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

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Holy Name Medical Center Inc. (NPI 1104859131)

Field	Value
Entity Type	Organization
Organization	Holy Name Medical Center Inc.
Address	718 Teaneck Rd
City	Teaneck
State	NJ
ZIP	07666
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 10, 2006

Payer Source	Total Paid
Medicaid	$107.1M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused hospital: there is no Medicare billing on file and lifetime Medicaid revenue is $107.1M, so operational and reimbursement risk is concentrated in the Medicaid payer stream. The NPI was enumerated on 2006-07-10 (~20 years ago), indicating an established presence in the market.

Revenue concentration is high in a few line items: the top 3 Medicaid codes account for 38.6% of this provider's total Medicaid revenue, with 99284 contributing $12.9M (17.5%), J2350 contributing $9.1M (12.4%), and 99283 contributing $6.4M (8.7%). These three codes alone drive over one-third of reported Medicaid receipts, highlighting key service lines that dominate reimbursement.

Emergency care is a primary revenue driver: 99284 has 43.8K claims at $294 avg paid/claim for $12.9M and 99283 has 21.7K claims at $294 avg paid/claim for $6.4M, both cited as typical, unremarkable volume in-state. Combined with observation services G0378 (8.8K claims, $416 avg, $3.6M), this pattern indicates large ED throughput and short-stay observation activity that form a core part of inpatient/ED operations.

The provider is a notable regional center for high-cost specialty infusions and related procedures: J2350 (550 claims, $16562 avg paid/claim, $9.1M) ranks #1 of 5 providers in-state and is described as notably above typical state volume for this code, while J2323 (1.3K claims, $4426 avg paid/claim, $5.8M) also ranks #1 in-state. These patterns, together with chemotherapy administration codes 96413 (9.7K claims, $228 avg, $2.2M) and 96365 (14.4K claims, $107 avg, $1.5M), point to significant specialty infusion and oncology/infusion clinic activity.

Physical and manual therapy are unusually large service lines here: 97110 (90.1K claims, $44 avg paid/claim, $4M) is labeled an extreme outlier, far above typical state volume for this code, and 97140 (57.8K claims, $38 avg paid/claim, $2.2M) is also an extreme outlier. These volumes suggest a very large outpatient rehabilitation footprint that could affect contracting, network capacity, and ancillary revenue strategies.

The hospital maintains a strong imaging and procedural footprint across multiple modalities: 93458 (1.4K claims, $1026 avg, $1.5M) ranks #1 of 49 providers in-state and is notably above typical state volume for this code, 76641 (12.3K claims, $140 avg, $1.7M) ranks #3 of 100 and is notably above typical state volume, and 93306 (8K claims, $382 avg, $3M) sits at a high in-state percentile but is characterized as typical, unremarkable volume. Together these data show capacity for advanced cardiac, breast, and general imaging services.

Competitive standing is mixed by service line: the provider is a dominant in-state player for select codes (J2350 and J2323 both rank #1 in-state and 93458 ranks #1 of 49), while its emergency codes (99284, 99283) are described as typical, unremarkable volumes despite large claim counts. Multiple high-percentile and top-rank codes indicate the hospital is a major regional resource for infusion, cath/angiography imaging, and rehab, rather than a uniformly dominant general hospital across all specialties.

From a payer and network perspective, reliance on Medicaid ($107.1M) with no Medicare billing on file reduces diversification of payer mix and concentrates revenue exposure to Medicaid policy and rates. The concentration of revenue in a few codes (38.6% from the top three) and the presence of extreme outlier therapy volumes and #1-ranked infusion/imaging codes should be considered when assessing contracting leverage, utilization management priorities, and operational capacity demands.

Medicaid: Complete Services Breakdown

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

411 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.	43,790	$290	$12.9M
J2350	Injection, ocrelizumab, 1 mg	550	$16,560	$9.1M
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.	21,740	$290	$6.4M
J2323	Injection, natalizumab, 1 mg	1,320	$4,430	$5.8M
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…	90,090	$40	$4M
G0378	Hospital observation service, per hour	8,750	$420	$3.6M
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.	17,910	$190	$3.4M
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…	7,970	$380	$3M
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.	3,350	$780	$2.6M
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…	9,710	$230	$2.2M

Showing 1–10 of 411

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

Holy Name Medical Center Inc. — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

411 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	26	80	6,290	$690	$6.6M
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…	38	130	3,180	$60	$4.2M
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.	70	260	4,240	$220	$4.1M
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.	38	320	580	$230	$4M
J2323	Injection, natalizumab, 1 mg	1	10	1,050	$3,490	$3M
J2350	Injection, ocrelizumab, 1 mg	1	10	130	$14,830	$2.8M
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.	55	280	920	$200	$2.6M
J9312	Injection, rituximab, 10 mg	4	10	180	$5,830	$2.2M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	82	150	3,680	$30	$1.5M
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	28	40	1,690	$70	$1.4M

Showing 1–10 of 411

Nearby Providers

Other providers in the same ZIP code as Holy Name Medical Center Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Awca Home Care Agency, Inc.	NJ	Home Health Agency	$0	$25.2M
Care-4-me,llc	NJ	Home Health Agency	$0	$18.1M
Excelcare Medical Associates, PA	NJ	Internal Medicine Physician	$0	$10M
Friendly Urgent Care, LLC	NJ	Urgent Care Clinic/Center	$0	$8.6M
New Jersey Laser Dentistry	NJ	Dental Clinic/Center	$0	$8.5M
Vincent Ho	NJ	Retina Specialist (Ophthalmology) Physician	$2.4M	$0
Holy Name Ems	NJ	Land Ambulance	$1.3M	$919K
Tamara Lenis	NJ	Ophthalmology Physician	$1.7M	$0
Neil Gonter	NJ	Rheumatology Physician	$1.6M	$0
Luis Gonzalez Gonzalez	NJ	Ophthalmology Physician	$1.5M	$0

Holy Name Medical Center Inc. — Billing Profile & Reimbursement Data

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Holy Name Medical Center 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

Nearby Providers

Frequently Asked Questions

References