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

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

Southcoast Hospitals Group, Inc (NPI 1306871223)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southcoast Hospitals Group, Inc
Address	363 Highland Ave
City	Fall River
State	MA
ZIP	02720
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 11, 2006

Payer Source	Total Paid
Medicaid	$97.6M
Medicare	$0

SOUTHCOAST HOSPITALS GROUP, INC reports $97.6M in lifetime Medicaid revenue and has no Medicare billing on file, making its observable claims footprint effectively single‑payer in the available dataset. Because there is no Medicare activity to analyze, national Medicare competitive standing cannot be assessed from these data. The provider has an NPI enumeration date of 2006-07-11 (~20 years ago), indicating long-tenured participation in the programs reported here.

Revenue is highly concentrated in emergency department evaluation and management services: the top three Medicaid codes 99283, 99284, and 99285 together account for 38.4% of this provider's total Medicaid revenue. Individually these codes produce large shares ($9.7M for 99283 at 14.9%, $8.1M for 99284 at 12.3%, and $7.3M for 99285 at 11.2%), signaling ED visits are the single largest revenue driver for the Medicaid book of business.

The code mix points to an acute-care hospital operating a high-volume emergency department with substantial observation and infusion activity. High revenues for G0378 (35.6K claims, $5.5M revenue) and the cluster of infusion codes 96361/96365/96366 (combined multi-million-dollar revenue) indicate frequent use of hospital observation beds and IV therapy for acute presentations and dehydration management.

State-level competitive standing in emergency services is strong: 99283 ranks #18 of 547 providers (97th percentile) and 99284 ranks #26 of 827 providers (97th percentile), each described as notably above typical state volume for the code. 99285 also ranks highly (#28 of 521, 95th percentile) and is described as notably above typical state volume, so for high-acuity ED encounters this provider is a major in-state participant rather than a modest contributor.

Several ancillary service lines also show above‑typical state volume, supporting a broad acute-care footprint beyond the ED. Therapeutic exercise 97110 (43.1K claims, $2.6M revenue) and lab/imaging staples such as 80053 (152.6K claims, $1.1M revenue) and 71046 (36.9K claims, $773.9K revenue) are each flagged as notably above typical state volume, suggesting strong outpatient therapy, laboratory, and radiology throughput alongside inpatient/ED care.

Other high-volume items are more typical in-state for a hospital of this size: G0378 (observation service) is at the 91st percentile and described as typical/unremarkable, and infusion code 96361 is at the 77th percentile described as typical/unremarkable. These placements indicate that while the facility has high absolute volumes, some key hospital operational services fall within expected ranges for Massachusetts peers.

The provider also reports substantial high-throughput infectious disease and molecular testing volumes tied to acute care and public health demand: 87637 (multiplex SARS–CoV–2/influenza/RSV) and U0003 (SARS–CoV‑2 high-throughput testing) each appear in the top-25 Medicaid codes and are positioned at relatively high in-state percentiles. This pattern is consistent with a hospital that maintains significant laboratory capacity supporting both inpatient and ED workflows.

Given the Medicaid concentration ($97.6M total and top three codes accounting for 38.4% of Medicaid revenue) the provider is financially and operationally exposed to shifts in Medicaid policy or reimbursement for ED/observation services. Analysts should treat Southcoast as a long-standing, Medicaid-centric acute-care hospital with a dominant in-state emergency medicine footprint and broad ancillary service volumes driving its Medicaid revenue base.

Medicaid: Complete Services Breakdown

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

464 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.	64,450	$150	$9.7M
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.	54,860	$150	$8.1M
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.	46,450	$160	$7.3M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	19,180	$370	$7.1M
G0378	Hospital observation service, per hour	35,610	$150	$5.5M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	43,150	$60	$2.6M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	16,860	$150	$2.4M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	17,330	$120	$2.1M
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.	11,840	$160	$1.9M
87637	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)…	14,240	$140	$1.9M

Showing 1–10 of 464

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Southcoast Hospitals Group, Inc — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

464 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	11	10	210	$5,200	$5.5M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	21	90	7,560	$350	$4.2M
S9485	Crisis intervention mental health services, per diem	37	110	1,250	$540	$3.2M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	16	50	1,870	$210	$1.4M
G0378	Hospital observation service, per hour	7	70	7,250	$100	$1.3M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	12	80	4,380	$140	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	29	110	5,660	$30	$1.1M
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.	28	520	120	$130	$1M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	20	130	1,830	$60	$974.3K
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	7	60	1,750	$260	$907.4K

Showing 1–10 of 464

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southcoast Hospitals Group, Inc	MA	General Acute Care Hospital	$0	$172.9M
Southcoast Hospitals Group, Inc	MA	General Acute Care Hospital	$0	$26.2M
Daniel Martin	MA	Pulmonary Disease Physician	$316.7K	$0
Ossama Labib	MA	Internal Medicine Physician	$294.6K	$0
Mark Durfee	MA	Emergency Medicine Physician	$160.3K	$131.7K
Mushtaque Chachar	MA	Neurology Physician	$234.6K	$0
Irina Merport	MA	Internal Medicine Physician	$234.4K	$0
Gregory Russell	MA	Cardiovascular Disease Physician	$227.7K	$0
John Carroll	MA	Urology Physician	$220.4K	$0
Maria Rumsey	MA	Cardiovascular Disease Physician	$217.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Stanley Street Treatment And Resources, Inc.	MA	Substance Abuse Rehabilitation Facility	$672.8K	$38.4M
Family Service Association Of Greater Fall River	MA	Case Management Registered Nurse	$0	$36.5M
Family Service Association Of Greater Fall River, Inc.	MA	Mental Health Counselor	$0	$32.9M
Steppingstone Inc	MA	Multi-Specialty Clinic/Center	$0	$29.9M
Stanley Street Treatment And Resources, Inc	MA	Federally Qualified Health Center (FQHC)	$0	$18.4M
First Physicians Corporation	MA	Emergency Medicine Physician	$0	$12.7M
Bay State Afc, LLC	MA	Foster Care Agency	$0	$11.3M
Saint Vincent's Services, Inc.	MA	Adolescent and Children Mental Health Clinic/Center	$0	$10.3M
Alert Ambulance Service, Inc	MA	Land Ambulance	$2M	$6.5M
People, Incorporated	MA	Developmentally Disabled Services Day Training Agency	$0	$8.5M

Southcoast Hospitals Group, 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