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.

Sentara Hospitals (NPI 1437119310)

Field	Value
Entity Type	Organization
Organization	Sentara Hospitals
Address	600 Gresham Dr
City	Norfolk
State	VA
ZIP	23507
Taxonomy	General Acute Care Hospital
NPI Enumerated	March 24, 2006

Payer Source	Total Paid
Medicaid	$88M
Medicare	$0

Key Findings

This provider is effectively single‑payer in the available data: there is no Medicare billing on file while Total Medicaid revenue is $88M, so Medicaid accounts for the observable bulk of the organization’s publicly reported payer activity. That concentration makes Medicaid reimbursement patterns and state-level contracting dynamics the primary drivers of its financial profile.

Revenue is concentrated in a small set of emergency services: the precomputed top‑3 Medicaid codes account for 43.8% of this provider’s total Medicaid revenue. Those top three are 99284 (60.1K claims, $160 avg paid/claim, $9.6M revenue; 15.4%), 99283 (62.2K claims, $154 avg paid/claim, $9.6M revenue; 15.3%), and 99285 (49.4K claims, $165 avg paid/claim, $8.2M revenue; 13.1%), indicating a heavy reliance on emergency department evaluation & management billing.

The code mix points to a high‑throughput emergency department as a core service line: 99284 and 99283 both rank at the 96th percentile in the state and are labeled "notably above typical state volume," while 99285 sits at the 95th percentile (labeled "typical, unremarkable volume"). These ranks and claim volumes suggest sustained ED visit volume across low, moderate, and high complexity visits, supporting staffing, throughput, and downstream inpatient/observation activity.

Beyond ED E/M, the provider shows substantive capability in imaging and advanced diagnostics: high‑revenue imaging codes include 70450 (18.3K claims, $3.4M revenue, 94th percentile), 74177 (16.9K claims, $2.3M revenue, 94th percentile), 78815 (2.6K claims, $1.8M revenue, rank #2 of 36, 97th percentile), 71275 and 70553 are also present. Coupled with frequent infusion/IV codes (96361, 96365, 96366, 96415), the mix indicates on‑site CT/PET/MR capacity and significant infusion/chemotherapy or hydration services supporting both acute and specialty outpatient care.

The provider shows localized leadership in several high‑cost injectable and blood product services: J2357 (3.7K claims, $956K revenue, ranks #1 of 13, 100th percentile; "notably above typical state volume"), Q5104 (686 claims, $866.4K revenue, ranks #1 of 5, 100th percentile), and P9016 (3.9K claims, $775.4K revenue, ranks #2 of 27, 96th percentile; "notably above typical state volume"). These positions point to concentrated utilization of specific biologics and transfusion services that are material to specialty pharmacy and inpatient revenue lines.

Ancillary outpatient and observation services are significant contributors to the Medicaid mix: therapeutic exercise 97110 represents $3M (4.8% of Medicaid revenue) and ranks in the 98th percentile, hospital observation G0378 contributes $1.2M (2.0%), lab drug screening 80307 contributes $816.7K (1.3%), and oxygen administration 94640 contributes $635.6K (1.0%) and ranks in the 97th percentile. Together these codes portray a broad set of support services—PT/rehab, observation bed use, lab screening, and respiratory care—that complement the ED and imaging volumes.

Statewide competitive standing is strong on multiple high‑volume Medicaid measures: many of the provider’s top codes sit in the 90th+ percentiles and several are ranked #1 or #2 within the state for their respective codes. The absence of Medicare billing on file prevents national benchmarking against Medicare peers, so assessments of broader market share should be confined to the Medicaid/state level.

The provider’s NPI was enumerated on 2006-03-24 (~20 years ago), indicating an established operating history in the market. That tenure is consistent with the scale implied by the high ED throughput, extensive imaging and infusion service mix, and leadership positions on several state Medicaid codes.

Medicaid: Complete Services Breakdown

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

663 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.	60,110	$160	$9.6M
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.	62,220	$150	$9.6M
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.	49,420	$170	$8.2M
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.	22,310	$270	$6M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	18,340	$190	$3.4M
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…	64,010	$50	$3M
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.	20,040	$130	$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.	16,900	$140	$2.3M
78815	PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.…	2,580	$710	$1.8M
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	8,740	$190	$1.6M

Showing 1–10 of 663

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

Sentara Hospitals — 10 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

663 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	13	90	9,030	$280	$3.2M
J1459	Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg	3	10	700	$1,300	$2.8M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	14	70	3,200	$110	$2.8M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	4	10	800	$1,530	$2.1M
J2350	Injection, ocrelizumab, 1 mg	2	10	20	$18,310	$1.9M
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.	17	340	160	$130	$1.3M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	4	10	450	$540	$1.3M
J2357	Injection, omalizumab, 5 mg	1	10	830	$990	$1.2M
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.	24	630	90	$140	$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.	13	140	3,240	$160	$1M

Showing 1–10 of 663

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sentara Hospitals	VA	General Acute Care Hospital	$0	$79.7M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$78.5M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$57.9M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$52.3M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$21.9M
Sentara Hospitals	VA	Air Ambulance	$977.3K	$170.6K
Michele Henry	VA	Chiropractor	$16.7K	$0

Nearby Providers

Other providers in the same ZIP code as Sentara Hospitals, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Childrens Hospital Of The Kings Daughters Inc	VA	Children's Hospital	$0	$288.2M
Childrens Specialty Group PLLC	VA	Pediatrics Physician	$0	$87.7M
Sentara Reference Lab Solutions, LLC	VA	Clinical Medical Laboratory	$12.9M	$4.7M
Medical Center Radiologists Inc	VA	Diagnostic Radiology Physician	$0	$13.7M
Childrens Hospital Of The Kings Daughters Inc	VA	Adolescent and Children Mental Health Clinic/Center	$0	$10.2M
Childrens Hospital Of The Kings Daughters Inc	VA	Pediatrics Physician	$0	$8.4M
Jonathan Wiesen	VA	Internal Medicine Physician	$2.4M	$0
Deepak Deshmukh	VA	Vascular Surgery Physician	$1.4M	$0
Edwin Crandley	VA	Radiation Oncology Physician	$315.3K	$0
James Post	VA	Anatomic Pathology & Clinical Pathology Physician	$211.2K	$4.7K

Sentara Hospitals — Billing Profile & Reimbursement Data

Sign up for Sentara Hospitals — Billing Profile & Reimbursement Data policy alerts

Sentara Hospitals — Billing Profile & Reimbursement Data

Sign up for Sentara Hospitals — Billing Profile & Reimbursement Data policy alerts

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