑state (100th percentile, notably above typical state volume), while related newborn codes 99479 ($2.4M, rank #2 of 22, 95th percentile) and 99472 ($1.7M) also appear on the top list. These placements signal a significant NICU or neonatal follow‑up operation contributing materially to Medicaid revenue and referral patterns.

Outpatient internal medicine and higher‑complexity office visits are also major contributors: 99214 accounts for $6.8M with 111.4K claims and is listed as an extreme outlier in the state (rank #12 of 4404, 100th percentile), and 99215 contributes $1.6M (rank #7 of 1128, 99th percentile). Given the provider taxonomy of Internal Medicine Physician and these volumes, the NPI is processing very large volumes of established patient outpatient care in addition to its ED and neonatal activity.

High volumes in diagnostic cardiology and sleep services diversify the service mix beyond E/M: 93306 produced $1.5M (rank #7 of 224, 97th percentile), 93303 produced $875.7K (rank #6 of 36, 86th percentile), and sleep studies 95810 and 95811 appear in the top codes with elevated ranks. These procedure and testing codes indicate on‑site imaging and diagnostic capability that augment the provider’s clinical breadth and downstream revenue.

Statewide competitive standing is strong and in several cases dominant: multiple codes are at or near the 100th percentile (for example 99469 rank #1 of 16, 99214 at the 100th percentile, 99235 rank #1 of 11 at 100th percentile) and several others are described as extreme outliers or notably above typical state volume. Across emergency, neonatal, inpatient, and outpatient E/M codes this NPI behaves as a major in‑state player rather than a modest, average provider, which should influence benchmarking and contracting strategies.

The NPI has long tenure (enumerated 2006-05-10, approximately 20 years), which combined with the concentrated, high‑volume Medicaid coding suggests established referral relationships and operational scale. The absence of Medicare billing at this NPI may reflect an organizational billing structure (Medicaid concentration or billing under different NPIs/taxonomies) and should prompt reviewers to check other affiliated NPIs or entity‑level billing to fully capture cross‑payer activity.

Medicaid: Complete Services Breakdown

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

204 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	139,250	$70	$10.3M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	111,440	$60	$6.8M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	19,120	$330	$6.3M
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.	96,870	$50	$4.4M
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.	47,400	$80	$3.7M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	23,860	$100	$2.4M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	55,050	$40	$2M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	4,930	$340	$1.7M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	14,150	$110	$1.6M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	22,540	$70	$1.5M

Showing 1–10 of 204

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

East Carolina University — 17 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

204 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.	8	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.	10	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.	17	280	2,690	$130	$1.6M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	1	20	2,430	$300	$1.5M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	5	10	1,880	$290	$1.4M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	2	20	3,950	$100	$740.3K
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.	150	160	490	$100	$435.6K
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.	28	150	1,340	$80	$395.9K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	20	2,270	$90	$369.8K
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	6	40	1,080	$110	$365.2K

Showing 1–10 of 204

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vidant Medical Group LLC	NC	Multi-Specialty Clinic/Center	$0	$78M
Pitt County Memorial Hospital, Inc	NC	General Acute Care Hospital	$0	$60.3M
East Carolina University	NC	Pediatrics Physician	$0	$22.8M
Pitt County Memorial Hospital Inc	NC	Ambulance	$0	$15.6M
Eastern Radiologists Inc	NC	Diagnostic Radiology Physician	$0	$14.3M
Duplin General Hospital Incorporated	NC	General Acute Care Hospital	$0	$13.6M
East Carolina Health - Heritage Inc	NC	General Acute Care Hospital	$0	$12.9M
East Carolina University	NC	Obstetrics & Gynecology Physician	$0	$12.3M
East Carolina Health - Chowan Inc	NC	Critical Access Hospital	$0	$9.5M
East Carolina University	NC	Family Medicine Physician	$0	$9.5M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pride In North Carolina, LLC	NC	Community/Behavioral Health Agency	$0	$98.2M
Pinnacle Home Care, Inc.	NC	Developmentally Disabled Services Day Training Agency	$0	$59.3M
Easter Seals Ucp Nc & Va, Inc.	NC	Community/Behavioral Health Agency	$0	$38.8M
Maxim Healthcare Services, Inc.	NC	Home Health Agency	$0	$35M
Pathways To Life, Inc	NC	Community/Behavioral Health Agency	$0	$30.4M
Behavioral Framework Nc LLC	NC	Behavior Analyst	$0	$29.4M
Venture Rehabilitation Group	NC	Speech-Language Pathologist	$0	$16M
At Home Personal Care Services,inc. Of North Carolina	NC	Home Health Agency	$0	$14.5M
East Carolina Home Care	NC	In Home Supportive Care Agency	$0	$14.5M
Carolina Therapy Connection, PC	NC	Pediatric Occupational Therapist	$0	$12.5M

East Carolina University — 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