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.

St Claire Medical Center Inc (NPI 1124078696)

Key Findings

Field	Value
Entity Type	Organization
Organization	St Claire Medical Center Inc
Address	222 Medical Cir
City	Morehead
State	KY
ZIP	40351
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 12, 2006

Payer Source	Total Paid
Medicaid	$71.2M
Medicare	$0

This facility is effectively single-payer in scope for our data set: there is no Medicare billing on file while reported Medicaid revenue totals $71.2M. That imbalance means the provider’s financial footprint in our data is driven entirely by state Medicaid business rather than Medicare fee-for-service activity.

Revenue is concentrated in a small set of Medicaid codes: the precomputed top 3 codes account for 32.8% of the provider’s total Medicaid revenue. Those top drivers are 99284 ($6.9M, 16.5%), 99283 ($4.1M, 9.8%), and G0483 ($2.7M, 6.5%), indicating a mix of emergency evaluation and definitive toxicology testing as primary revenue contributors.

The code mix points to a high-volume emergency care operation: 99284 shows 40.9K claims, 99283 shows 33.1K claims, and 99285 has 9.1K claims. Combined with the revenue shares above, these volumes suggest substantial ED throughput and an operational emphasis on unscheduled acute care and ED-based evaluation and management.

Ancillary and laboratory services make up a meaningful share of Medicaid revenue, reflecting onsite testing and diagnostics capacity: G0483 (18.4K claims, $2.7M), G0480 (14.4K claims, $1.3M), 80307 (33.8K claims, $1.8M), and the proprietary PLA 0202U (6.9K claims, $2.3M). This pattern indicates the hospital performs high volumes of definitive drug testing and specialized respiratory PCR testing, supporting both ED and inpatient workflows.

Outpatient and clinic-level volume is unusually large for several low‑acuity evaluation codes: 99212 (66.2K claims, $1.9M) and 99211 (68.6K claims, $1.9M) each rank in the 99th percentile and are labeled as an extreme outlier / notably above typical state volume. That combination of very high claim counts with modest per-claim payments suggests extensive ambulatory or clinic visit throughput alongside the ED activity.

Imaging and cardiac services are notable contributors to the Medicaid mix: CT abdomen/pelvis with contrast 74177 ($2.1M), CT head 70450 ($1.2M), transthoracic echo 93306 ($1.2M), and imaging supervision for left heart catheterization 93458 ($978.9K). These codes reflect a capacity for advanced diagnostic imaging and interventional cardiology support that complements the hospital’s emergency and acute-care case mix.

Competitively, the provider is a solid regional participant but not typically the statewide leader on most top codes: 99284 ranks #33 of 282 (89th percentile), 99283 ranks #36 of 284 (88th percentile), and many other high-revenue codes fall in the 76th–91st percentile range. The two exceptions that stand out competitively are 99212 and 99211 at the 99th percentile, where the provider is far above typical state volume, signaling a distinctive strength in high-throughput ambulatory services.

The provider’s NPI was enumerated on 2006-05-12 (~20 years ago), indicating long tenure in the market. Combined with the absence of Medicare billing and a $71.2M Medicaid revenue base, this long-standing, Medicaid-centered footprint suggests sensitivity to state policy and payer-rate changes rather than shifts in Medicare reimbursement.

Medicaid: Complete Services Breakdown

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

475 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.	40,910	$170	$6.9M
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.	33,090	$120	$4.1M
G0483	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…	18,390	$150	$2.7M
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…	6,950	$330	$2.3M
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.	9,580	$220	$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.	9,110	$220	$2M
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,…	66,220	$30	$1.9M
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.	68,580	$30	$1.9M
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.	33,780	$50	$1.8M
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…	45,240	$30	$1.3M

Showing 1–10 of 475

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

St Claire Medical Center Inc — 4 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

475 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	136	310	830	$120	$3.7M
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.	33	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.	81	240	4,710	$150	$2.6M
G0483	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…	12	70	1,650	$100	$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.	36	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.	35	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.	31	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	72	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…	6	30	2,320	$290	$1.2M
S9129	Occupational therapy, in the home, per diem	10	30	7,220	$70	$1.1M

Showing 1–10 of 475

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Claire Medical Center Inc.	KY	Emergency Medicine Physician	$0	$4M
St. Claire Medical Center, Inc	KY	Family Medicine Physician	$0	$3.3M
St Claire Medical Center, Inc.,	KY	Cardiovascular Disease Physician	$0	$3.3M
St. Claire Medical Center, Inc	KY	Home Health Agency	$0	$3.1M
Tariq Mahmood	OK	Medical Oncology Physician	$253.8K	$17.8K
Eusebio Desuyo	ND	Pulmonary Disease Physician	$132.6K	$0
Matthew Shotwell	KY	Interventional Cardiology Physician	$109.3K	$0
Samuel Quaynor	GA	Neurology Physician	$93.9K	$14.6K
Steven Koenig	KY	Pulmonary Disease Physician	$104.5K	$0
Obiora Maludum	TN	Interventional Cardiology Physician	$104.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Edgewater Recovery Center LLC	KY	Substance Abuse Rehabilitation Facility	$0	$50.3M
D&s Residential Services, LP	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$33.6M
Gateway Area Development District	KY	Supports Brokerage Agency	$0	$20.8M
Lincare Inc.	KY	Durable Medical Equipment & Medical Supplies	$0	$3.4M
St Claire Medical Center, Inc	KY	Urgent Care Clinic/Center	$0	$3.3M
Rowan County Fiscal Court	KY	Land Ambulance	$384.7K	$767.5K
Christian Weigel	KY	Internal Medicine Physician	$105K	$0
Andrei Korossy	KY	Physical Therapist	$89.6K	$0
Lacinda Rishel	KY	Physician Assistant	$82.7K	$0
Alisha Perry	KY	Physician Assistant	$55.1K	$0

St Claire Medical Center Inc — Billing Profile & Reimbursement Data

Sign up for St Claire Medical Center Inc — Billing Profile & Reimbursement Data policy alerts

St Claire Medical Center Inc — Billing Profile & Reimbursement Data

Sign up for St Claire Medical Center Inc — Billing Profile & Reimbursement Data policy alerts

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