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

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

Heartland Regional Medical Center (NPI 1437259694)

Field	Value
Entity Type	Organization
Organization	Heartland Regional Medical Center
Address	5325 Faraon St
City	Saint Joseph
State	MO
ZIP	64506
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 25, 2006

Payer Source	Total Paid
Medicaid	$57.1M
Medicare	$0

Key Findings

HEARTLAND REGIONAL MEDICAL CENTER reports no Medicare billing on file and $57.1M in lifetime Medicaid revenue, making Medicaid the effective sole public payer on record for this entity. The absence of Medicare activity indicates this profile should be read as a Medicaid-centric operation rather than a mixed Medicare/Medicaid facility. The provider’s NPI was enumerated on 2006-09-25 (~20 years ago), so this is an established hospital with a multi‑year claims history under the current identifier.

Revenue concentration is high: the precomputed top-3 codes account for 51.6% of the provider’s total Medicaid revenue. Those top codes are G0463 ($12.6M, 23.9%), X4011 ($8.7M, 16.4%), and X4003 ($6M, 11.3%), which together drive a majority of billed Medicaid dollars and imply a lean set of high-impact services to monitor for contract/value discussions.

Business and service-line mix looks outpatient- and acute-care oriented. G0463 (Hospital outpatient clinic visit) is the single largest Medicaid revenue driver at $12.6M with 194K claims and $65 avg paid/claim, signaling a substantial hospital outpatient clinic footprint; simultaneously, the presence of high-volume emergency department E/M codes (99284, 99283, 99285) totaling multiple million dollars suggests integrated ED throughput that feeds both outpatient and acute services.

Emergency department utilization is pronounced versus in-state peers: 99284 ($3.9M, 17K claims) ranks #29 of 953 providers in-state (97th percentile) and 99283 ($3.1M, 19.4K claims) ranks #31 of 1263 (98th percentile). These rank positions indicate the hospital is a major state provider of moderate- and low-complexity ED visits, contributing meaningfully to its Medicaid revenue mix and likely driving downstream inpatient and ancillary demand.

The provider shows outsized diagnostic and monitoring intensity. 80053 (comprehensive metabolic panel, $3.2M, 62.6K claims) is labeled an "extreme outlier" and ranks #5 of 242 in-state (98th percentile), and 85025 (CBC, $2.4M, 60.2K claims) ranks #10 of 324 (97th percentile). High volumes for 94761 (oxygen saturation monitoring, $2.7M, 25.2K claims) which ranks #1 of 13 (100th percentile) further corroborate a diagnostic-heavy outpatient/ED service model.

Competitive standing across key Medicaid codes is mixed but often strong. G0463 ranks #4 of 96 (97th percentile) and X4003 ranks #4 of 69 (96th percentile), indicating the hospital is notably above typical state volume and among the larger in-state providers for those services; by contrast X4011 ($8.7M) ranks #19 of 106 (83th percentile), which is described as typical volume for that code and reflects areas where the provider is less dominant.

Several high-revenue procedure groups are concentrated in a relatively small set of codes beyond the top three: in addition to ED and clinic codes, respiratory and multiplex PCR testing codes (0202U, 87637, 87502, 87804) and drug testing/definitive panels (G0480, 80307) appear in the top-25 list and collectively indicate a sizable investment in lab/diagnostic throughput that supplements clinic/ED revenue. These patterns suggest contracts and network negotiations should focus on outpatient clinic capacity, ED throughput, and high-volume lab services.

Operational risk and contracting takeaways: because a majority of Medicaid dollars are driven by a few high-impact codes (precomputed top-3 codes account for 51.6%) and the provider has no Medicare billing on file, payers should treat HEARTLAND as effectively single‑payer Medicaid exposure with concentrated code-level risk. Where the provider shows state-leading volume (e.g., G0463, X4003, 94761 and the "extreme outlier" 80053), negotiation levers around unit price, utilization management, and lab service arrangements are likely to have outsized impact on total Medicaid spend with this entity.

Medicaid: Complete Services Breakdown

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

204 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	194,050	$70	$12.6M
X4011	N/A	17,840	$490	$8.7M
X4003	N/A	94,450	$60	$6M
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.	16,960	$230	$3.9M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	62,640	$50	$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.	19,390	$160	$3.1M
94761	The provider takes multiple measurements of the patient’s oxygen saturation using a sensor on the ear or finger.	25,230	$110	$2.7M
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	60,200	$40	$2.4M
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.	7,820	$290	$2.3M
81001	Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other…	10,270	$110	$1.1M

Showing 1–10 of 204

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Heartland Regional Medical Center — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

204 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
X4011	N/A	19	110	5,700	$340	$3.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	4	100	2,240	$80	$2.2M
Y7506	N/A	51	100	980	$250	$1.6M
X4003	N/A	4	70	1,480	$80	$1.1M
X4006	N/A	36	50	370	$780	$969.5K
D7999	N/A	5	20	190	$2,300	$708.3K
Y7507	N/A	14	50	270	$360	$594.9K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	27	90	1,850	$120	$384.1K
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.	50	600	140	$170	$384.1K
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…	17	110	2,100	$70	$364.3K

Showing 1–10 of 204

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Heartland Regional Medical Center	MO	General Practice Physician	$0	$20.4M
Southern Illinois Healthcare Foundation, Inc.	IL	Federally Qualified Health Center (FQHC)	$0	$6.3M
Corey Krenz	MO	Family Nurse Practitioner	$491.4K	$0
Jack Kotlarz	IL	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	$455.2K	$0
Andrew Walker	MO	Radiation Oncology Physician	$317.6K	$0
Kala Danushkodi	MO	Physical Medicine & Rehabilitation Physician	$306.4K	$0
Rony Abou-jawde	MO	Medical Oncology Physician	$303K	$0
Sam Alnajjar	AZ	Critical Care Medicine (Internal Medicine) Physician	$280.2K	$0
Habib Munshi	MO	Pulmonary Disease Physician	$227.5K	$530
Mohan Hindupur	MO	Cardiovascular Disease Physician	$225.1K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Res-care Kansas, Inc.	MO	Home Health Agency	$0	$64.8M
Choices Of St Joseph, Inc	MO	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$64.3M
Family Guidance Center For Behavioral Healthcare	MO	Community/Behavioral Health Agency	$0	$63.4M
Heartland Residential Care, Inc.	MO	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$49.1M
Peace Of Mind Home Care, LLC	MO	Home Health Agency	$0	$39.8M
Progressive Community Services	MO	Case Management Agency	$0	$14M
United Cerebral Palsy Of Northwest Missouri	MO	Voluntary or Charitable Agency	$0	$12.2M
Regional Emergency Medical Services Authority	MO	Land Ambulance	$1.3M	$7.4M
St Joseph Center For Outpatient Surgery, LLC	MO	Ambulatory Surgical Clinic/Center	$2M	$92.9K
Murphy Watson Burr Surgery Center Inc	MO	Ophthalmologic Surgery Clinic/Center	$1.3M	$89.6K

Heartland Regional 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