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

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Inspira Medical Centers, Inc. (NPI 1164487542)

Field	Value
Entity Type	Organization
Organization	Inspira Medical Centers, Inc.
Address	1505 W Sherman Ave
City	Vineland
State	NJ
ZIP	08360
Taxonomy	General Acute Care Hospital
NPI Enumerated	April 19, 2006

Payer Source	Total Paid
Medicaid	$227M
Medicare	$0

Key Findings

INSPIRA MEDICAL CENTERS, INC. is effectively a Medicaid-focused institution: it reports no Medicare billing on file and $227M in lifetime Medicaid revenue, indicating that Medicaid is the primary — and for available data, the sole — public payer driving its recorded revenue stream. This payer concentration suggests operations and reimbursement exposure that are heavily aligned with state Medicaid policy and utilization patterns rather than Medicare fee schedules or aged populations.

Revenue concentration is high: the top three Medicaid codes (99284, 99283, 99285) together account for 64.7% of the provider's total Medicaid revenue, showing that emergency department E/M services are the dominant revenue drivers. This concentration implies that acute emergency care and higher-acuity ED visits form the core service line generating the majority of Medicaid inflows.

The provider functions as a high-volume emergency care center by code mix and volume: 99284 has $51.6M revenue (26.7% of Medicaid revenue) with 88.9K claims, 99283 has $40M (20.7%) with 104.3K claims, and 99285 has $33.3M (17.3%) with 47.9K claims. These volumes and revenue share indicate ED services at low-to-high E/M complexity dominate clinical throughput, consistent with a general acute care hospital operating a busy emergency department.

Competitive standing in-state is strong for many ED and related service codes. The provider ranks in very high percentiles for several top codes: 99284 at the 96th percentile (rank #15 of 319), 99283 at the 97th percentile (rank #8 of 262), and 99282 at the 95th percentile (rank #8 of 141). These rankings characterize INSPIRA as a major regional ED provider for Medicaid patients and a leading contributor to state ED volume for those specific E/M codes.

There are distinct specialty and outpatient behavioral health signals beyond the ED: H0035 (mental health partial hospitalization) contributes $12.7M (6.6% of Medicaid revenue) with 39.2K claims, and 90837 (psychotherapy ≥53 minutes) contributes $2.8M while ranking #1 of 194 providers in-state as an extreme outlier. The presence of both partial hospitalization and high-volume long psychotherapy sessions suggests integrated or co-located behavioral health services that materially add to Medicaid revenue and patient mix.

Operationally, INSPIRA also shows sizable utilization of ambulance and transport-related services (A0427, A0429, A0434, A0425) and observation care (G0378). For example, A0427 and A0429 together represent multiple millions of dollars in revenue and high claim counts, and G0378 accounts for $13M (6.7% of Medicaid revenue). This pattern supports a care model that handles large numbers of emergency transports and observation stays, reinforcing ED-centric throughput and downstream observation utilization.

Clinical ancillary services with notable volume include routine cardiac and imaging procedures: 93005 (ECG) has 60.1K claims and $1.4M revenue (rank #5 of 93, 96th percentile), 74177 (CT abdomen/pelvis with contrast) has $974.6K revenue (94th percentile), and 93306 (echocardiography) contributes $1.9M (87th percentile). These ranks indicate the hospital delivers substantial diagnostic testing capacity supporting its ED and inpatient workflows.

Tenure and presence: the NPI was enumerated on 2006-04-19 (~20 years ago), indicating two decades of recorded participation in federal provider enrollment. That length of enrollment is consistent with an established regional hospital infrastructure and sustained Medicaid billing relationships.

Medicaid: Complete Services Breakdown

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

502 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.	88,890	$580	$51.6M
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.	104,320	$380	$40M
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.	47,920	$700	$33.3M
G0378	Hospital observation service, per hour	16,020	$810	$13M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	39,170	$330	$12.7M
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.	30,890	$240	$7.4M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	18,130	$280	$5.1M
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	10,620	$360	$3.8M
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	22,330	$150	$3.4M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	28,810	$100	$2.8M

Showing 1–10 of 502

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

Inspira Medical Centers, Inc. — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

502 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	16	80	6,290	$690	$6.6M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	64	170	21,080	$100	$4.2M
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…	48	130	3,180	$60	$4.2M
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.	8	260	4,240	$220	$4.1M
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.	15	320	580	$230	$4M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	6	30	9,660	$310	$3.4M
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.	21	280	920	$200	$2.6M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	27	30	860	$1,530	$2.1M
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	150	3,680	$30	$1.5M
86480	The lab analyst performs a test to evaluate a cell mediated immunity gamma interferon antigen response to certain tuberculosis, or TB, antibodies.	17	40	810	$30	$1.4M

Showing 1–10 of 502

Related Providers

Other providers that share a Tax Identification Number (TIN) with Inspira Medical Centers, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laboratory Corporation Of America Holdings	NC	Clinical Medical Laboratory	$214.6M	$1.4B
Laboratory Corporation Of America Holdings	NJ	Clinical Medical Laboratory	$143.3M	$717.5M
Bioreference Health, LLC	NJ	Clinical Medical Laboratory	$66.8M	$620.1M
Laboratory Corporation Of America Holdings	OH	Clinical Medical Laboratory	$56.9M	$617M
Laboratory Corporation Of America Holdings	AL	Clinical Medical Laboratory	$60.5M	$289.1M
Laboratory Corporation Of America	AZ	Clinical Medical Laboratory	$38.5M	$265.9M
Laboratory Corporation Of America Holdings	NC	Clinical Medical Laboratory	$3.5M	$281.4M
Laboratory Corporation Of America Holdings	NC	Clinical Medical Laboratory	$0	$264.7M
Laboratory Corporation Of America Holdings	WV	Clinical Medical Laboratory	$1.9M	$220M
Laboratory Corporation Of America	FL	Clinical Medical Laboratory	$47.4M	$171.2M

Nearby Providers

Other providers in the same ZIP code as Inspira Medical Centers, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Elwyn New Jersey	NJ	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$206.7M
Arthritis & Rheumatology Associates Of South Jersey PC	NJ	Rheumatology Physician	$0	$53.4M
Winter Enterprises	NJ	Oral and Maxillofacial Surgery (Dentist)	$0	$17M
Comminity Programs Inc.	NJ	Adult Day Care Clinic/Center	$0	$13.7M
City Of Vineland Board Of Education	NJ	Local Education Agency (LEA)	$0	$12.8M
Pinnacle Treatment Centers Nj Iii LLC	NJ	Methadone Clinic	$264.3K	$10.9M
Excelcare Alliance, LLC	NJ	Family Medicine Physician	$0	$11M
Confident Care Corp	NJ	Home Health Agency	$0	$8.2M
Stephen Soloway	NJ	Rheumatology Physician	$2.7M	$0
City Of Vineland	NJ	Ambulance	$798.1K	$1.6M

Inspira Medical Centers, Inc. — Billing Profile & Reimbursement Data

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Inspira Medical Centers, Inc. — 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