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

Why is the Medicaid comparison limited to Indiana 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. Indiana (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.

Saint Joseph Regional Medical Center, Inc. (NPI 1225082878)

Saint Joseph Regional Medical Center, Inc. is a pulmonary disease physician provider located in Plymouth, Indiana. This profile covers 0 Medicare and 93 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Saint Joseph Regional Medical Center, Inc.
Address	2349 Lake Ave Ste 99
City	Plymouth
State	IN
ZIP	46563
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	May 19, 2006

Payer Source	Total Paid
Medicaid	$5.5M
Medicare	$0

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

93 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	38,480	$50	$1.8M
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	9,870	$70	$690.5K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	5,440	$80	$413.5K
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…	10,540	$40	$390.1K
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	4,740	$70	$345.7K
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…	10,140	$30	$314.3K
99204	The provider sees a new 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 provider…	3,000	$80	$234K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	2,320	$90	$206.1K
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…	1,640	$80	$124.7K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	1,530	$70	$110.1K

Showing 1–10 of 93

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Indiana Distribution

Saint Joseph Regional Medical Center, Inc. — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

93 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	353	360	3,490	$110	$1.5M
J0585	Injection, onabotulinumtoxina, 1 unit	16	30	280	$820	$992.2K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	423	580	710	$60	$582.9K
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…	69	2,120	870	$60	$450.6K
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…	285	690	1,070	$80	$422.3K
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…	345	2,380	920	$50	$376.8K
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	43	160	1,390	$70	$294.8K
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	18	190	1,680	$70	$264.2K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	118	530	740	$30	$210K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	11	40	780	$100	$187.4K

Showing 1–10 of 93

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ascension Se Wisconsin Hospital, Inc	WI	General Acute Care Hospital	$0	$94.4M
Saint Joseph Regional Medical Center-south Bend Campus, Inc.	IN	General Acute Care Hospital	$0	$18.7M
Saint Joseph Regional Medical Center, Inc.	IN	Family Medicine Physician	$0	$10.7M
Saint Joseph Regional Medical Center- Plymouth Campus Inc	IN	General Acute Care Hospital	$0	$6.5M
Saint Joseph Regional Medical Center-south Bend Campus, Inc.	IN	Family Medicine Physician	$0	$4.8M
Douglas Liepert	IN	Sleep Medicine (Otolaryngology) Physician	$392K	$0
Hunter Nolen	MO	Urology Physician	$359.5K	$0
Eric Kim	CA	Neurology Physician	$300.8K	$0
Marcos Cruz	PR	Neurology Physician	$142.7K	$63.2K
Greg Schaublin	FL	Neurology Physician	$202.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hhc Indiana Inc.	IN	Psychiatric Hospital	$0	$15.3M
Dental Center Of Plymouth LLC	IN	Dentist	$0	$3M
South Bend Psychiatry LLC	IN	Psychiatry Physician	$0	$2.8M
Muhammad Hussain	IN	Medical Oncology Physician	$932.8K	$0
Adam Perlmutter	IN	Urology Physician	$156.4K	$0
John Lafree	IN	Physical Therapist	$63K	$0
Brian Piazza	IN	Surgery Physician	$28.5K	$0
Melinda Halupa	IN	Nurse Practitioner	$22.5K	$0

Saint Joseph Regional Medical Center, Inc. — Billing Profile & Reimbursement Data

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Saint Joseph Regional Medical Center, Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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