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.

Memorial Hospital Of South Bend (NPI 1295772093)

Key Findings

Field	Value
Entity Type	Organization
Organization	Memorial Hospital Of South Bend
Address	615 N Michigan St
City	South Bend
State	IN
ZIP	46601
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 1, 2006

Payer Source	Total Paid
Medicaid	$33.3M
Medicare	$0

This provider has no Medicare billing on file and reports $33.3M in lifetime Medicaid revenue, making its claims footprint effectively single‑payer (Medicaid) in scale and exposure. Analysts should treat Medicaid reimbursement trends as the primary driver of financial performance rather than any Medicare activity.

Revenue is highly concentrated: the top three Medicaid codes (99283, 99284, 41899) account for 66.8% of the provider’s total Medicaid revenue, with 99283 alone contributing $13.2M (40.7%) and 99284 contributing $5.3M (16.4%). That level of concentration means changes in ED visit mix or reimbursement for these few codes would materially affect overall Medicaid income.

The code mix strongly indicates an emergency‑department‑centric operation: the top two revenue codes are ED E/M visits (99283 and 99284) and additional ED codes (99282, 99285) also appear in the top list. High volumes of chest x‑rays (71045, 71046), ECGs (93005), and basic labs (85025, 80048) align with a facility that processes large numbers of walk‑in or ambulance‑arrived ED patients and supports on‑site diagnostic services.

99283 is a clear outlier within the state: it ranks #9 of 364 providers (98th percentile) and is labeled an "extreme outlier," signaling Memorial Hospital is far above typical in low‑level ED visit volume relative to peers. Other ED and lab codes show elevated positions as well — 99282 ranks #6 of 197 (97th percentile, notably above typical state volume) and 99284 ranks #26 of 382 (93rd percentile, described as typical, unremarkable volume) — collectively portraying a facility with disproportionate ED throughput on several measures.

The presence and rank of 41899 ($3.1M, 9.7% of Medicaid revenue, #2 of 32, 97th percentile, typical, unremarkable volume) points to a meaningful volume of dental/oral procedures billed under an unspecified code; this is an unusual high‑revenue component for a general acute care hospital and suggests a notable oral surgery or dental service line within the hospital mix.

Ancillary and transport services support the ED focus: sizable claims and revenue for ambulance mileage and basic/advanced life support (A0425, A0428, A0427, A0426) plus high ranks for multiplex respiratory testing (87636, #3 of 50, 96th percentile, notably above typical) indicate integrated pre‑hospital and on‑site lab capacity tied to emergency operations. These patterns imply operational dependence on both patient arrivals by ambulance and fast diagnostic throughput.

The facility has an established presence, with its NPI enumerated on 2006-06-01 (~20 years ago), which supports interpreting current high volumes as sustained operational scale rather than a recent surge. For network or contracting teams, tenure combined with concentration in a few Medicaid codes argues for targeted negotiations around ED and urgent care reimbursement and capacity planning.

From a risk/opportunity standpoint, the hospital’s Medicaid revenue profile is both a competitive strength and a concentration vulnerability: being a statewide outlier on key ED codes (especially 99283) gives market leverage in emergency care, but the fact that 66.8% of Medicaid revenue is driven by three codes increases sensitivity to policy, utilization, or coding shifts affecting those specific services. Payers should monitor ED utilization trends and the high‑ranked ancillary codes (lab and imaging) when modeling future spend or designing utilization management programs.

Medicaid: Complete Services Breakdown

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

123 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	99,240	$130	$13.2M
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.	48,030	$110	$5.3M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	1,950	$1,610	$3.1M
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.	14,240	$120	$1.7M
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	10,910	$130	$1.4M
A0425	Ground mileage, per statute mile	10,640	$90	$957.8K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	9,230	$90	$812.2K
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…	13,220	$60	$753.4K
99221	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	1,430	$510	$734.5K
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.	4,450	$150	$676.7K

Showing 1–10 of 123

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

Memorial Hospital Of South Bend — 6 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

123 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
A0431	Ambulance service, conventional air services, transport, one way (rotary wing)	6	10	240	$2,220	$3.2M
A0436	Rotary wing air mileage, per statute mile	6	10	490	$910	$1.6M
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.	26	380	2,470	$100	$1.5M
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.	9	360	3,490	$110	$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.	110	330	1,530	$100	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	86	100	2,210	$70	$926K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	2	30	450	$1,270	$886.9K
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	112	180	1,730	$180	$744.6K
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…	33	130	3,770	$60	$617.7K
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.	105	150	440	$100	$545.6K

Showing 1–10 of 123

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
William Paul	IN	Oral and Maxillofacial Surgery (Dentist)	$0	$5.4M
Natali Balog	IN	Rheumatology Physician	$2.4M	$0
Mary Ann Domingo	IN	Rheumatology Physician	$1.4M	$0
Ahmed Abdel-latief	IN	Cardiovascular Disease Physician	$248K	$0
Mayank Mittal	IN	Interventional Cardiology Physician	$189.2K	$0
Vinod Chauhan	IN	Cardiovascular Disease Physician	$123.9K	$0
John Kobayashi	IN	Cardiovascular Disease Physician	$121K	$0
Muhammad Aslam	IN	Interventional Cardiology Physician	$119.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Bend Emergency Physicians, Inc	IN	Emergency Medicine Physician	$0	$11.8M
City Of South Bend	IN	Land Ambulance	$874.9K	$8.5M
Healthlinc, Inc	IN	Federally Qualified Health Center (FQHC)	$0	$5.5M
Beacon Medical Group, Inc.	IN	Pediatrics Physician	$0	$4.7M
Beacon Medical Group, Inc.	IN	Family Medicine Physician	$0	$4.7M
Beacon Medical Group, Inc.	IN	Psychiatry Physician	$0	$4.4M
Labcorp Indiana Inc	IN	Clinical Medical Laboratory	$0	$4M
South Bend Community School Corporation	IN	Local Education Agency (LEA)	$0	$3.9M
Lincoln Counseling, PC	IN	Social Worker	$0	$3.4M
Pediatrix Medical Group Of Indiana, PC	IN	Neonatal-Perinatal Medicine Physician	$0	$2.6M

Memorial Hospital Of South Bend — 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