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.

Bayhealth Medical Center, Inc (NPI 1285809509)

Key Findings

Field	Value
Entity Type	Organization
Organization	Bayhealth Medical Center, Inc
Address	640 S State St
City	Dover
State	DE
ZIP	19901
Taxonomy	Colon & Rectal Surgery Physician
NPI Enumerated	April 28, 2008

Payer Source	Total Paid
Medicaid	$12.4M
Medicare	$0

This entity is effectively single‑payer Medicaid: there is no Medicare billing on file and total Medicaid revenue reported is $12.4M, indicating the provider’s commercial and Medicare footprint is either minimal or not captured in the available files. Analysts should treat Medicaid as the dominant and visible source of fee‑for‑service volume when assessing financial exposure and contracting leverage.

Revenue is highly concentrated in three office‑visit E/M codes: 99214 ($3.9M, 34.6%), 99213 ($1.8M, 16.1%), and 99204 ($1.2M, 10.5%), which together account for 61.3% of the provider’s total Medicaid revenue. That level of concentration means a small set of visit types drives the majority of cash flow recorded in Medicaid.

The code mix points to a high‑volume ambulatory practice model: the top revenue drivers are E/M office visits (99214, 99213, 99204) with very large claim counts (76.3K claims for 99214; 55K claims for 99213), while procedural codes typically associated with colon & rectal surgery—such as 45380 and 43239—contribute comparatively small shares ($115.2K and $222.9K respectively). This suggests operations are oriented toward clinic throughput and longitudinal outpatient management rather than being procedure‑heavy.

State competitive standing on key codes is dominant: 99214 ranks #3 of 504 providers in‑state (100th percentile; extreme outlier, far above typical state volume), 99213 ranks #6 of 543 (99th percentile; extreme outlier), and 99204 ranks #2 of 182 (99th percentile; extreme outlier). Those ranks indicate the provider is a major statewide source of Medicaid office‑visit volume and an outlier relative to peer facilities for these E/M services.

The provider also shows unusually high volumes for diagnostic cardiac testing and ECGs in Medicaid: 93306 (11.1K claims, $388.3K; ranks #1 of 24, 100th percentile; notably above typical state volume) and 93000 (26.1K claims, $156.4K; ranks #2 of 50, 98th percentile; extreme outlier). Coupled with multiple inpatient E/M codes (e.g., 99232; 11.2K claims, $324.2K and 99222; 5K claims, $321.2K), the profile suggests integration with hospital‑based diagnostics and inpatient care flows in addition to ambulatory clinics.

Because the top three codes represent 61.3% of Medicaid revenue and are predominantly office E/M visits, the provider’s Medicaid financial performance is sensitive to policy or rate changes affecting E/M valuation and coding. Payers and analysts should monitor shifts in E/M reimbursement, prior authorization rules, and visit‑mix trends when projecting future Medicaid spend with this entity.

The dataset shows sustained high patient throughput consistent with long operational tenure: the provider’s NPI was enumerated on 2008‑04‑28 (~18 years ago), supporting an established presence in the market and capacity to generate large claim volumes over time. This longevity combined with current volume outlier status suggests entrenched referral patterns and workflow capacity.

Several other codes show elevated but more moderate standing (for example, 99396 $192.6K ranks #4 of 52, 94th percentile; 99215 $259.4K ranks #7 of 147, 96th percentile), indicating breadth beyond the top three E/M codes into preventive and higher‑complexity visits. While these do not drive the bulk of revenue, they reflect a diversified outpatient service mix that complements the dominant visit types.

Medicaid: Complete Services Breakdown

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

163 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…	76,290	$50	$3.9M
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…	54,980	$30	$1.8M
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…	12,550	$90	$1.2M
99203	The provider sees a new 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 provider…	15,410	$50	$724.5K
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…	11,090	$40	$388.3K
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…	11,180	$30	$324.2K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	5,020	$60	$321.2K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	510	$590	$302.5K
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…	4,320	$60	$259.4K
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.	1,550	$140	$222.9K

Showing 1–10 of 163

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

Bayhealth Medical Center, Inc — 9 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

163 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.	26	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.	28	40	770	$110	$1.9M
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…	1	20	2,440	$190	$591.1K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	5	10	420	$420	$392.6K
59514	The provider admits the patient to the hospital for delivery, delivers the fetus and placenta via an abdominal incision, and provides care immediately after delivery on the same date of service. This…	5	10	220	$410	$340.8K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	23	50	1,030	$60	$292.3K
99460	The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.	4	10	960	$90	$285.9K
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…	11	80	940	$30	$277.8K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	14	20	930	$50	$250K
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…	8	10	850	$80	$246.1K

Showing 1–10 of 163

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayhealth Medical Center, Inc.	DE	General Acute Care Hospital	$0	$79.3M
Bayhealth Medical Center, Inc.	DE	General Acute Care Hospital	$0	$39.5M
Christiana Care Health Services Inc	DE	Hospitalist Physician	$0	$13.6M
Bayhealth Medical Center, Inc.	DE	Clinic/Center	$0	$3.7M
Tyler Yerkes	DE	Physician Assistant	$1.1M	$0
Eranga Haththotuwa	DE	Cardiovascular Disease Physician	$694.5K	$0
Sankalp Pathak	NJ	Interventional Cardiology Physician	$639.9K	$0
Pranitha Naini	VA	Medical Oncology Physician	$595.3K	$0
Megdad Zaatreh	NJ	Neurology Physician	$582.2K	$3.8K
Bayhealth Medical Center, Inc	DE	Anatomic Pathology Physician	$0	$502.9K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayhealth Emergency Physicians LLC	DE	Emergency Medicine Physician	$0	$16.7M
Ahl And O'connor Orthodontics, LLC	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$12.5M
State Of Delaware	DE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8.2M
The Children's Secret Garden	DE	Medically Fragile Infants and Children Day Care	$0	$8.1M
Apogee Medical Group, Delaware, Inc	DE	Internal Medicine Physician	$0	$7.9M
First State Oral And Maxillofacial Surgery Corp	DE	Oral and Maxillofacial Surgery (Dentist)	$0	$5M
Jamie Ahl	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$4.9M
Kent Diagnostic Radiology Associates PA	DE	Diagnostic Radiology Physician	$0	$4.6M
The Mind And Body Consortium, LLC.	DE	Psychiatry Physician	$0	$3.9M
State Of Delaware	DE	State or Local Public Health Clinic/Center	$0	$3.8M

Bayhealth Medical Center, Inc — Billing Profile & Reimbursement Data

Sign up for Bayhealth Medical Center, Inc — Billing Profile & Reimbursement Data policy alerts

Bayhealth Medical Center, Inc — Billing Profile & Reimbursement Data

Sign up for Bayhealth Medical Center, Inc — Billing Profile & Reimbursement Data policy alerts

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