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NPI 1376139139 · Wilmington, NC · General Acute Care Hospital
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Novant Health New Hanover Regional Medical Center LLC is a general acute care hospital provider located in Wilmington, North Carolina. This profile covers 0 Medicare and 226 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 | Novant Health New Hanover Regional Medical Center LLC |
| Address | 2131 S 17th St |
| City | Wilmington |
| State | NC |
| ZIP | 28401 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | December 16, 2020 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $57.5M |
| Medicare | $0 |
This provider effectively operates as a Medicaid-focused hospital: there is no Medicare billing on file and total Medicaid revenue is $57.5M, indicating Medicaid is the material payer supporting its billed services. The absence of Medicare activity makes the provider effectively single‑payer in the available claims data and concentrates reimbursement dynamics around state Medicaid policy and fee schedules.
Revenue concentration is high: the precomputed top three Medicaid codes (99284, 99283, 0241U) account for 75.1% of the provider's total Medicaid revenue, with 99284 reported at $24.7M (47.6% of Medicaid revenue), 99283 at $11M (21.2%), and 0241U at $3.3M (6.3%). This level of concentration means a small set of service lines (primarily ED E/M and a single high‑volume test/procedure coded as 0241U) drive most of the organization’s Medicaid receipts.
The code mix points to an emergency-department–centric operating model. High-revenue ED E/M codes 99284 and 99283 are the top two Medicaid revenue drivers by far, and related ED/EHR codes including 99285, 99282, and observation codes G0378/G0379 appear in the top list, signaling heavy throughput of ambulatory emergency and observation services rather than elective inpatient procedures.
Competitive standing on key codes is mixed: for high-acuity ED care 99284 ranks #26 of 325 providers in-state (92th percentile) and 99283 ranks #31 of 316 (90th percentile), which the source describes as typical, unremarkable volume despite the high percentiles. By contrast, 0241U is an outlier — it ranks #3 of 136 providers in-state (99th percentile) and is described as an "extreme outlier, far above typical state volume for this code," indicating a distinctive local specialization or unusually high utilization of that specific test/procedure relative to peers.
Other service lines and ancillary volumes reinforce the ED/outpatient picture: G0463 (hospital outpatient clinic visit) appears with $2.3M in revenue and ranks #6 of 86 (94th percentile), while observation codes G0378 and G0379 show notable positioning (G0379 ranks #1 of 12, 100th percentile, described as "notably above typical state volume"). Imaging, lab, and IV administration codes (e.g., 74177, 80048, 96374) are present but represent much smaller shares, consistent with a facility focused on acute assessment and short-term management.
High utilization of unclassified or miscoded billings is notable: J3490 (unclassified drugs) appears with large claim volume (134K claims) and $267.9K revenue, ranking #5 of 158 (97th percentile) and described as "notably above typical state volume for this code." That pattern, together with the extreme outlier status of 0241U, suggests the provider has high volumes in service lines that may be coded to catch‑all or specialty test codes rather than standard procedure codes.
Tenure is short-to-moderate: the NPI was enumerated 2020-12-16 (~6 years ago), so the provider has been active under this identifier for roughly the past six years. This timeframe implies the observed utilization profile and any outlier patterns have developed relatively quickly within the Medicaid environment rather than over multiple decades.
From a payer/contracting perspective, the heavy reliance on a small number of high-revenue Medicaid codes (top three = 75.1% of Medicaid revenue) creates concentrated exposure to changes in ED reimbursement, Medicaid policy, or listings for the specific high-volume test 0241U. Analysts should flag these codes for focused contract reviews and utilization management discussions because modifications to payment rules or practice patterns affecting these services would disproportionately impact the provider's revenue stream.
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.
226 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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. | 62,720 | $390 | $24.7M |
| 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. | 50,260 | $220 | $11M |
| 0241U | N/A | 20,910 | $160 | $3.3M |
| 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. | 5,080 | $470 | $2.4M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 77,030 | $30 | $2.3M |
| 96374 | The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition. | 15,810 | $40 | $695.6K |
| 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. | 5,580 | $120 | $680.4K |
| 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… | 12,930 | $50 | $672.4K |
| 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… | 14,600 | $40 | $613.3K |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 790 | $650 | $507.8K |
Showing 1–10 of 226
How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. North Carolina median
226 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 81420 | The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,… | 15 | 20 | 240 | $400 | $13.6M |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 4 | 10 | 110 | $5,750 | $3.2M |
| 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. | 26 | 330 | 6,130 | $130 | $2.7M |
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 22 | 30 | 170 | $260 | $2.6M |
| 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… | 47 | 160 | 840 | $70 | $2.3M |
| 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. | 31 | 320 | 6,160 | $120 | $2.1M |
| 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. | 117 | 280 | 2,690 | $130 | $1.6M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 152 | 170 | 2,470 | $140 | $1.2M |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 23 | 80 | 420 | $30 | $1.2M |
| 86003 | The lab analyst performs the technical lab test to analyze a specimen such as serum for allergen–specific immunoglobulin E (IgE), using a crude allergen extract. The test result is quantitative or… | 30 | 40 | 220 | $60 | $920.5K |
Showing 1–10 of 226
Other providers in the same ZIP code as Novant Health New Hanover Regional Medical Center LLC, ranked by combined Medicare and Medicaid revenue.
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