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NPI 1487657789 · Sheboygan, WI · Ambulance
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Orange Cross Ambulance Inc is a ambulance provider located in Sheboygan, Wisconsin. This profile covers 7 Medicare and 9 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 | Orange Cross Ambulance Inc |
| Address | 1919 Ashland Avenue |
| City | Sheboygan |
| State | WI |
| ZIP | 53081 |
| Taxonomy | Ambulance |
| NPI Enumerated | May 31, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.2M |
| Medicare | $753.5K |
Business/service-line profile: ORANGE CROSS AMBULANCE INC is an ambulance operator (taxonomy: Ambulance) whose billing mix is dominated by emergency and basic/advanced life support transports and mileage charges. Top-line CPT/HCPCS on both payers are emergency ALS and BLS transport codes (A0427, A0429) plus ground mileage (A0425), and lower but present volumes appear for specialty care transport (A0434) and non-emergency BLS (A0428), consistent with an operation that provides both emergency response and routine patient transport services.
Medicare revenue concentration: Medicare revenue totals $753.5K and the provider’s top three Medicare codes account for 80.5% of that Medicare revenue. The largest Medicare contributors are A0427 ($256.6K, 34.7% of Medicare revenue), A0425 ($201.5K, 27.2% of Medicare revenue), and A0429 ($138.2K, 18.7% of Medicare revenue), indicating very high dependence on a small set of transport/mileage codes for Medicare receipts.
Medicaid revenue concentration: Medicaid revenue totals $1.2M with the top three Medicaid codes accounting for 73.9% of Medicaid revenue. Medicaid receipts are concentrated in A0427 ($445.6K, 37.0% of Medicaid revenue), A0429 ($313.8K, 26.0% of Medicaid revenue), and A0425 ($131.5K, 10.9% of Medicaid revenue), showing a similar payer-specific reliance on emergency BLS/ALS transports and mileage for Medicaid as for Medicare.
Payer mix and scale: This provider reports larger lifetime Medicaid revenue ($1.2M) than Medicare revenue ($753.5K), indicating that Medicaid is the larger single payer by dollars in its historical billing profile rather than the operation being effectively single-payer. Both payers show the same service lines driving revenue, but the absolute scale of Medicaid receipts is materially higher than Medicare in the available lifetime data.
Competitive standing — Medicare (national): For its highest Medicare codes the provider generally sits in mid-to-high national percentiles but is characterized in the source data as "typical, unremarkable volume" for those codes. Examples include A0427 (ranks #1135 of 6841 nationally, 83th percentile), A0425 (ranks #728 of 8934 nationally, 92th percentile), and A0429 (ranks #1285 of 7808 nationally, 84th percentile), which together suggest the provider is a modest national participant for ambulance services rather than a dominant national operator.
Competitive standing — Medicaid (in-state): Within Wisconsin the provider shows relatively strong positioning on its top Medicaid codes versus state peers, with A0427 ranking #28 of 166 in-state (84th percentile), A0429 ranking #26 of 153 in-state (84th percentile), and A0425 ranking #14 of 158 in-state (92th percentile). These in-state percentiles point to a solid regional presence on the key ALS/BLS and mileage codes, making the provider a higher-volume peer within Wisconsin even though the source labels volumes as typical within those percentiles.
Operational signal — mileage-heavy activity: The claim-level counts for mileage are substantial on both payers (Medicare A0425: 28.8K claims; Medicaid A0425: 7.7K claims), and mileage revenue is a top-three revenue driver on both Medicare and Medicaid. That pattern indicates the business model relies heavily on per-mile billing as a consistent revenue stream alongside transport-level charges, which has operational implications for dispatch radius, trip frequency, and fuel/vehicle utilization.
Tenure and stability: The provider’s NPI has been enumerated since 2005-05-31 (~21 years ago), indicating a long-tenured ambulance operation. Combined with a concentrated code mix that repeatedly shows up across payers, the data support a picture of an established, stable EMS supplier with enduring reliance on emergency ALS/BLS transports and mileage billing.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 680 | $380 | $256.6K |
| A0425 | Ground mileage, per statute mile | 28,790 | $10 | $201.5K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 440 | $310 | $138.2K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 390 | $200 | $78.8K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 120 | $240 | $29.5K |
| A0433 | Advanced life support, level 2 (als 2) | 40 | $550 | $20.8K |
| A0434 | Specialty care transport (sct) | 20 | $660 | $15.2K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 7 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.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 3,780 | $120 | $445.6K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 3,370 | $90 | $313.8K |
| A0425 | Ground mileage, per statute mile | 7,740 | $20 | $131.5K |
| A0390 | Als mileage (per mile) | 680 | $140 | $96.7K |
| A0998 | Ambulance response and treatment, no transport | 1,350 | $50 | $64.7K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 1,680 | $40 | $60.3K |
| A0380 | Bls mileage (per mile) | 520 | $90 | $47.7K |
| A0382 | Bls routine disposable supplies | 3,490 | $10 | $34.9K |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation | 990 | $10 | $9.9K |
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 26 | 150 | 450 | $150 | $480.6K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 28 | 170 | 690 | $150 | $372.4K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 10 | 30 | 700 | $40 | $231.9K |
| A0380 | Bls mileage (per mile) | 45 | 110 | 290 | $30 | $113.7K |
| A0390 | Als mileage (per mile) | 58 | 140 | 440 | $50 | $103.4K |
| A0998 | Ambulance response and treatment, no transport | 12 | 50 | 180 | $60 | $70.4K |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation | 9 | 30 | 490 | $10 | $27.5K |
| A0425 | Ground mileage, per statute mile | 14 | 160 | 770 | $10 | $20.6K |
| A0382 | Bls routine disposable supplies | 6 | 40 | 580 | $10 | $15.4K |
Other providers in the same ZIP code as Orange Cross Ambulance Inc, ranked by combined Medicare and Medicaid revenue.
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