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NPI 1306898960 · Indianapolis, IN · General Acute Care Hospital
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St. Vincent Hospital & Health Care Center, Inc. is a general acute care hospital provider located in Indianapolis, Indiana. This profile covers 0 Medicare and 218 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | St. Vincent Hospital & Health Care Center, Inc. |
| Address | 2001 W 86th St |
| City | Indianapolis |
| State | IN |
| ZIP | 46260 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | May 16, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $58.9M |
| Medicare | $0 |
This provider is effectively single‑payer at scale: there is no Medicare billing on file and all reported federal payer revenue is from Medicaid, totaling $58.9M. The absence of Medicare revenue means analyses of this facility should be framed around Medicaid activity and state-level competitive dynamics rather than national Medicare benchmarking.
Revenue is highly concentrated in a small number of outpatient and emergency services: the top three Medicaid codes (99283, G0463, 99284) account for 56.4% of the provider’s total Medicaid revenue. Specifically, 99283 generated $13.3M (24.9%), G0463 generated $11.2M (20.9%), and 99284 generated $5.7M (10.7%), signaling that a majority of Medicaid dollars flow through ED evaluation/management and hospital outpatient clinic visits.
The code mix (large receipts for 99283, 99284 and high claim counts for G0463) points to a hospital operating as a high‑volume emergency department and hospital outpatient clinic for Medicaid patients. G0463 shows 128.3K claims and 99283 shows 76.1K claims, which together indicate that assessment/management visits and low‑to‑moderate acuity ED care are the core service lines driving Medicaid volume.
Competitive standing on key codes shows the provider is a major statewide player for selected services: G0463 ranks #3 of 99 providers in‑state and is labeled an "extreme outlier" (98th percentile), while 99283 ranks #11 of 364 providers (97th percentile; "notably above typical state volume"). By contrast, 99284 ranks #33 of 382 providers (92th percentile; "typical, unremarkable volume"), indicating very strong dominance in outpatient clinic visit volume and especially in lower‑acuity ED encounters.
The facility also functions as a testing and diagnostic hub for respiratory pathogens and newborn screening: 87635 (SARS–COV–2 testing) generated $1M from 22.6K claims and ranks #4 of 246 providers (99th percentile; "extreme outlier"), and 87502 (multiplex influenza testing) generated $960.8K from 12.8K claims and ranks #3 of 159 providers (99th percentile; "extreme outlier"). In addition, newborn hearing screening 92558 is a local leader with $789.4K revenue from 7.3K claims and ranks #1 of 7 providers (100th percentile; "notably above typical state volume").
Maternal and pediatric services contribute meaningful Medicaid revenue and breadth of care: antepartum/transfer codes 59425 and 59426 together account for $3.4M ($2M and $1.4M respectively, 3.7% and 2.6% of Medicaid revenue) and fetal monitoring 59025 contributed $413.7K (0.8%). Preventive care codes such as 99391 ($1.6M, 3.0%, ranks #13 of 278, 96th percentile) and 99392 ($1.6M, 2.9%, ranks #10 of 294, 97th percentile) further underscore a significant pediatric and preventive ambulatory footprint within the Medicaid population.
Procedural and surgical pediatrics are notable revenue contributors: tympanostomy 69436 produced $2.3M (4.3%) and ranks #5 of 58 providers (93th percentile; "typical, unremarkable volume"), while tonsil/adenoid removals 42820 produced $1.4M (2.6%) and rank #6 of 28 providers (81th percentile; "typical, unremarkable volume"). These values indicate consistent surgical throughput in ENT procedures for younger patients.
The provider has an established presence in the market, with its NPI enumerated on 2006-05-16 (~20 years ago), suggesting long tenure and operational stability in the Indianapolis market that likely supports the high accumulated Medicaid volumes and the institutional role as a large ED/outpatient/diagnostic center.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
218 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. | 76,110 | $180 | $13.3M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 128,300 | $90 | $11.2M |
| 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. | 43,260 | $130 | $5.7M |
| 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. | 12,890 | $200 | $2.6M |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 1,550 | $1,490 | $2.3M |
| 59425 | This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior… | 15,540 | $130 | $2M |
| 99391 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 14,970 | $110 | $1.6M |
| 99392 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 15,370 | $100 | $1.6M |
| 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. | 12,560 | $120 | $1.5M |
| 59426 | This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the… | 11,900 | $120 | $1.4M |
Showing 1–10 of 218
How this provider's Medicaid billing volume and revenue compare to other Indiana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Indiana median
218 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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. | 33 | 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. | 11 | 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. | 64 | 330 | 1,530 | $100 | $1.1M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 3 | 100 | 2,210 | $70 | $926K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 84 | 180 | 1,730 | $180 | $744.6K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 98 | 200 | 1,130 | $160 | $730.5K |
| 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… | 41 | 130 | 3,770 | $60 | $617.7K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 521 | 580 | 710 | $60 | $582.9K |
| 95715 | The patient undergoes electroencephalography, a study of the electrical activity of the brain, lasting 12 to 26 hours with intermittent monitoring and maintenance. A video recording is made, and an… | 3 | 10 | 410 | $650 | $547.6K |
| 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. | 98 | 150 | 440 | $100 | $545.6K |
Showing 1–10 of 218
Other providers in the same ZIP code as St. Vincent Hospital & Health Care Center, Inc., ranked by combined Medicare and Medicaid revenue.
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