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

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

Prospect Ccmc, LLC (NPI 1457715146)

Field	Value
Entity Type	Organization
Organization	Prospect Ccmc, LLC
Address	1 Medical Center Blvd
City	Chester
State	PA
ZIP	19013
Taxonomy	General Acute Care Hospital
NPI Enumerated	April 8, 2016

Payer Source	Total Paid
Medicaid	$40.9M
Medicare	$0

Key Findings

PROSPECT CCMC, LLC shows an essentially single-payer Medicaid billing profile: Total Medicare revenue is listed as none (no Medicare billing on file) while total Medicaid revenue is $40.9M, indicating the provider’s billing footprint is driven almost entirely by Medicaid payers. This makes the provider's financial and utilization analysis best interpreted through its Medicaid activity rather than any Medicare comparison.

Revenue concentration is high: the precomputed top three Medicaid codes by revenue (99283, 99284, and G0378) account for 63.6% of this provider's total Medicaid revenue. Individually those codes generate $9.9M (26.0%), $7.2M (19.0%), and $7.1M (18.6%) respectively, so a small set of ED/observation codes dominate the topline Medicaid receipts.

Service-line implication from the top codes: the revenue mix is characteristic of a high-volume emergency and short-term observation hospital operation — 99283 and 99284 are emergency department E/M codes for low-to-moderate decision-making and G0378 is hospital observation service per hour. The prominence of these codes suggests the facility’s core operation for Medicaid patients is acute emergency care plus observation stays rather than long inpatient or specialty clinic volumes.

Competitive standing on emergency codes is strong in-state: 99283 ranks #18 of 1063 providers in-state (98th percentile; extreme outlier) and 99284 ranks #48 of 1604 (97th percentile; notably above typical state volume), indicating PROSPECT CCMC is a top-volume provider for these ED levels among Pennsylvania peers. By contrast G0378 ranks #22 of 149 providers in-state (86th percentile; typical, unremarkable volume), so while observation contributes materially to revenue, its observation volume is not as exceptional relative to a smaller peer set.

High-acuity ED activity is also notable: 99285 (high-level ED E/M) generated $6.9M (18.2% of Medicaid revenue) and ranks #23 of 1228 providers in-state (98th percentile; extreme outlier). The combination of strong ranks for both moderate and high ED E/M codes signals consistently elevated ED case volumes and acuity among Medicaid patients compared with statewide peers.

Ancillary and transport services appear present but not dominant: ambulance transports A0429 and A0427 together contribute modest revenue ($756.1K and $602.7K respectively) and are in mid-to-upper percentiles (82nd and 69th) that the data labels as typical or unremarkable for the state. A broader set of imaging, therapy, and outpatient codes appear in the top-25 Medicaid list at lower revenue slices, suggesting additional service lines exist but they do not drive the provider’s Medicaid topline.

Operational tenure is established but not long-standing: the provider’s NPI was enumerated on 2016-04-08 (~10 years ago), which provides a roughly decade-long administrative presence in payer files. That tenure combined with the high ED volumes implies a sustained role in serving Medicaid emergency/observation needs in its regional market.

From a payer or network planning perspective, the provider should be treated as a Medicaid-centric, high-volume emergency and observation hospital with concentrated revenue risk in a small set of ED/observation codes (top three = 63.6%). Any contract, utilization review, or network-capacity analysis should prioritize emergency department throughput, observation bed management, and Medicaid reimbursement dynamics given the absence of Medicare billing on file.

Medicaid: Complete Services Breakdown

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

246 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.	32,840	$300	$9.9M
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.	25,180	$290	$7.2M
G0378	Hospital observation service, per hour	3,160	$2,230	$7.1M
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.	26,200	$260	$6.9M
99281	The provider sees a patient for the lowest level emergency department visit.	6,170	$280	$1.7M
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	2,150	$350	$756.1K
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	1,500	$400	$602.7K
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.	2,060	$280	$578.9K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	3,110	$130	$388.6K
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.	5,570	$50	$295K

Showing 1–10 of 246

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Prospect Ccmc, LLC — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

246 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	22	150	510	$870	$1.4M
T1015	Clinic visit/encounter, all-inclusive	812	1,690	760	$170	$1.2M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	289	690	2,240	$80	$1M
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	126	130	310	$60	$769.3K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	74	210	730	$40	$689.7K
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	88	290	710	$300	$631.5K
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	70	390	510	$250	$557.8K
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…	47	70	620	$60	$464.8K
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.	48	1,600	270	$120	$409.7K
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.	18	1,060	150	$130	$405.4K

Showing 1–10 of 246

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prospect Ccmc, LLC	PA	Clinic/Center	$0	$5.5M

Nearby Providers

Other providers in the same ZIP code as Prospect Ccmc, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Uhs Recovery Foundation Inc	PA	Community/Behavioral Health Agency	$0	$51.6M
Chespenn Health Services	PA	Federally Qualified Health Center (FQHC)	$0	$9.8M
Community Surgical Supply Of Toms River LLC	PA	Durable Medical Equipment & Medical Supplies	$0	$7.1M
Mylene Go	PA	Hematology & Oncology Physician	$792.9K	$0
Sherry Jose	PA	Pain Medicine (Anesthesiology) Physician	$304.3K	$45.3K
Heather Hahn	PA	Diagnostic Radiology Physician	$320.4K	$0
John Witherell	PA	Ophthalmology Physician	$309K	$0
Kenneth Lander	PA	Pulmonary Disease Physician	$295.4K	$4.4K
John Feehery	PA	Otolaryngology Physician	$276.7K	$0
Raymond Wolfe	PA	Orthopaedic Surgery Physician	$254.6K	$0

Prospect Ccmc, LLC — Billing Profile & Reimbursement Data

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Prospect Ccmc, LLC — 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