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NPI 1457824989 · Danbury, CT · Ambulance
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Western Connecticut Health Network Affiliates, Inc is a ambulance provider located in Danbury, Connecticut. This profile covers 5 Medicare and 5 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Western Connecticut Health Network Affiliates, Inc |
| Address | 24 Hospital Ave |
| City | Danbury |
| State | CT |
| ZIP | 06810 |
| Taxonomy | Ambulance |
| NPI Enumerated | January 8, 2019 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.5M |
| Medicare | $1.3M |
Service mix is concentrated in ground non-emergency transport: the provider’s Medicare top codes are dominated by A0428 (Ambulance service, basic life support, non-emergency transport) with $908.8K revenue (71.3% of Medicare revenue) and A0425 (Ground mileage) with $306.6K (24.0%), while Medicaid shows A0428 at $1.1M (70.5%), S0215 (mileage) at $289.3K (18.7%) and A0425 at $151K (9.8%). These patterns indicate an operational focus on scheduled or non-emergent patient transport and mileage-based billing rather than high volumes of emergency ALS dispatches.
Revenue is highly concentrated in a small set of codes for both payers: the precomputed top-3 Medicare codes account for 98.0% of this provider’s total Medicare revenue, and the precomputed top-3 Medicaid codes account for 99.0% of its total Medicaid revenue. That level of concentration means financial performance is tightly linked to utilization and reimbursement of a very small group of ambulance and mileage codes.
The provider has a mixed payer footprint but is slightly Medicaid-tilted in scale: lifetime Medicare revenue is $1.3M versus lifetime Medicaid revenue of $1.5M, so both payers matter materially to operations rather than the entity being effectively single-payer. This balance suggests contract and authorization processes with Medicaid plans will be as important as Medicare billing workflows.
National competitive standing on Medicare for primary codes is relatively prominent by percentile but labeled as typical in the data: A0428 ranks #161 of 2772 providers nationally (94th percentile; typical, unremarkable volume) and A0425 ranks #461 of 8934 (95th percentile; typical, unremarkable volume). These positions imply the provider posts strong absolute volumes for those codes compared with many peers, while the underlying descriptor classifies the activity as within the typical range for ambulance providers.
State-level competitive position on Medicaid is mixed: A0428 ranks #8 of 17 in-state (56th percentile; typical, unremarkable volume), indicating a middle-tier footing for BLS non-emergency transports in Connecticut, while A0425 ranks #15 of 128 (89th percentile; typical, unremarkable volume), signaling comparatively strong mileage billing statewide. Conversely, S0215 ranks #11 of 16 (33th percentile; typical, unremarkable volume), so non-emergency mileage modifiers are not uniformly dominant across all in-state non-emergency transport codes.
Tenure is relatively short compared with long-established EMS providers: the NPI was enumerated on 2019-01-08 (~7 years ago), which suggests this organization has built its reported Medicare/Medicaid volume over a modest multi-year window rather than decades. Analysts should consider that growth trajectories and local contracting relationships may still be evolving given that timeline.
Emergency and advanced-life-support emergency activity is minimal relative to non-emergency work: Medicare emergency/ALS codes A0429 and A0427 together account for a small share of Medicare revenue (A0429 $19.2K, 1.5%; A0427 $5.9K, 0.5%) and rank low nationally (A0429 #5181 of 7808, 33th percentile; A0427 #6666 of 6841, 2th percentile). Medicaid mirrors this pattern with A0429 at $6.5K (0.4%) ranked #116 of 122 in-state (5th percentile), indicating limited reliance on emergency ALS transports in the business model.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 4,060 | $220 | $908.8K |
| A0425 | Ground mileage, per statute mile | 43,800 | $10 | $306.6K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 130 | $270 | $34.5K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 50 | $360 | $19.2K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 10 | $420 | $5.9K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 23,160 | $50 | $1.1M |
| S0215 | Non-emergency transportation; mileage, per mile | 4,520 | $60 | $289.3K |
| A0425 | Ground mileage, per statute mile | 18,880 | $10 | $151K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 70 | $130 | $9.1K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 70 | $100 | $6.5K |
How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Connecticut median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 8 | 20 | 17,430 | $80 | $2.7M |
| S0215 | Non-emergency transportation; mileage, per mile | 11 | 20 | 10,360 | $20 | $2.6M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 116 | 120 | 1,930 | $180 | $1.3M |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 12 | 10 | 360 | $120 | $206.1K |
| A0425 | Ground mileage, per statute mile | 15 | 130 | 2,510 | $10 | $141.8K |
Other providers in the same ZIP code as Western Connecticut Health Network Affiliates, Inc, ranked by combined Medicare and Medicaid revenue.
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