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NPI 1154795581 · Riverdale, GA · General Acute Care Hospital
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Prime Healthcare Foundation - Southern Regional, LLC is a general acute care hospital provider located in Riverdale, Georgia. This profile covers 0 Medicare and 248 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 | Prime Healthcare Foundation - Southern Regional, LLC |
| Address | 11 Upper Riverdale Rd Sw |
| City | Riverdale |
| State | GA |
| ZIP | 30274 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | November 23, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $25.9M |
| Medicare | $0 |
This provider is effectively single‑payer in the available claims data: there is no Medicare billing on file while lifetime Medicaid revenue totals $25.9M, and the NPI has been enumerated since 2015-11-23 (~11 years ago), indicating roughly an 11‑year operational history in this dataset. The absence of Medicare activity makes Medicaid the dominant source of observed fee‑for‑service revenues and shapes any competitive assessment to be Medicaid‑centric.
Revenue is highly concentrated in emergency department evaluation and management codes: the top three Medicaid revenue drivers are 99284 ($5.3M, 24.2%), 99283 ($3.6M, 16.3%), and 99285 ($3.3M, 15.2%), and those three codes together account for 55.6% of the provider’s total Medicaid revenue. This concentration implies that a majority of the facility’s billed Medicaid revenue is generated by ED encounters with moderate to high E/M intensity.
The code mix supports an ED‑centric acute care model with substantial ancillary throughput: large volumes of ED E/M codes (25.6K claims for 99284, 28.6K for 99283, 11.6K for 99285) are paired with observation (G0378: $414.1K), high counts of CT imaging (74177 $1M; 70450 $951.5K), and numerous infusion/IV administration codes (96374 $758.2K; 96375 $386K; 96361 $405.1K). Together these items indicate the hospital operates significant on‑site diagnostic and treatment capacity to support emergency and short‑stay care pathways.
On competitive standing within the state for its principal ED codes, the provider appears to be a high‑volume but not exceptional outlier: 99284 ranks #19 of 231 providers in‑state (92th percentile; typical, unremarkable volume), 99283 ranks #18 of 237 (93th percentile; typical, unremarkable volume), and 99285 ranks #18 of 139 (88th percentile; typical, unremarkable volume). These percentile positions suggest stronger than average ED throughput relative to many peers while the accompanying label frames the volumes as within expected ranges rather than extreme outliers.
Obstetric monitoring and prenatal imaging are notable pockets of above‑typical activity: 59025 (fetal heart rate monitoring) generated $546.5K (2.5% of Medicaid revenue) and ranks #3 of 41 providers in‑state (95th percentile; notably above typical state volume), and 76801 (first‑trimester ultrasound) produced $224.9K (1.0%) and also ranks #3 of 41 (95th percentile). These ranks and the “notably above typical” designation indicate the facility has a relatively large obstetric diagnostic caseload compared with most in‑state peers.
Frequent use of therapeutic and diagnostic infusions and injections is evident across many mid‑rank Medicaid codes: 96374 has 12.2K claims and $758.2K in revenue (3.5%), 96372 reports 12.9K claims and $349.1K (1.6%), and 96361 has 9.4K claims and $405.1K (1.8%). The combination of high claim counts and meaningful aggregate dollars for multiple infusion/administration codes supports the interpretation that the hospital routinely delivers IV therapies and procedural medications in the ED and short‑stay settings.
Imaging and diagnostic services are material secondary revenue contributors, consistent with an emergency/acute care role: abdominal/pelvic CT with contrast 74177 accounts for $1M (4.6%), CT head 70450 $951.5K (4.3%), and CT abdomen without contrast 74176 $657.9K (3.0%), while routine chest radiography (71046/71045) and CT angiography (71275) also appear in the top 25. These findings point to significant on‑site radiology capacity supporting diagnostic workflows tied to the ED and inpatient evaluation.
Overall competitive positioning is mixed: the provider ranks in the upper percentiles (many codes in the 70th–95th percentile range) for a number of services—showing above‑average activity in ED, imaging, infusion, and some obstetric diagnostics—yet the majority of top codes are described as “typical, unremarkable volume,” so the facility looks like a busy, regionally important acute care hospital for Medicaid patients rather than a statewide dominant system across all major service lines.
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.
248 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. | 25,630 | $210 | $5.3M |
| 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. | 28,600 | $130 | $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. | 11,600 | $290 | $3.3M |
| 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. | 3,250 | $310 | $1M |
| 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. | 12,690 | $80 | $989.7K |
| 70450 | The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities. | 5,980 | $160 | $951.5K |
| 96374 | The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition. | 12,230 | $60 | $758.2K |
| 74176 | The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs. | 2,150 | $310 | $657.9K |
| 59025 | In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements. | 6,920 | $80 | $546.5K |
| 93005 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 16,400 | $30 | $426.5K |
Showing 1–10 of 248
How this provider's Medicaid billing volume and revenue compare to other Georgia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Georgia median
248 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 18 | 140 | 200 | $280 | $1.9M |
| G0378 | Hospital observation service, per hour | 10 | 20 | 2,070 | $160 | $1.1M |
| 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… | 18 | 40 | 850 | $70 | $983K |
| 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. | 19 | 230 | 120 | $170 | $937.5K |
| 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 | 240 | 170 | $120 | $779.3K |
| 96361 | The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration. | 6 | 30 | 3,810 | $70 | $500.3K |
| G0480 | 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 | 30 | 940 | $30 | $467.9K |
| 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. | 21 | 70 | 2,840 | $30 | $428.7K |
| 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. | 15 | 70 | 380 | $170 | $423K |
| 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. | 6 | 50 | 600 | $90 | $409.7K |
Showing 1–10 of 248
Other providers in the same ZIP code as Prime Healthcare Foundation - Southern Regional, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| John Miller | GA | Ophthalmology Physician | $1.9M | $0 |
| Premier Womens Obgyn, LLC | GA | Obstetrics & Gynecology Physician | $0 | $1.4M |
| Georgia Urology PA | GA | Urology Physician | $0 | $1M |
| Clayton County Dialysis, LLC | GA | End-Stage Renal Disease (ESRD) Treatment Clinic/Center | $0 | $965.3K |
| South Atlanta Radiology Associates, P.C. | GA | Diagnostic Radiology Physician | $0 | $642.6K |
| Education System Management, Inc | GA | Clinical Medical Laboratory | $0 | $577.6K |
| F & M Family Eyecare, LLC | GA | Optometrist | $0 | $373.8K |
| La'cuana Sherman | GA | Professional Counselor | $0 | $312.9K |
| Rajinikanth Seshan | GA | Nephrology Physician | $289.2K | $0 |
| Alpesh Patel | GA | Hospitalist Physician | $272.6K | $0 |
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