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

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

Queens North Hawaii Community Hospital (NPI 1477559029)

Key Findings

Field	Value
Entity Type	Organization
Organization	Queens North Hawaii Community Hospital
Address	67-1125 Mamalahoa Hwy
City	Kamuela
State	HI
ZIP	96743
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 27, 2005

Payer Source	Total Paid
Medicaid	$13M
Medicare	$0

QUEENS NORTH HAWAII COMMUNITY HOSPITAL is a General Acute Care Hospital in KAMUELA, HI with an NPI enumerated 2005-06-27 (~21 years ago), indicating long-standing credentialing in the national registry. Its billing footprint in the available data is concentrated in state Medicaid files rather than Medicare, which shapes competitive and payer-risk considerations below.

This provider has no Medicare billing on file while reporting Total Medicaid revenue of $13M, so its reported revenue mix is effectively single-payer Medicaid in the available datasets. That absence of Medicare activity means operational and reimbursement exposure is concentrated on Medicaid policy and rates rather than split across payers.

Revenue is highly concentrated: the precomputed top three Medicaid codes (99283, 99284, 99285) together account for 69.4% of this provider’s Medicaid revenue. Individually these codes are 99283 $4.5M (35.0%), 99284 $2.8M (22.0%), and 99285 $1.6M (12.4%), showing the bulk of dollars come from mid- and high-complexity emergency department E/M visits.

The code mix indicates an emergency-department–centric operation with supporting imaging and ancillary services. High claim counts and revenue for 99283 (10.4K claims, $434 avg paid/claim, $4.5M revenue) and 99284 (6.7K claims, $424 avg paid/claim, $2.8M revenue), plus notable CT of the abdomen/pelvis 74177 (1.4K claims, $661 avg paid/claim, $939.3K revenue), reflect routine ED evaluation with on-site advanced imaging and observable downstream diagnostic capacity.

State-level competitive standing on the principal ED codes is modest rather than dominant: 99283 ranks #20 of 45 providers in-state (57th percentile; typical, unremarkable volume for this code), 99284 ranks #21 of 47 (57th percentile; typical, unremarkable volume for this code), and 99285 ranks #24 of 39 (39th percentile; typical, unremarkable volume for this code). These ranks indicate typical peer-level ED activity rather than outlier market share in Hawaii Medicaid.

Ancillary service lines are present but revenue-dilutive relative to the ED: physical therapy code 97110 shows 6.9K claims and $308.6K revenue (2.4% of Medicaid revenue) and ranks #16 of 110 providers in-state (86th percentile; typical, unremarkable volume), while 97140 (5.2K claims, $161.2K revenue, 1.3% of Medicaid revenue) ranks #14 of 88 (85th percentile; typical, unremarkable volume). These entries indicate meaningful utilization in rehab services versus peers even though they are small shares of total Medicaid revenue.

Clinical breadth is evident across imaging and women’s/obstetric services consistent with a general acute hospital: CT head 70450 (1.3K claims, $156K revenue), echocardiography 93306 (1K claims, $207.6K revenue, 1.6% of Medicaid revenue, ranks #23 of 59 (62th percentile; typical, unremarkable volume for this code)), and obstetric ultrasound codes 76811/76816 appear in the top 25, supporting inpatient and outpatient diagnostic capacity beyond emergency care.

The provider’s concentration of Medicaid revenue in ED E/M codes creates operational sensitivity: since 99283/99284/99285 account for 69.4% of Medicaid revenue and there is no Medicare offset, changes in ED visit volume, case mix, or Medicaid reimbursement policy would disproportionately affect total reported revenue. Analysts should treat this as a single-payer Medicaid exposure when modeling financial or utilization scenarios for the hospital.

Medicaid: Complete Services Breakdown

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

135 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.	10,370	$430	$4.5M
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.	6,660	$420	$2.8M
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.	2,960	$540	$1.6M
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.	4,140	$340	$1.4M
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.	1,420	$660	$939.3K
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…	6,860	$50	$308.6K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	1,040	$200	$207.6K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	350	$570	$198K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	5,200	$30	$161.2K
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.	1,270	$120	$156K

Showing 1–10 of 135

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Queens North Hawaii Community Hospital — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

135 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	20	50	8,590	$340	$5.2M
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.	21	50	3,740	$290	$3.8M
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.	24	40	3,820	$330	$3.3M
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.	11	30	2,660	$330	$1.5M
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.	17	40	1,050	$510	$1.3M
99281	The provider sees a patient for the lowest level emergency department visit.	14	20	950	$220	$651.2K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	18	30	770	$430	$536.6K
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.	21	30	2,500	$40	$455.4K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	18	30	1,750	$70	$378K
84443	The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the…	20	20	1,050	$30	$375.8K

Showing 1–10 of 135

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Patrick Gonzales	CA	Vascular & Interventional Radiology Physician	$2.7M	$0
Vivek Kesari	MD	Nuclear Medicine Physician	$1.4M	$0
Patrick Ryan	CA	Diagnostic Radiology Physician	$722.4K	$0
Queen's North Hawaii Community Hospital	HI	General Practice Physician	$0	$642K
Edwin Herd	HI	Pediatrics Physician	$0	$640.5K
Queen's North Hawaii Community Hospital	HI	Obstetrics & Gynecology Physician	$0	$622.5K
Sunil Gandhi	CA	Diagnostic Radiology Physician	$551.9K	$0
Faisal Shah	NY	Diagnostic Radiology Physician	$245.2K	$259.8K
Nicholas Vu	CT	Diagnostic Radiology Physician	$472.5K	$1.7K
Joshua Rabang	CA	Diagnostic Radiology Physician	$307.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hawaii Life Flight, LLC	HI	Air Ambulance	$379.2K	$2M
Five Mountains Hawaii, Inc	HI	Rural Health Clinic/Center	$0	$1.6M
Liberty Dialysis-north Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.6M
Paniolo Pediatric And Family Medicine Inc	HI	Pediatrics Physician	$0	$1.4M
Vein Clinics Of Hawaii LLC	HI	Vascular Surgery Physician	$0	$673.3K
John Mascaro	HI	Marriage & Family Therapist	$0	$523.3K
Steven Chelminiak	HI	Clinical Social Worker	$0	$498.8K
Duerler, Inc.	HI	Family Medicine Physician	$0	$479.7K
Queens North Hawaii Community Hospital	HI	Orthopaedic Surgery Physician	$0	$230.7K
Keiki Therapy LLC	HI	Occupational Therapist	$0	$230.2K

Queens North Hawaii Community Hospital — Billing Profile & Reimbursement Data

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Queens North Hawaii Community Hospital — 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