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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

North Carolina Baptist Hospital (NPI 1144211301)

Field	Value
Entity Type	Organization
Organization	North Carolina Baptist Hospital
Address	Medical Center Blvd
City	Winston Salem
State	NC
ZIP	27157
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 4, 2005

Payer Source	Total Paid
Medicaid	$138.4M
Medicare	$0

Key Findings

This provider is effectively single‑payer in the available data: there is no Medicare billing on file while Medicaid revenue totals $138.4M, indicating Medicaid is the dominant and sole reported public payer exposure on file. The absence of Medicare billing means the organization's public revenue profile and payer negotiation posture will be driven almost entirely by Medicaid policy and contracts.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management codes: the top three Medicaid codes (99284, 99283, 99213) account for 63.5% of the provider's total Medicaid revenue. Those codes individually account for $37.1M (30.3%), $27M (22.0%), and $13.8M (11.2%) respectively, signaling that a large share of cash flow is tied to ED and ambulatory E/M activity.

The code mix points to a large emergency department and outpatient clinic footprint: 99284, 99283, 99285, and 99282 are all prominent in the top codes list and 99213 is the single largest-volume outpatient visit code. High volumes of ED E/M codes alongside the very large 99213 volume suggest the hospital operates both a busy ED and extensive outpatient evaluation/management clinics rather than being focused solely on inpatient procedural services.

Despite the ED focus, the provider also shows meaningful specialty infusion activity — J1745 (infliximab) generated $13.2M (10.8% of Medicaid revenue) and ranks #2 of 6 providers in-state with an 80th percentile standing, while J2323 (natalizumab) generated $1.1M and ranks #1 of 4 providers. The presence of multiple high-cost biologic and injection codes (also including J0475 and J0585) indicates organized infusion/infusion suite capabilities and a payer exposure to specialty drug reimbursement.

Competitive standing varies by code: 99213 is an extreme outlier (rank #2 of 4130 providers in-state, 100th percentile), reflecting extraordinarily high outpatient visit volume relative to peers. ED codes are also at high percentiles — 99283 ranks #14 of 316 (96th percentile, noted as notably above typical state volume) while 99284 ranks #16 of 325 (95th percentile, described as typical, unremarkable volume) — together these ranks indicate the provider is a major state-level player for ambulatory and ED throughput.

Laboratory and diagnostic throughput is substantial: high claim counts for 80053 (137.9K claims, $1.1M revenue; rank #6 of 289, 98th percentile) and 85025 (156.5K claims, $1.1M revenue; rank #4 of 608, 100th percentile) point to significant on‑site lab capacity supporting both inpatient and outpatient volumes. Respiratory and infectious disease testing codes (87636 and 87635) also appear with notable volume and high percentiles, confirming active diagnostic testing operations.

Concentration risk and operational sensitivity are material: with 63.5% of Medicaid revenue coming from the top three codes (99284, 99283, 99213), changes in ED/ambulatory reimbursement, utilization patterns, or coding policy could disproportionately affect revenue. Coupled with the lack of Medicare billing, the provider's revenue is more exposed to Medicaid policy shifts than peers with a mixed payer base.

The provider is long‑tenured in public datasets, with an NPI enumeration date of 2005-11-04 (~21 years ago), indicating an established presence in the market and sustained Medicaid engagement reflected in $138.4M of reported Medicaid revenue. This longevity, together with the extreme outpatient volumes, supports the view of an entrenched regional facility that serves large ambulatory and ED patient flows.

Medicaid: Complete Services Breakdown

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

416 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.	74,520	$500	$37.1M
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.	84,060	$320	$27M
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…	393,230	$40	$13.8M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1,310	$10,100	$13.2M
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.	9,990	$660	$6.6M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	22,580	$170	$3.8M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	103,790	$30	$3.2M
J0585	Injection, onabotulinumtoxina, 1 unit	1,560	$1,570	$2.4M
J0475	Injection, baclofen, 10 mg	1,300	$1,300	$1.7M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	7,970	$160	$1.2M

Showing 1–10 of 416

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

North Carolina Baptist Hospital — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

416 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	13	20	240	$400	$13.6M
G0330	Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an…	8	10	200	$1,440	$3.6M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	2	10	110	$5,750	$3.2M
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.	16	330	6,130	$130	$2.7M
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…	15	30	170	$260	$2.6M
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…	37	160	840	$70	$2.3M
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.	14	320	6,160	$120	$2.1M
81229	The lab analyst performs the technical lab test using comparative genomic hybridization (CGH) microarray, also referred to as chromosomal microarray (CMA) or molecular karyotype performed by…	8	10	680	$480	$1.9M
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.	87	280	2,690	$130	$1.6M
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	16	80	420	$30	$1.2M

Showing 1–10 of 416

Nearby Providers

Other providers in the same ZIP code as North Carolina Baptist Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wake Forest University Health Sciences	NC	Multi-Specialty Clinic/Center	$0	$188.2M
Wake Air Care LLC	NC	Air Ambulance	$2.5M	$2.4M
Vishak John	NC	Ophthalmology Physician	$4.3M	$0
Thomas Williamson	NC	Hematology & Oncology Physician	$2.4M	$0
Omar Sangueza	NC	Dermatopathology (Pathology) Physician	$810.1K	$0
Jennifer Stanislaus	NC	Anesthesiology Physician	$557.1K	$0
Thomas Sullivan	NC	Diagnostic Radiology Physician	$18.9K	$393.7K
Rajiv Shah	NC	Ophthalmology Physician	$328.3K	$0
Bradley Unruh	NC	Diagnostic Radiology Physician	$279.6K	$0
Jordan Allem	NC	Cardiovascular Disease Physician	$257.3K	$0

North Carolina Baptist Hospital — 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