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

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

Methodist Health, Inc. (NPI 1083759633)

Key Findings

Field	Value
Entity Type	Organization
Organization	Methodist Health, Inc.
Address	1305 N Elm St
City	Henderson
State	KY
ZIP	42420
Taxonomy	General Acute Care Hospital
NPI Enumerated	February 21, 2007

Payer Source	Total Paid
Medicaid	$51M
Medicare	$0

METHODIST HEALTH, INC. presents as effectively single-payer at the facility level: there is no Medicare billing on file and all reported lifetime government revenue is Medicaid-only, totaling $51M. This concentration means analyses and risk assessments for this provider should focus on Medicaid payment patterns and state-level competitive dynamics rather than Medicare benchmarks.

Revenue is strongly concentrated in emergency department evaluation-and-management codes: the top three Medicaid codes 99284, 99283, and 99285 together account for 59.2% of this provider's total Medicaid revenue. Individually, 99284 generated $10.7M (31.4K claims, 28.1% of Medicaid revenue), 99283 generated $6.2M (34.3K claims, 16.4%), and 99285 generated $5.6M (12.6K claims, 14.7%), indicating the ED is the primary revenue driver.

The service mix implied by the top codes points to a high-throughput emergency-care operation supported by acute diagnostics and short-stay observation. High-volume ED E/M codes (99283–99285) are complemented by substantial imaging (74177 at $2.7M and 70450 at $1.1M) and observation-hour billing G0378 ($749.5K), consistent with frequent ED presentations requiring CT workups and monitored observation care.

Competitive standing within Kentucky is solid but not dominant for the main ED codes: 99284 ranks #42 of 282 providers in-state (85th percentile), 99283 ranks #34 of 284 (88th percentile), and 99285 ranks #58 of 239 (76th percentile). These rankings indicate above-average state activity for ED services—a meaningful regional presence—while still being one of many sizable ED providers rather than the single market leader.

Operational throughput signals are reinforced by ancillary volumes and testing patterns. The provider reported 132.9K claims for 36415 (blood draw) with $398.8K revenue and ranks #25 of 731 in-state (97th percentile; notably above typical state volume for this code), which supports the interpretation of high patient turnover and frequent laboratory utilization.

Respiratory and infectious disease testing appears material to outpatient activity: U0003 produced $568.3K and 87637 produced $757.3K in Medicaid revenue, with U0003 ranking #20 of 106 providers (82nd percentile) and 87637 ranking #7 of 48 (87th percentile). This indicates the provider performed sizable volumes of COVID/respiratory testing relative to peers, reflecting either ED testing demand or regional testing needs.

Other outpatient diagnostics and procedures contribute meaningfully but at much smaller shares: CT abdomen/pelvis with contrast 74177 ($2.7M, 7.3%), chest radiography 71045 ($677.2K, 1.8%), and EKG service 93005 ($514.3K, 1.4%) round out the revenue mix. These services are consistent with an ED-forward hospital that provides standard emergency imaging and cardiac screening capabilities.

The provider has an established tenure in the NPI registry, enumerated on 2007-02-21 (~19 years ago). That longevity, combined with above-average state percentiles across multiple ED and ancillary codes, suggests an entrenched local hospital presence focused on emergency and acute diagnostic services for the Medicaid population.

Medicaid: Complete Services Breakdown

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

362 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.	31,420	$340	$10.7M
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.	34,250	$180	$6.2M
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.	12,560	$440	$5.6M
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.	8,040	$340	$2.7M
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.	6,820	$160	$1.1M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	11,990	$70	$887.2K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	3,420	$230	$793.9K
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	6,420	$120	$757.3K
G0378	Hospital observation service, per hour	11,190	$70	$749.5K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	16,120	$40	$677.2K

Showing 1–10 of 362

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Methodist Health, Inc. — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

362 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.	42	280	7,150	$150	$3M
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.	58	240	4,710	$150	$2.6M
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.	34	280	5,700	$120	$2M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	32	40	740	$1,170	$1.7M
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.	40	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	14	90	2,770	$190	$1.3M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	18	30	2,320	$290	$1.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	40	80	7,740	$30	$1.1M
C1713	Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)	33	40	550	$910	$1.1M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	62	170	2,610	$250	$1M

Showing 1–10 of 362

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Park Nicollet Methodist Hospital	MN	General Acute Care Hospital	$0	$17.2M
Jason Fogg	KY	Pain Medicine (Physical Medicine & Rehabilitation) Physician	$1.2M	$0
Douglas Johnson	KY	Family Medicine Physician	$256.5K	$0
Jeremy Luckett	KY	Internal Medicine Physician	$245K	$0
Rami Jambeih	KY	Pulmonary Disease Physician	$216K	$0
Lebnan Saad	KY	Pulmonary Disease Physician	$193.7K	$0
Harold Haller	KY	Pulmonary Disease Physician	$193K	$0
Scott Kellie	KY	Pulmonary Disease Physician	$169.8K	$0
Douglas Sheffer	IN	Cardiovascular Disease Physician	$167.9K	$720
Tausif Sayied	KY	Pulmonary Disease Physician	$162.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lighthouse Counseling Services, Inc.	KY	Mental Health Counselor	$0	$12.1M
Stability Counseling And Associates LLC	KY	Mental Health Counselor	$0	$6.5M
Robert Wagoner	KY	Oral & Maxillofacial Surgery (D.M.D.)	$0	$4.7M
Brad T Fulkerson, Dmd,msd,llc	KY	Pediatric Dentistry	$0	$3.6M
Community Alternatives Kentucky, Inc.	KY	Developmentally Disabled Services Day Training Agency	$0	$3.3M
Hugh E Sandefur Ind Inc	KY	Contractor	$0	$3.1M
James Fellows	KY	Urology Physician	$192.2K	$137.8K
Anthony Perkins	KY	Diagnostic Radiology Physician	$259K	$0
Michael Roof	KY	Family Medicine Physician	$226.9K	$0
Sridhar Banuru	KY	Cardiovascular Disease Physician	$214.7K	$1.9K

Methodist Health, Inc. — Billing Profile & Reimbursement Data

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Methodist Health, 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