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

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

Southcoast Hospitals Group, Inc (NPI 1447275037)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southcoast Hospitals Group, Inc
Address	101 Page St
City	New Bedford
State	MA
ZIP	02740
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 13, 2006

Payer Source	Total Paid
Medicaid	$172.9M
Medicare	$0

This provider has no Medicare billing on file and reports $172.9M in total Medicaid revenue, so its visible commercial/public-payer footprint in the dataset is effectively Medicaid-centric rather than split across Medicare and Medicaid. Analysts should treat SOUTHCOAST HOSPITALS GROUP, INC as operating primarily within the Medicaid payment stream for the purposes of peer comparisons and utilization profiling.

Revenue is highly concentrated in emergency department evaluation-and-management activity: the precomputed top-three Medicaid codes account for 37.8% of total Medicaid revenue, driven by 99283 (99.8K claims, $17.1M revenue, 14.8%), 99285 (92.7K claims, $14.4M revenue, 12.5%), and 99284 (79.1K claims, $12.1M revenue, 10.5%). This concentration indicates that ED encounters are the single largest revenue driver for the facility’s Medicaid business.

The facility is a dominant statewide ED actor based on rank and percentile: 99283 ranks #7 of 547 providers in-state (99th percentile; extreme outlier), 99285 ranks #8 of 521 (99th percentile; extreme outlier), and 99284 ranks #17 of 827 (98th percentile; extreme outlier). Those placements signal throughput and case-mix volumes for ED care that are far above typical in-state competitors.

Observation and infusion services amplify the acute-care/ED profile: G0378 (66.5K claims, $7.4M revenue, 6.4%) ranks #2 of 70 providers in-state (99th percentile; extreme outlier), and infusion-related codes such as 96361 (29.5K claims, $10.6M revenue, 9.2%) and 96365/96366 also appear high on the list. Together these codes suggest substantial use of observation-status care and IV therapy consistent with high emergency-department-to-observation throughput rather than purely outpatient clinic activity.

Rehabilitation and therapy are material non-ED service lines for Medicaid revenue: 97110 (105.5K claims, $7.8M revenue, 6.8%) ranks #6 of 746 providers in-state (99th percentile; extreme outlier), with additional therapy codes 97530 (38.7K claims, $2.9M, 2.5%) and 97140 (40K claims, $1.4M, 1.2%) also ranking well above peers. This mix indicates an integrated physical/occupational therapy volume that is unusually large for in-state peers and contributes meaningfully to total Medicaid revenue.

High-volume laboratory and imaging throughput supports the acute-care footprint: 87637 (19.4K claims, $2.6M, 2.3%) ranks #3 of 104 providers in-state (98th percentile; notably above typical state volume), 70450 (27.2K claims, $3.1M, 2.7%) ranks #9 of 226 (96th percentile; notably above typical state volume), and 74177 (21.3K claims, $3.1M, 2.7%) ranks #15 of 224 (94th percentile; notably above typical). The facility also reports very large hematology panel volume via 85025 (288K claims, $1.4M, 1.2%) at the 99th percentile, pointing to sizable lab throughput.

Surgical and procedural volumes are nontrivial and sometimes extreme compared with peers: debridement 11042 (12.7K claims, $2.5M, 2.1%) ranks #3 of 98 providers in-state (98th percentile; extreme outlier), and endoscopy/biopsy 43239 (2.7K claims, $1.5M, 1.3%) sits at the 82nd percentile. These placements indicate accessible procedural capacity (wound care, endoscopy) that complements the hospital’s emergency and observation services.

The provider has a long-established NPI (enumerated 2006-07-13, ~20 years ago), which supports interpretation of high volumes as the result of an entrenched service footprint and developed referral/throughput patterns in its market rather than a short-term surge or new entrant effect. Analysts should consider regional referral networks and capacity factors when modeling utilization and competitive positioning.

Medicaid: Complete Services Breakdown

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

545 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	99,800	$170	$17.1M
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.	92,730	$160	$14.4M
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.	79,110	$150	$12.1M
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.	29,520	$360	$10.6M
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…	105,520	$70	$7.8M
G0378	Hospital observation service, per hour	66,530	$110	$7.4M
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…	33,550	$140	$4.7M
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.	27,240	$110	$3.1M
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.	21,330	$140	$3.1M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	38,730	$70	$2.9M

Showing 1–10 of 545

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Southcoast Hospitals Group, Inc — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

545 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	12	10	210	$5,200	$5.5M
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.	10	90	7,560	$350	$4.2M
S9485	Crisis intervention mental health services, per diem	28	110	1,250	$540	$3.2M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	9	50	1,870	$210	$1.4M
G0378	Hospital observation service, per hour	2	70	7,250	$100	$1.3M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	6	80	4,380	$140	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	32	110	5,660	$30	$1.1M
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.	8	520	120	$130	$1M
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…	14	130	1,830	$60	$974.3K
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	2	60	1,750	$260	$907.4K

Showing 1–10 of 545

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southcoast Hospitals Group, Inc	MA	General Acute Care Hospital	$0	$97.6M
Southcoast Hospitals Group, Inc	MA	General Acute Care Hospital	$0	$26.2M
Daniel Martin	MA	Pulmonary Disease Physician	$316.7K	$0
Ossama Labib	MA	Internal Medicine Physician	$294.6K	$0
Mark Durfee	MA	Emergency Medicine Physician	$160.3K	$131.7K
Mushtaque Chachar	MA	Neurology Physician	$234.6K	$0
Irina Merport	MA	Internal Medicine Physician	$234.4K	$0
Gregory Russell	MA	Cardiovascular Disease Physician	$227.7K	$0
John Carroll	MA	Urology Physician	$220.4K	$0
Maria Rumsey	MA	Cardiovascular Disease Physician	$217.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Commonwealth Of Massachusetts	MA	Case Management Agency	$0	$226M
Child & Family Services, Inc.	MA	Mental Health Counselor	$0	$169.5M
High Point Treatment Center Inc.	MA	Counselor	$516K	$98.4M
Greater New Bedford Community Health Center, Inc.	MA	Community Health Clinic/Center	$0	$42.5M
Boston Neurobehavioral Associates, LLC	MA	Psychiatry Physician	$0	$17.1M
City Of New Bedford	MA	Land Ambulance	$1.7M	$11.7M
Shokoohi & Vakili LLC	MA	Pediatric Dentistry	$0	$12M
Anchor Medical Group And Wellness Center PC	MA	Addiction Medicine (Internal Medicine) Physician	$0	$10.6M
Commonwealth Of Massachusetts-dmh	MA	Case Management Agency	$0	$9.4M
Kennedy Donovan Center, Inc	MA	Developmentally Disabled Services Day Training Agency	$0	$7.6M

Southcoast Hospitals Group, 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