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.

Brockton Hospital, Inc. (NPI 1063431286)

Key Findings

Field	Value
Entity Type	Organization
Organization	Brockton Hospital, Inc.
Address	680 Centre St
City	Brockton
State	MA
ZIP	02302
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 19, 2006

Payer Source	Total Paid
Medicaid	$160.8M
Medicare	$0

BROCKTON HOSPITAL reports no Medicare billing on file and $160.8M in lifetime Medicaid revenue, making its current payment footprint effectively single-payer (Medicaid) at scale. This concentration means reimbursement and utilization trends will be driven almost entirely by state Medicaid policy and managed-Medicaid contracts rather than traditional Medicare dynamics.

Revenue concentration is high: the top 3 Medicaid codes by revenue account for 33.6% of this provider's total Medicaid revenue, driven by 99211 ($15.5M, 14.0%), 99283 ($10.9M, 9.8%), and 99285 ($10.8M, 9.8%). Those three codes alone represent a third of Medicaid receipts and point to a narrow set of high-volume services that materially impact overall financial performance.

The code mix strongly indicates an emergency- and outpatient-focused acute care operation: very large volumes for ED E/M codes 99283, 99284, and 99285, combined with G0378 (hospital observation service) and G0463 (hospital outpatient clinic visit), suggest the hospital runs a high-throughput emergency department with substantial observation and outpatient clinic activity. High counts for infusion/IV codes (96361, 96365) further support frequent same-day or short-stay medical management.

BROCKTON is a major statewide player for multiple high-volume Medicaid services: 99211 ranks #5 of 413 in-state (99th percentile), 99283 is #9 of 547 (99th percentile, labeled an "extreme outlier"), and 99213 sits at #38 of 5303 (99th percentile). These rank/percentile signals indicate the provider is outpacing most in Massachusetts on core ED and outpatient visit volumes, consistent with a dominant regional role for those lines.

Several codes are explicitly flagged as statistical outliers or notably above typical state volume, reinforcing the hospital's concentrated strengths: 99283 and 99213 are described as "extreme outlier" or "extreme outlier, far above typical state volume," while 99211, 99284, 97110, 76856, 76830, and 87635 are described as "notably above typical" or at the 99th percentile. These labels point to unusually high utilization in emergency care, physical therapy, imaging, and COVID testing relative to peers.

The provider shows breadth across ancillary and specialty outpatient services beyond emergency care: high-volume imaging (76856 pelvic ultrasound at $2.2M, rank #3 of 185, 99th percentile), CT abdomen/pelvis 74177 ($2.1M), head CT 70450 ($1.7M), and obstetric ultrasound codes (76801 at $1.3M, rank #3 of 102, 98th percentile) indicate robust radiology and perinatal service lines supporting both ED and outpatient demand.

Physical rehabilitation and infusion services are significant revenue drivers: 97110 has 106.2K claims for $6.7M (6.0% of Medicaid revenue) and ranks #5 of 746 (99th percentile), while 96361 (IV fluids hourly) contributes $6.5M and is a routine-volume code. Together these suggest a steady pipeline of therapy and infusion care that complements acute and observation services.

The NPI was enumerated on 2006-07-19 (~20 years ago), indicating long-tenured operations in the market. That tenure, combined with concentrated Medicaid revenue and repeatedly top-percentile ranks across multiple codes, suggests an established regional facility whose financial and utilization profile is highly dependent on sustained Medicaid flows and high ED/outpatient throughput.

Medicaid: Complete Services Breakdown

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

543 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	105,440	$150	$15.5M
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.	90,500	$120	$10.9M
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.	72,960	$150	$10.8M
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.	84,280	$120	$10M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	68,590	$140	$9.8M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	58,090	$160	$9.4M
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…	106,190	$60	$6.7M
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.	19,570	$330	$6.5M
G0378	Hospital observation service, per hour	23,510	$130	$3.1M
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…	15,610	$190	$2.9M

Showing 1–10 of 543

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

Brockton Hospital, Inc. — 13 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

543 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	20	90	7,560	$350	$4.2M
S9485	Crisis intervention mental health services, per diem	100	110	1,250	$540	$3.2M
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	11	20	310	$260	$2.1M
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…	20	50	1,870	$210	$1.4M
G0378	Hospital observation service, per hour	14	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.	17	80	4,380	$140	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	13	110	5,660	$30	$1.1M
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.	16	520	120	$130	$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…	39	130	1,830	$60	$974.3K
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	12	60	1,750	$260	$907.4K

Showing 1–10 of 543

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Signature Healthcare Medical Group Inc	MA	Internal Medicine Physician	$0	$33.4M
Nicklas Oldenburg	RI	Radiation Oncology Physician	$399.1K	$0
Maulshree Gupta	MA	Family Medicine Physician	$105.4K	$134.2K
James Mensching	MA	Emergency Medicine Physician	$88K	$139.9K
Pratik Pradhan	MA	Otolaryngology Physician	$171.8K	$0
Russell Shu	MA	Otolaryngology Physician	$159.6K	$0
Allen Rossetti-chung	RI	Radiation Oncology Physician	$145.4K	$0
Michele Albert	MA	Radiation Oncology Physician	$132.4K	$0
Alireza Nezhad	MA	Cardiovascular Disease Physician	$118.7K	$200
Jagdish Dhingra	MA	Otolaryngology Physician	$107K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Commonwealth Of Massachusetts-dmh	MA	Community/Behavioral Health Agency	$0	$208.3M
Beyond Independent Living LLC	MA	Foster Care Agency	$0	$29.2M
Adult Day Health, Inc.	MA	Adult Day Care Clinic/Center	$0	$8.8M
Commonwealth Of Massachusetts-dmh	MA	Case Management Agency	$0	$7.4M
Hathaway Road Dental, PC	MA	General Practice Dentistry	$0	$6.1M
Apothecare Pharmacy LLC	MA	Long Term Care Pharmacy	$14.8K	$1.2M
Shields Signature Imaging, LLC	MA	Mobile Radiology Clinic/Center	$755K	$490.3K
Charles King	MA	Podiatrist	$219.8K	$263.7K
Alex Teixeira	MA	Gastroenterology Physician	$170.3K	$0
Ahmed Chaudhary	MA	Radiation Oncology Physician	$140.6K	$0

Brockton Hospital, Inc. — Billing Profile & Reimbursement Data

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Brockton 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