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NPI 1134220031 · Saint Joseph, MI · General Acute Care Hospital
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Lakeland Hospitals At Niles And St Joseph, Inc is a general acute care hospital provider located in Saint Joseph, Michigan. This profile covers 0 Medicare and 576 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Lakeland Hospitals At Niles And St Joseph, Inc |
| Address | 1234 Napier Ave |
| City | Saint Joseph |
| State | MI |
| ZIP | 49085 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | September 26, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $78.1M |
| Medicare | $0 |
This entity reports no Medicare billing on file and $78.1M in total Medicaid revenue, so its reported public-payer footprint in the dataset is effectively single-payer and Medicaid-dependent; absence of Medicare activity implies analyses and contracting reviews should treat Medicaid as the primary revenue exposure. The lack of Medicare claims also limits cross-payer benchmarking in national Medicare measures for this provider.
Revenue is heavily concentrated in emergency department evaluation-and-management codes: 99284 ($10.5M, 17.7%), 99285 ($9.9M, 16.7%), and 99283 ($9.4M, 15.8%) together account for 50.2% of the provider’s total Medicaid revenue. That concentration means a small set of ED visit types drives the majority of Medicaid dollars and any changes to ED utilization or reimbursement would materially affect overall revenue.
The code mix indicates the facility operates as an acute-care, high-throughput emergency and observation center: besides the three top ED E/M codes it reports G0378 (hospital observation service) at $7.2M (12.2%), suggesting substantial observation-hold activity in addition to ED throughput. High volumes of IV administration codes (e.g., 96374 $3.6M, 6.1%; 96365 $1.4M, 2.3%) and chemotherapy administration (96413 $1.1M, 1.9%) further point to on-site infusion and acute medical treatment capacity.
State-level competitive standing is mixed by code: for 99283 the provider ranks #18 of 447 in-state (96th percentile) and is described as notably above typical state volume, indicating a dominant role for that lower-complexity ED visit in the region; by contrast 99284 ranks #33 of 477 (93th percentile; typical, unremarkable) and 99285 ranks #53 of 404 (87th percentile; typical, unremarkable), so the facility is not uniformly the top-volume site across all ED acuity levels. Taken together, these ranks show a strong in-state presence for specific ED and observation services rather than across all emergency categories.
Several ancillary lines show either meaningful scale or outlier status in-state: therapeutic exercise 97110 accounts for $1.8M (3.1%) and ranks #9 of 547 (99th percentile; extreme outlier, far above typical state volume), and neuromuscular reeducation 97112 is $682K (1.1%) and ranks #17 of 355 (95th percentile; notably above typical state volume). These figures indicate a substantial outpatient therapy program that is unusually large relative to other Michigan providers.
Infusion, imaging, and procedural services complement the ED/observation profile: CT abdomen/pelvis 74177 is $1.4M (2.4%) and CT head 70450 is $544.9K (0.9%), while select infusion-related codes show both volume and elevated state percentiles (96365 $1.4M, 2.3% and ranks #8 of 165, 96th percentile; 96375 $957.6K, 1.6% and ranks #9 of 155, 95th percentile). This mix supports an operational model that couples emergency throughput with on-site diagnostics and therapeutic infusions/chemotherapy.
Operational risk and opportunity notes: because a majority of Medicaid revenue is concentrated in a few ED/observation codes and the provider has no Medicare reimbursement reported, payer-negotiation leverage or policy shifts affecting Medicaid ED payment or observation rules could disproportionately affect the provider’s revenue base. Conversely, the strong state percentiles on therapy and infusion services suggest opportunities to monetize or expand those specialty services with managed-care partners.
The provider has a long tenure in the NPI registry (enumerated 2006-09-26 (~20 years ago)), which, combined with repeated high statewide percentiles on several codes, points to an established regional acute-care hospital with entrenched ED, observation, therapy, and infusion operations that dominate certain service lines in Michigan.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
576 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. | 53,510 | $200 | $10.5M |
| 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. | 31,760 | $310 | $9.9M |
| 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. | 75,910 | $120 | $9.4M |
| G0378 | Hospital observation service, per hour | 21,500 | $340 | $7.2M |
| 96374 | The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition. | 38,370 | $100 | $3.6M |
| 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… | 79,160 | $20 | $1.8M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 26,140 | $60 | $1.6M |
| 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. | 10,080 | $140 | $1.4M |
| 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. | 15,200 | $90 | $1.4M |
| 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… | 11,370 | $100 | $1.2M |
Showing 1–10 of 576
How this provider's Medicaid billing volume and revenue compare to other Michigan providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Michigan median
576 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J9271 | Injection, pembrolizumab, 1 mg | 13 | 10 | 90 | $6,340 | $5.2M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 47 | 150 | 5,330 | $50 | $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. | 53 | 400 | 1,510 | $190 | $2.6M |
| 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 | 480 | 1,350 | $110 | $1.7M |
| 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. | 18 | 450 | 1,540 | $90 | $1.3M |
| 96374 | The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition. | 12 | 150 | 7,610 | $90 | $1.2M |
| G0378 | Hospital observation service, per hour | 7 | 100 | 2,820 | $180 | $1.1M |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 18 | 50 | 150 | $1,300 | $889.5K |
| G0482 | 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… | 59 | 70 | 680 | $100 | $604K |
| 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… | 29 | 160 | 2,720 | $60 | $546.6K |
Showing 1–10 of 576
Other providers in the same ZIP code as Lakeland Hospitals At Niles And St Joseph, Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Region Iv Area Agency On Aging, Inc | MI | Case Management Agency | $0 | $36.3M |
| Hsh Senior Services, LLC | MI | Home Health Agency | $0 | $35.6M |
| Epmg Southwest Michigan PLLC | MI | Emergency Medicine Physician | $0 | $11.9M |
| Jason So | MI | Retina Specialist (Ophthalmology) Physician | $2.8M | $0 |
| Benjamin Nicholson | MI | Retina Specialist (Ophthalmology) Physician | $2.5M | $0 |
| Great Lakes Surgery Center LLC | MI | Ambulatory Surgical Clinic/Center | $1.3M | $51.3K |
| David Brown | MI | Ophthalmology Physician | $1.1M | $0 |
| Erick Rivas | MI | Family Medicine Physician | $245.1K | $306.6K |
| Stanley Pletcher | MI | Ophthalmology Physician | $230.7K | $0 |
| David Cooke | MI | Ophthalmology Physician | $225.5K | $0 |
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