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

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

Edwards Health Care Services, Inc. (NPI 1255330825)

Field	Value
Entity Type	Organization
Organization	Edwards Health Care Services, Inc.
Address	5640 Hudson Industrial Pkwy
City	Hudson
State	OH
ZIP	44236
Taxonomy	Durable Medical Equipment & Medical Supplies
NPI Enumerated	July 18, 2005

Payer Source	Total Paid
Medicaid	$149.9M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $149.9M in lifetime Medicaid revenue, making it effectively a single‑payer (Medicaid) durable medical equipment and supplies provider at scale rather than a mixed Medicare/Medicaid operation. The absence of Medicare activity means competitive and utilization analysis should focus on Medicaid flows and in‑state peer comparisons.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 70.7% of the provider's total Medicaid revenue, driven by A9276 ($47.1M, 31.4%), E0784 ($31M, 20.7%), and A4230 ($27.9M, 18.6%). This concentration indicates that a small set of product lines dominates the provider's financial profile and reimbursement footprint.

The code mix shows a clear service‑line focus on diabetes management DME and recurring supplies: A9276 (CGM sensor), A9277 (CGM transmitter), A9278 (CGM receiver), E0784 (external ambulatory insulin pump), and multiple infusion set and supply codes such as A4230 and A4232. Presence of supply allowance codes (A4239 and K0553) and high volumes of infusion set and syringe items suggests the business model combines high‑value durable items with high‑frequency consumable resupply.

On statewide competitive standing, the provider is a leading supplier for several diabetes‑related items: E0784 ranks #1 of 2 providers in‑state (100th percentile), A4232 ranks #1 of 4 (100th percentile), while A9276 ranks #2 of 8 (86th percentile) and A4230 ranks #2 of 5 (75th percentile). These rankings imply market leadership for insulin pump equipment and top‑tier positions for several CGM and pump supply codes, though some categories still have notable peers.

Beyond the top three, the provider shows concentrated above‑typical volumes on other supply codes that support ongoing revenue: A4239 ($7.6M, 5.1%) ranks #2 of 14 (92th percentile; notably above typical state volume), A6257 ($412.6K, 0.3%) ranks #1 of 8 (100th percentile; notably above typical), and A5120 ($250.3K, 0.2%) ranks #2 of 19 (94th percentile; notably above typical). These elevated percentiles for supply items underscore a broad operational footprint in consumables that complements the durable equipment lines.

Payment levels reinforce the mixed revenue profile: top codes include a high average paid/claim for E0784 ($543 avg paid/claim) alongside lower per‑claim payments for high‑volume supplies such as A9276 ($231 avg paid/claim) and A4230 ($141 avg paid/claim). This combination of higher‑priced durable items and lower‑priced, high‑frequency supplies produces the observed concentration in total revenue.

The provider has an established tenure, with its NPI enumerated on 2005-07-18 (~21 years ago), suggesting long‑standing participation in the Medicaid DME market. Sustained, sizable Medicaid receipts and long enrollment duration point to mature supplier relationships and operational capacity for high‑volume distribution.

For payers and contracting teams, the narrow product concentration (70.7% of Medicaid revenue tied to three codes) and several state‑leading percentiles present both risk and opportunity: utilization management, targeted contracting, or supply‑chain oversight focused on CGM sensors/transmitters/receivers and insulin pump equipment could materially influence spend. Given the provider's statewide leadership on select codes, negotiation or program design efforts that target these specific lines are likely to have outsized impact on Medicaid DME expenditures.

Medicaid: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
A9276	Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply	203,750	$230	$47.1M
E0784	External ambulatory infusion pump, insulin	57,180	$540	$31M
A4230	Infusion set for external insulin pump, non needle cannula type	197,870	$140	$27.9M
A9277	Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system	21,240	$570	$12.2M
A4232	Syringe with needle for external insulin pump, sterile, 3 cc	215,550	$40	$8.2M
A4239	Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service	51,150	$150	$7.6M
K0553	Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service	47,050	$110	$5.3M
A9274	External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories	8,270	$380	$3.2M
A9278	Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system	4,280	$500	$2.1M
A4231	Infusion set for external insulin pump, needle type	17,070	$110	$1.9M

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Edwards Health Care Services, Inc. — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
E0784	External ambulatory infusion pump, insulin	1	10	33,980	$940	$31.9M
A9276	Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply	2	10	5,280	$270	$15.8M
A4230	Infusion set for external insulin pump, non needle cannula type	2	10	2,700	$130	$11.7M
A9274	External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories	2	10	8,270	$440	$6.1M
A9277	Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system	2	10	2,230	$400	$5.7M
A4232	Syringe with needle for external insulin pump, sterile, 3 cc	1	10	70,590	$40	$3.3M
A4231	Infusion set for external insulin pump, needle type	2	10	23,640	$100	$2.4M
A4225	Supplies for external insulin infusion pump, syringe type cartridge, sterile, each	2	10	82,740	$30	$2.1M
E0603	Breast pump, electric (ac and/or dc), any type	8	30	2,290	$150	$1.8M
K0553	Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service	2	20	450	$120	$1.7M

Showing 1–10 of 28

Related Providers

Other providers that share a Tax Identification Number (TIN) with Edwards Health Care Services, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Edwards Health Care Services, Inc.	KY	Durable Medical Equipment & Medical Supplies	$0	$81.9M
Edwards Health Care Services, Inc.	NC	Durable Medical Equipment & Medical Supplies	$0	$35.2M
Edwards Health Care Services, Inc.	SC	Durable Medical Equipment & Medical Supplies	$0	$2.4M

Nearby Providers

Other providers in the same ZIP code as Edwards Health Care Services, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Clinical Specialties Inc.	OH	Home Infusion Therapy Pharmacy	$0	$12.6M
Raymond Wawrowski	OH	Physician Assistant	$4.7M	$0
Mark Armstrong	OH	Diagnostic Radiology Physician	$357.6K	$49.6K
Elizabeth Gaary	OH	Diagnostic Radiology Physician	$153.4K	$0
Emil Hayek	OH	Cardiovascular Disease Physician	$83.8K	$0
Tejas Samaroo	OH	Diagnostic Radiology Physician	$75K	$0
Raul Martin	OH	Diagnostic Radiology Physician	$71.4K	$0
Josef Noga	OH	Diagnostic Radiology Physician	$53.6K	$0
Bryan Lazzara	OH	Diagnostic Radiology Physician	$37K	$0
Ronald Bailey	OH	Diagnostic Radiology Physician	$35.1K	$0

Edwards Health Care Services, 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