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

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

Riverside Hospital Inc (NPI 1366547747)

Field	Value
Entity Type	Organization
Organization	Riverside Hospital Inc
Address	500 J Clyde Morris Blvd
City	Newport News
State	VA
ZIP	23601
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 13, 2006

Payer Source	Total Paid
Medicaid	$136.7M
Medicare	$0

Key Findings

RIVERSIDE HOSPITAL Inc reports total Medicaid revenue of $136.7M and has no Medicare billing on file, making Medicaid effectively its sole recorded public payer in this dataset; this single-payer concentration could meaningfully affect reimbursement exposure and contract negotiations. The provider’s NPI was enumerated 2006-09-13 (~20 years ago), indicating a long-established operation in the market.

Revenue concentration is high within a small set of services: the precomputed top 3 Medicaid codes account for 37.2% of the provider’s total Medicaid revenue, signaling that a minority of service lines generate a majority of Medicaid dollars. Those top contributors include G0463 ($13M, 13.6%), 96361 ($12.2M, 12.7%), and 99284 ($10.4M, 10.8%), which together explain the concentration noted above.

The code mix indicates a high-volume acute care and emergency-facing operation: emergency department E/M codes 99284, 99283, 99282, 99285 and 99281 appear among the top revenue drivers (99284 $10.4M, 99283 $9.8M, 99282 $3.9M, 99285 $2.8M, 99281 $1.5M), consistent with substantial ED throughput and a range of acuity levels being managed on Medicaid patients. Several of those ED codes rank well above typical state volume (e.g., 99284 ranks #22 of 620, 97th percentile; 99283 ranks #27 of 626, 96th percentile), supporting characterization of this hospital as a busy regional ED for Medicaid enrollees.

Infusion and procedural therapy are another dominant business line: 96361 (IV fluids, additional hour) is an extreme statewide outlier and the single largest-ranking code by state for its cohort (96361: 45.9K claims, $12.2M revenue, ranks #1 of 90, 100th percentile), and related infusion codes 96365, 96366, and 96360 also appear high on the list with extreme or notable statewide ranks. This pattern suggests extensive inpatient/outpatient infusion activity and potentially large-volume dehydration or infusion services on the Medicaid population.

The hospital also shows strong procedure-based specialty volume in endoscopy and colonoscopy: 45380 (colonoscopy with biopsy) generates $2.6M and ranks #1 of 89 (100th percentile), 43239 (upper endoscopy with biopsy) is $2.6M and ranks #7 of 146 (96th percentile), and 45385 (polypectomy) is $2.1M and ranks #2 of 65 (98th percentile). These rankings indicate the provider is a major statewide performer for GI procedural services on Medicaid.

Outpatient clinic and ancillary services contribute materially to revenue: G0463 (hospital outpatient clinic visit) accounts for $13M (13.6% of Medicaid revenue) and ranks #3 of 70 in-state (97th percentile) but is labeled as a typical, unremarkable volume for this code, implying broad baseline clinic activity rather than a niche specialty driver. High-volume therapy and rehabilitation codes such as 97110 (112.5K claims, $5.5M, ranks #5 of 401, 99th percentile) and 97161 (10.4K claims, $1.2M, ranks #2 of 133, 99th percentile) further show large outpatient rehab/therapy throughput.

Oncology-related services are present but mixed in competitive standing: J9271 (pembrolizumab) is $6.1M and ranks #4 of 10 in-state (67th percentile), while chemotherapy administration codes (96413, 96365) are on the top list with notable or extreme ranks. This combination indicates established oncology infusion capacity within the hospital, though J9271’s statewide rank is middling relative to the small set of high-volume oncology providers.

Taken together, the distribution of high-ranking, extreme-outlier codes (notably 96361 at 100th percentile, 45380 at 100th percentile, and multiple therapy/infusion codes at 98–99th percentiles) portrays RIVERSIDE HOSPITAL as a high-volume, procedure- and infusion-centered acute care hospital for Medicaid patients in Virginia, with concentrated revenue risk tied to a handful of service lines and little to no Medicare diversification on file.

Medicaid: Complete Services Breakdown

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

623 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	141,670	$90	$13M
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.	45,890	$270	$12.2M
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.	63,200	$160	$10.4M
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.	60,210	$160	$9.8M
J9271	Injection, pembrolizumab, 1 mg	1,370	$4,430	$6.1M
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…	112,490	$50	$5.5M
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.	24,410	$160	$3.9M
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.	19,680	$140	$2.8M
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.	4,240	$620	$2.6M
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.	15,160	$170	$2.6M

Showing 1–10 of 623

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Riverside Hospital Inc — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

623 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	4	10	800	$5,190	$4.6M
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.	1	90	9,030	$280	$3.2M
S0201	Partial hospitalization services, less than 24 hours, per diem	75	80	1,870	$470	$2.9M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	3	70	3,200	$110	$2.8M
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.	51	340	160	$130	$1.3M
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.	27	630	90	$140	$1.1M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	80	110	1,830	$220	$1.1M
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.	6	140	3,240	$160	$1M
G0378	Hospital observation service, per hour	12	80	3,650	$160	$1M
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.	22	620	70	$120	$1M

Showing 1–10 of 623

Related Providers

Other providers that share a Tax Identification Number (TIN) with Riverside Hospital Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Riverside Physician Services, Inc.	VA	Family Medicine Physician	$0	$44.7M
Shore Health Services Inc.	VA	Rural Acute Care Hospital	$0	$24.7M
Riverside Middle Peninsula Hospital Inc	VA	General Acute Care Hospital	$0	$19M
Riverside Physician Services Inc	VA	Emergency Medicine Physician	$0	$17.3M
Michumi PLLC	VA	Emergency Medicine Physician	$0	$12.4M
Doctors' Hospital Of Williamsburg	VA	General Acute Care Hospital	$0	$12M
Riverside Hospital Inc.	VA	Family Medicine Physician	$0	$7.7M
Matthew Reed	VA	Ophthalmology Physician	$4.6M	$0
Brian Keel	VA	Ophthalmology Physician	$2.7M	$0
Anthony Farah	VA	Ophthalmology Physician	$653.9K	$0

Nearby Providers

Other providers in the same ZIP code as Riverside Hospital Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hope In Home Care LLC	VA	Respite Care	$0	$63.4M
New Life, LLC	VA	Community/Behavioral Health Agency	$0	$10.6M
All Ways There Home Care	VA	Home Health Agency	$0	$9.4M
Universal Mental Health Services, LLC	VA	Adolescent and Children Mental Health Clinic/Center	$0	$7.1M
Peninsula Radiological Associates Limited	VA	Diagnostic Radiology Physician	$0	$6.5M
Charles Kersh	VA	Radiation Oncology Physician	$408.8K	$0
Michael Hooker	VA	Orthopaedic Surgery Physician	$382.5K	$0
Brian Holloway	VA	Student in an Organized Health Care Education/Training Program	$377.4K	$0
Huy Tran	VA	Internal Medicine Physician	$374.4K	$0
Dean Kostov	VA	Neurological Surgery Physician	$304.4K	$0

Riverside Hospital 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