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

Why is the Medicaid comparison limited to Maine 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. Maine (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. Joseph Hospital (NPI 1154321545)

Field	Value
Entity Type	Organization
Organization	St. Joseph Hospital
Address	360 Broadway
City	Bangor
State	ME
ZIP	04401
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 28, 2005

Payer Source	Total Paid
Medicaid	$38.8M
Medicare	$0

Key Findings

ST. JOSEPH HOSPITAL reports $38.8M in lifetime Medicaid revenue and has no Medicare billing on file, making its public payer footprint effectively single‑payer Medicaid in this dataset. This concentration means Medicaid policy, reimbursement rates, and state contracting dynamics will disproportionately affect the provider’s revenue base compared with peers that bill Medicare.

Revenue is concentrated: the top three Medicaid codes account for 39.1% of the provider’s total Medicaid revenue. The individual top contributors are G0463 (15.3%), 99284 (13.0%), and 99285 (10.9%), indicating a small set of high-yield service lines drive a large share of dollars.

The mix of top codes shows an operational emphasis on emergency and outpatient assessment: G0463 (106.4K claims, $48 avg paid/claim, $5.1M revenue) and emergency E/M codes 99284 (35.3K claims, $123 avg, $4.3M) and 99285 (13.7K claims, $266 avg, $3.6M) together power a substantial share of revenue. These volumes and the code descriptions suggest the hospital runs a high-volume hospital outpatient clinic and emergency department handling moderate- to high-acuity presentations rather than being primarily a low-acuity clinic.

ST. JOSEPH is a statewide leader in provision of extended‑release buprenorphine: Q9992 (1.9K claims, $1477 avg, $2.9M revenue) and Q9991 (1.6K claims, $1403 avg, $2.2M revenue) both rank #1 in-state and are at the 100th percentile. This indicates the hospital is a primary site for Sublocade administration in Maine and a significant regional access point for medication‑assisted treatment.

Outpatient E/M volume for established patients is an outlier: 99214 shows 62.2K claims, $34 avg paid/claim, $2.1M revenue (6.3%) and ranks #9 of 461 providers in-state (98th percentile; extreme outlier, far above typical state volume for this code). That unusually high volume of 99214 visits suggests a large ambulatory clinic footprint or centralized outpatient scheduling that differentiates the hospital from most in-state peers.

Specialty procedural lines are meaningful contributors: therapeutic and diagnostic endoscopy codes such as 45385 (2.4K claims, $358 avg, $863.9K; ranks #2 of 22, 95th percentile), 45380 (1.8K claims, $408 avg, $742.6K; ranks #3 of 22, 90th percentile), and 43239 (2.8K claims, $253 avg, $719.3K; ranks #5 of 31, 87th percentile) point to a robust GI service line. High-volume imaging and cardiac testing codes (74177, 70450, 93306) plus infusion codes (96374, 96365, 96375) further indicate significant diagnostic, procedural, and infusion capacity on site.

Competitive standing is mixed: the hospital is a dominant in-state provider for specific, high-revenue items like Sublocade injections and is an extreme outlier for 99214 office visits, but its emergency department E/M codes generally sit in the 80th–90th percentile range (characterized in the data as typical, unremarkable volume). In short, ST. JOSEPH is a major statewide player in a few specialty areas while its ED activity represents high absolute volumes that are nevertheless more comparable to many peers.

The NPI has been enumerated since 2005-07-28 (~21 years ago), signaling a long-tenured presence in the market. Combined with the service-line footprint observed in Medicaid billing, this tenure supports the interpretation that the hospital is an established regional provider with entrenched outpatient, ED, and addiction-treatment operations.

Medicaid: Complete Services Breakdown

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

424 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	106,390	$50	$5.1M
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.	35,330	$120	$4.3M
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.	13,700	$270	$3.6M
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.	39,160	$80	$3.3M
Q9992	Injection, buprenorphine extended-release (sublocade), greater than 100 mg	1,930	$1,480	$2.9M
Q9991	Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg	1,560	$1,400	$2.2M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	62,230	$30	$2.1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	11,450	$90	$1.1M
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.	6,450	$150	$947.7K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	2,410	$360	$863.9K

Showing 1–10 of 424

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

St. Joseph Hospital — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

424 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	12	60	18,740	$60	$4.6M
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.	9	60	9,550	$100	$1.5M
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.	10	60	4,690	$180	$1.5M
Q9991	Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg	1	10	630	$1,490	$1.4M
Q9992	Injection, buprenorphine extended-release (sublocade), greater than 100 mg	1	10	440	$1,500	$1.1M
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.	6	50	11,590	$60	$942.4K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	5	10	200	$1,690	$796.1K
Q5104	Injection, infliximab-abda, biosimilar, (renflexis), 10 mg	3	10	140	$1,840	$630.5K
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…	2	10	240	$2,300	$551K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	6	30	6,230	$70	$515.4K

Showing 1–10 of 424

Related Providers

Other providers that share a Tax Identification Number (TIN) with St. Joseph Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Medical Foundation, Inc.	MS	Geriatric Medicine (Family Medicine) Physician	$0	$1.8M
Amit Khaneja	NY	Clinical Neurophysiology Physician	$1.3M	$301K
Daniel Stroupe	IL	Infectious Disease Physician	$123.1K	$318K
Vadak Ranganathan	OH	Neurology Physician	$62.6K	$144K
Babak Attaran Rezaei	TX	Neurology Physician	$161.4K	$0
Kamesh Sivagnanam	TX	Cardiovascular Disease Physician	$132K	$15.1K
William Wheeler	SC	Cardiovascular Disease Physician	$144.1K	$0
Shawn Brandenburg	NE	Orthopaedic Surgery Physician	$127.7K	$0
Julie Quinn	ME	Physician Assistant	$110.6K	$0
Ganesha Santhyadka	ME	Pulmonary Disease Physician	$74.4K	$0

Nearby Providers

Other providers in the same ZIP code as St. Joseph Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eastern Maine Medical Center	ME	General Acute Care Hospital	$0	$159.3M
Creative Options, LLC	ME	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$78.7M
Mas Medical Staffing Corporation	ME	Community/Behavioral Health Agency	$0	$62.5M
Ohi	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$61.9M
Ohi	ME	Mental Illness Community Based Residential Treatment Facility	$0	$39.6M
Mert Enterprises, Inc.	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$36.3M
Penobscot Community Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$27.3M
Amicus	ME	Developmentally Disabled Services Day Training Agency	$0	$26.1M
Branches, LLC	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$25.4M
Lifeflight Of Maine, LLC	ME	Air Ambulance	$2.4M	$19.8M

St. Joseph 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

Related Providers

Nearby Providers

Frequently Asked Questions

References