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

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

Tidalhealth Nanticoke, Inc (NPI 1245214477)

Key Findings

Field	Value
Entity Type	Organization
Organization	Tidalhealth Nanticoke, Inc
Address	801 Middleford Rd
City	Seaford
State	DE
ZIP	19973
Taxonomy	General Acute Care Hospital
NPI Enumerated	December 1, 2005

Payer Source	Total Paid
Medicaid	$19.2M
Medicare	$0

This provider is effectively single‑payer in the available claims data: there is no Medicare billing on file while all reported federal revenue comes from Medicaid, totaling $19.2M. The absence of Medicare activity indicates Medicaid is the primary source of fee‑for‑service hospital reimbursements captured for this NPI.

Revenue is highly concentrated in a small set of services: the top three Medicaid codes — 99284, 99283, and 0241U — together account for 57.3% of the provider's total Medicaid revenue. Those three codes individually represent $3.5M (23.4%), $3.5M (22.9%), and $1.7M (11.0%) respectively, signaling dependence on a narrow set of high‑revenue billing lines.

The code mix points to a dominant emergency department (ED) operational role: high volumes for ED E/M codes 99284 (31.8K claims, $111 avg, $3.5M) and 99283 (29.1K claims, $119 avg, $3.5M), along with meaningful activity in 99285 (13.3K claims, $74 avg, $986.3K) and 99282 (5.8K claims, $126 avg, $733.2K). Together these ED E/M codes drive the largest Medicaid revenue buckets, indicating the site functions as a busy acute care/ED access point for Medicaid patients.

Competitive standing across the state is mixed: for core ED codes the provider sits in mid‑to‑upper percentiles but is not a statewide dominant outlier — 99284 ranks #7 of 35 providers (82th percentile, described as typical), 99283 ranks #10 of 26 (64th percentile, typical), and 99285 ranks #9 of 31 (73th percentile, typical). These ranks suggest a solid regional ED presence rather than a top‑market monopolist for emergency services.

Laboratory testing output is a pronounced feature with at least one extreme outlier: 87651 (Strep A) shows 13K claims for $312.8K and ranks #1 of 13 in‑state (100th percentile, labeled an "extreme outlier, far above typical state volume"). In addition, high claim volumes for routine lab panels — 85025 at 52.8K claims ($211.1K, rank #4 of 34, 91th percentile) and 80048 at 35.8K claims ($143.4K, rank #2 of 12, 91th percentile) — indicate heavy throughput of low‑unit‑value lab testing consistent with ED and hospital outpatient workflows.

The provider maintains on‑site diagnostic and procedural capacity beyond the ED: CT and endoscopy codes generate measurable revenue (74177: 3.7K claims, $455.2K; 70450: 4.7K claims, $173.8K; 43239: 1.7K claims, $422K; 45380: 781 claims, $207K). These figures show the hospital performs both advanced imaging and GI procedures that support acute and downstream specialty care for Medicaid patients.

Payment profile reflects many low–per‑claim, high‑volume services consistent with hospital lab and ED throughput: examples include 85025 at $4 avg paid/claim (52.8K claims, $211.1K revenue) and 80048 at $4 avg paid/claim (35.8K claims, $143.4K revenue), while certain procedures and scoped services carry higher per‑claim payments (43239 at $253 avg, 45380 at $265 avg). This mix suggests revenue is driven by volume for routine diagnostics and by higher‑unit procedural encounters for a smaller share of cases.

The provider has a long‑standing enrolled presence: NPI enumerated on 2005-12-01 (~21 years ago). That tenure, combined with concentrated Medicaid billing patterns and high ED/lab throughput, implies established referral and utilization patterns in its service area that payers should consider when evaluating network capacity and reimbursement arrangements.

Medicaid: Complete Services Breakdown

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

335 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.	31,790	$110	$3.5M
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.	29,070	$120	$3.5M
0241U	N/A	13,950	$120	$1.7M
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.	13,330	$70	$986.3K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	6,320	$130	$834K
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.	5,820	$130	$733.2K
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.	3,700	$120	$455.2K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	1,670	$250	$422K
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…	21,050	$20	$357.9K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	13,030	$20	$312.8K

Showing 1–10 of 335

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Tidalhealth Nanticoke, Inc — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

335 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.	10	30	11,180	$110	$3.4M
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.	7	40	770	$110	$1.9M
G0378	Hospital observation service, per hour	7	10	6,600	$190	$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.	9	30	1,350	$110	$1.5M
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.	7	20	4,570	$120	$1.4M
99281	The provider sees a patient for the lowest level emergency department visit.	4	10	110	$130	$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.	9	10	4,520	$120	$820.3K
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…	3	10	19,210	$30	$794.8K
0241U	N/A	3	10	2,480	$120	$788.1K
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…	15	20	2,440	$190	$591.1K

Showing 1–10 of 335

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tidalhealth Physician Network, Inc.	DE	Family Medicine Physician	$0	$8.7M
Justin Kucinski	MD	Internal Medicine Physician	$6.9M	$0
Tanya Clifford	MD	Nurse Practitioner	$2.9M	$0
Tidalhealth Physician Network, Inc.	DE	Family Medicine Physician	$0	$2.9M
William Doran	DE	Orthopaedic Surgery Physician	$351.6K	$0
Nanticoke Wellness Seaford	DE	Student Health Clinic/Center	$0	$268.5K
Annedreea Webber	DE	Family Nurse Practitioner	$80.5K	$0
Halim Charbel	MD	Gastroenterology Physician	$31.1K	$0
Taha Ansari	TX	Psychiatry Physician	$12.4K	$0
Mark Alter	IL	Child & Adolescent Psychiatry Physician	$9.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dynamic Therapy Services LLC	DE	Physical Therapist	$0	$12.8M
Addiction Medical Facility, LLC	DE	Substance Abuse Rehabilitation Facility	$98.8K	$9M
Resouces For Human Development, Inc.	DE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$5.4M
Ambient Medical Care, LLC	DE	Urgent Care Clinic/Center	$0	$3.3M
Lynch, Rodriguez And Keller, PA	DE	Dentist	$0	$3.3M
Ivonne Herrera	DE	Rheumatology Physician	$2.7M	$0
Seaford Internal Medicine LLC	DE	Internal Medicine Physician	$0	$2.7M
Alpha Care Medical, LLC	DE	Family Medicine Physician	$0	$2.6M
La Red Health Center, Inc.	DE	Federally Qualified Health Center (FQHC)	$0	$2.5M
Nanticoke River Physicians, LLC	DE	Emergency Medicine Physician	$0	$2.3M

Tidalhealth Nanticoke, 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