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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

San Juan Regional Medical Center, Inc. (NPI 1427058510)

Field	Value
Entity Type	Organization
Organization	San Juan Regional Medical Center, Inc.
Address	801 W Maple St
City	Farmington
State	NM
ZIP	87401
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 29, 2005

Payer Source	Total Paid
Medicaid	$141.5M
Medicare	$0

Key Findings

This provider is effectively single‑payer on file: Total Medicare revenue is listed as none (no Medicare billing on file), while Total Medicaid revenue is $141.5M, indicating virtually all reported fee‑for‑service activity in the dataset derives from Medicaid. Analysts should treat Medicaid as the dominant — and for reporting purposes sole — payer in this profile.

Revenue is highly concentrated in emergency department E/M services: the precomputed top‑3 Medicaid codes account for 43.5% of this provider's total Medicaid revenue, and those contributors are 99284 ($19.1M, 18.3%), 99283 ($14.4M, 13.8%), and 99285 ($11.9M, 11.4%). This concentration shows that a large share of Medicaid dollars flow through ED evaluation and management encounters.

The code mix points to an acute care hospital operating with a high‑volume emergency footprint supported by substantial transport and imaging capacity. High‑revenue ED codes (99284/99283/99285) are complemented by ambulance transports such as A0429 ($7.5M, 7.2%) and A0427 ($5.9M, 5.6%), CT imaging like 74177 ($3.2M, 3.0%) and 70450 ($2.8M, 2.7%), and observation hours G0378 ($2.9M, 2.8%), which together indicate integrated ED, observation, imaging, lab, and transport workflows.

Statewide competitive standing is strong in emergency and transport services: 99283 ranks #4 of 84 in‑state (96th percentile, noted as notably above typical state volume), 99284 ranks #5 of 76 (95th percentile), and A0429 ranks #2 of 56 (98th percentile, notably above typical state volume). These percentiles show the provider is a major Medicaid ED and ground‑transport destination in New Mexico even if not universally top ranked across every ED code.

There are clear statistical outliers in specific ancillary and infusion services that elevate Medicaid volumes: 96361 (IV fluids per additional hour) is ranked #1 of 40 in‑state (100th percentile) and labeled an extreme outlier, and 87631 (multiplex respiratory pathogen testing) is also #1 of 29 (100th percentile) and an extreme outlier. Such extreme outlier status for infusion and multiplex testing suggests unusually high throughput for prolonged IV therapy and respiratory diagnostics relative to statewide peers.

Air transport utilization is prominent and reimbursed at high per‑claim rates: A0430 (fixed wing one‑way) reports 2.7K claims with $1936 avg paid/claim and $5.2M revenue (4.9%), while A0431 (rotary wing one‑way) has $1909 avg paid/claim and $2.3M revenue (2.2%). The combination of frequent air transports and high per‑claim payments indicates regular patient transfers that extend beyond local ground EMS, consistent with a regional transfer or referral function.

Ancillary diagnostics and supportive services are material revenue contributors and rank highly in the state: CT and radiography codes such as 74177 ($3.2M) and 70450 ($2.8M) appear in the top revenue list alongside high‑volume lab and toxicology testing like G0480 ($1.5M, rank #2 of 54, 98th percentile) and 80053 (103.5K claims, $1.1M, rank #6 of 97). This mix reinforces that in‑house imaging, laboratory, and drug testing capacity support the ED/observation workload and are meaningful Medicaid revenue lines.

The provider has long tenure in the NPI registry (enumerated 2005-07-29, ~21 years ago), which together with $141.5M in Medicaid receipts and a high‑volume ED/transport code mix suggests an established regional General Acute Care Hospital focused on Medicaid populations and emergency/transfer activity. Analysts should interpret patterns as the behavior of a mature, Medicaid‑facing acute care facility rather than a new entrant or primarily Medicare‑focused hospital.

Medicaid: Complete Services Breakdown

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

516 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.	76,560	$250	$19.1M
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.	84,130	$170	$14.4M
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.	37,180	$320	$11.9M
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	26,360	$290	$7.5M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	20,730	$280	$5.9M
A0430	Ambulance service, conventional air services, transport, one way (fixed wing)	2,670	$1,940	$5.2M
A0435	Fixed wing air mileage, per statute mile	2,580	$1,530	$3.9M
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.	8,800	$360	$3.2M
G0378	Hospital observation service, per hour	5,100	$570	$2.9M
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.	49,150	$60	$2.9M

Showing 1–10 of 516

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

San Juan Regional Medical Center, Inc. — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

516 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
A0430	Ambulance service, conventional air services, transport, one way (fixed wing)	3	10	2,080	$2,410	$5.2M
A0435	Fixed wing air mileage, per statute mile	4	10	2,070	$1,980	$4.2M
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.	5	80	12,050	$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.	8	70	6,920	$210	$3.5M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	14	40	3,670	$80	$3.2M
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.	4	80	10,650	$130	$2.4M
A0431	Ambulance service, conventional air services, transport, one way (rotary wing)	4	10	510	$1,980	$2.2M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	5	50	1,320	$270	$2M
A0436	Rotary wing air mileage, per statute mile	4	10	510	$1,570	$1.8M
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.	10	60	3,070	$210	$1.4M

Showing 1–10 of 516

Related Providers

Other providers that share a Tax Identification Number (TIN) with San Juan Regional Medical Center, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
San Juan Regional Medical Center Inc	NM	Emergency Medicine Physician	$0	$23.8M
San Juan Regional Medical Center Inc	NM	Pediatrics Physician	$0	$15.7M
San Juan Regional Medical Center Inc	NM	Family Medicine Physician	$0	$7.9M
Orthopedic Associates PA	NM	Orthopaedic Surgery Physician	$0	$4.4M
San Juan Regional Medical Center Inc	NM	Hospitalist Physician	$0	$3.6M
San Juan Regional Medical Center Inc	NM	Neurology Physician	$0	$2.5M
San Juan Regional Medical Center Inc	NM	Internal Medicine Physician	$0	$1.5M
Clayton Labaume	CO	Surgical Physician Assistant	$1.4M	$0
San Juan Regional Medical Center Inc	NM	Psychiatry Physician	$0	$1.4M
Graeme Fisher	IL	Therapeutic Radiology Physician	$658K	$0

Nearby Providers

Other providers in the same ZIP code as San Juan Regional Medical Center, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Basin Coordinated Healthcare,inc	NM	Personal Care Attendant	$0	$79.7M
Presbyterian Medical Services	NM	Federally Qualified Health Center (FQHC)	$0	$41.2M
Links Ii Inc	NM	In Home Supportive Care Agency	$0	$38.9M
Generations Personal Care, Inc	NM	Personal Care Attendant	$0	$33.9M
Southwestern Private Services, Inc.	NM	Home Health Agency	$0	$30.4M
San Juan Center For Independence	NM	Home Health Agency	$0	$22.5M
Cottonwood Clinical Services, Inc.	NM	Community/Behavioral Health Agency	$0	$18.1M
Better Together Home And Community Services, LLC	NM	Child Intellectual and/or Developmental Disabilities Respite Care	$0	$14.5M
Southwestern Private Services, Inc	NM	Home Health Agency	$0	$7.3M
Pms Dba Roundtree Childrens' Development Services	NM	Developmental Disabilities Clinic/Center	$0	$6.9M

San Juan Regional Medical Center, Inc. — Billing Profile & Reimbursement Data

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San Juan Regional Medical Center, 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