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

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

Vanderbilt University Medical Center (NPI 1396882205)

Field	Value
Entity Type	Organization
Organization	Vanderbilt University Medical Center
Address	1211 Medical Center Drive
City	Nashville
State	TN
ZIP	37232
Taxonomy	General Acute Care Hospital
NPI Enumerated	January 31, 2007

Payer Source	Total Paid
Medicaid	$137.7M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reported Total Medicaid revenue of $137.7M; in these data the organization is effectively single-payer (Medicaid)-dominated, so comparisons should be framed against Medicaid activity and in-state peers rather than Medicare benchmarks. Analysts should treat Medicare-level benchmarking as not applicable for this entity because no Medicare revenue is captured on file.

Revenue concentration is high: the precomputed top 3 codes account for 58.3% of this provider's total Medicaid revenue. The three leading codes are G0463 ($39.7M, 34.8%), 99283 ($14M, 12.3%), and 99285 ($12.8M, 11.3%), indicating that a majority of Medicaid dollars are tied to a small set of outpatient and emergency service codes.

Code mix and service-line implications point to a high-volume outpatient and emergency practice model: G0463 shows 529K claims with $75 avg paid/claim and $39.7M revenue, reflecting very large hospital outpatient clinic assessment throughput, while ED evaluation-and-management codes 99283 (88.6K claims, $158 avg paid/claim, $14M revenue) and 99285 (33.1K claims, $388 avg paid/claim, $12.8M revenue) indicate substantial emergency department activity. Together these code volumes suggest the facility operates as a major regional center for ambulatory assessment and acute ED care within the Medicaid population.

On competitive standing within Tennessee the provider is a dominant outlier for several codes: G0463 ranks #1 of 62 providers in-state (100th percentile; extreme outlier), demonstrating exceptional outpatient clinic volume for assessment and management. ED codes are also strong — 99283 ranks #13 of 611 (98th percentile; notably above typical state volume) and 99285 ranks #20 of 565 (97th percentile; typical, unremarkable volume by the dataset label) — indicating leadership in ED throughput for low- and high-acuity E/M services compared with most in-state peers.

Specialty procedural volumes are meaningful contributors to Medicaid revenue and point to robust pediatric ENT and anesthesia-supported procedures: 42820 (tonsil/adenoid removal in patients <12) accounts for $12.8M (4.3K claims, $3004 avg paid/claim) and ranks #3 of 51 (96th percentile; notably above typical state volume), while 69436 (tympanostomy with tube) accounts for $4.4M (3.8K claims, $1153 avg paid/claim) and ranks #5 of 65 (94th percentile; notably above typical). These ranks and dollar amounts indicate the provider is a major in-state site for these pediatric operative services under Medicaid.

The provider is a statewide leader in lab and testing throughput and vaccination activity: 87636 (multiplex SARS–CoV‑2/flu A/B testing) shows 8.6K claims with $132 avg paid/claim and $1.1M revenue and ranks #1 of 64 providers in-state (100th percentile; extreme outlier), while 87637 ranks #1 of 31 (100th percentile; notably above typical) with $615.3K revenue. High-volume preventive and diagnostic coding also appears in 90471 (40.2K claims, $24 avg paid/claim, $965.8K revenue) which ranks #4 of 895 (100th percentile; extreme outlier) and 85025 (120.2K claims, $7 avg paid/claim, $841.5K revenue) which ranks #7 of 554 (99th percentile; notably above typical state volume), together signaling large laboratory and immunization operations supporting the Medicaid population.

The NPI was enumerated on 2007-01-31 (~19 years ago), indicating long-tenured enrollment in federal provider directories. This longevity, combined with the concentration of high-volume outpatient, ED, lab, and pediatric procedural codes, supports the characterization of an established regional referral and service hub for Medicaid patients.

Because a majority of Medicaid dollars are concentrated in outpatient clinic assessment (G0463) and ED E/M codes (the top-3 share is 58.3%), the provider’s Medicaid revenue is especially sensitive to changes in outpatient and ED reimbursement policies or coding guidance. Analysts monitoring contract negotiations or state Medicaid rule changes should prioritize these code families when modeling revenue impact or competitive shifts.

Medicaid: Complete Services Breakdown

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

487 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	529,040	$80	$39.7M
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.	88,580	$160	$14M
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.	33,100	$390	$12.8M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	4,260	$3,000	$12.8M
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.	23,740	$260	$6.1M
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	3,780	$1,150	$4.4M
J0475	Injection, baclofen, 10 mg	5,180	$720	$3.7M
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	23,680	$70	$1.8M
G0378	Hospital observation service, per hour	3,500	$460	$1.6M
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	2,110	$760	$1.6M

Showing 1–10 of 487

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Vanderbilt University Medical Center — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

487 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0475	Injection, baclofen, 10 mg	1	10	2,670	$710	$1.9M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	115	120	5,200	$120	$1.4M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	1	60	1,340	$50	$1.1M
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.	55	630	510	$120	$1.1M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	4	10	460	$2,200	$896.4K
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.	13	610	570	$110	$884.4K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	6	30	410	$520	$719.2K
J0585	Injection, onabotulinumtoxina, 1 unit	4	20	200	$880	$709.1K
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.	20	570	640	$100	$637.8K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	150	230	2,130	$40	$616.8K

Showing 1–10 of 487

Related Providers

Other providers that share a Tax Identification Number (TIN) with Vanderbilt University Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vanderbilt University Medical Center	TN	Internal Medicine Physician	$0	$189.5M
Vanderbilt University Medical Center	TN	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$29.1M
Vanderbilt University Medical Center	TN	General Acute Care Hospital	$0	$8M
Antonia Kolokythas	TN	Oral and Maxillofacial Surgery (Dentist)	$0	$5.9M
Vanderbilt Integrated Providers, LLC	TN	Family Medicine Physician	$0	$4.3M
Anita Agarwal	CA	Retina Specialist (Ophthalmology) Physician	$2.2M	$0
Heather Tamez	MD	Retina Specialist (Ophthalmology) Physician	$1.3M	$0
Linda Armstrong	GA	Diagnostic Radiology Physician	$643.9K	$175.1K
Kenneth Niermann	TN	Radiation Oncology Physician	$625.8K	$0
Stephen Kim	TN	Ophthalmology Physician	$608.9K	$0

Nearby Providers

Other providers in the same ZIP code as Vanderbilt University Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Han-chih Chang	TN	Radiation Oncology Physician	$2.6M	$0
Emily Carpenter	TN	Nurse Practitioner	$747.9K	$0
Corbin Johnson	TN	Radiation Oncology Physician	$577.1K	$0
Avni Finn	TN	Ophthalmology Physician	$504.5K	$0
Dinesh Gupta	TN	Cardiovascular Disease Physician	$397.9K	$80.2K
Dong Kim	TN	Radiation Oncology Physician	$469.4K	$0
Anthony Cmelak	TN	Radiation Oncology Physician	$391.9K	$0
Ryszard Dworski	TN	Allergy & Immunology Physician	$376.5K	$2.4K
Nathan Podoll	TN	Ophthalmology Physician	$363.9K	$0
Brian Thurber	TN	Diagnostic Radiology Physician	$356K	$0

Vanderbilt University Medical Center — Billing Profile & Reimbursement Data

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Vanderbilt University Medical Center — 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