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

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

Northeastern Vermont Regional Hospital, Inc (NPI 1487732301)

Key Findings

Field	Value
Entity Type	Organization
Organization	Northeastern Vermont Regional Hospital, Inc
Address	97 Sherman Drive
City	St Johnsbury
State	VT
ZIP	05819
Taxonomy	Primary Care Clinic/Center
NPI Enumerated	November 1, 2006

Payer Source	Total Paid
Medicaid	$2.8M
Medicare	$0

This provider has no Medicare billing on file (none) and reports $2.8M in lifetime Medicaid revenue, making it effectively a Medicaid-focused billing entity in the accessible claims data. The absence of Medicare activity means payer-mix analysis should treat this organization as single-payer (Medicaid) for observed professional/outpatient billing patterns rather than a mixed Medicare/Medicaid provider.

Revenue concentration is extremely high: the precomputed top three Medicaid codes account for 98.4% of the provider's total Medicaid revenue, and a single code, T1015, accounts for $2.7M (96.7% of Medicaid revenue). This indicates the hospital’s reported Medicaid income is overwhelmingly driven by the all-inclusive clinic visit/encounter line item rather than a broad spread of higher-value individual CPT services.

T1015 dominates operational profile and suggests the facility bills primarily as a clinic/encounter-based outpatient site: 63.5K claims at $42 avg paid/claim generating $2.7M in revenue and ranking #8 of 70 in-state (90th percentile; typical, unremarkable volume for this code). That code mix is consistent with a practice model centered on bundled clinic visits or clinic-site encounter billing rather than fee-for-service procedural volumes.

Although 99213 contributes only $24.8K (0.9% of Medicaid revenue), its raw claim volume is notable at 24.8K claims and it ranks #13 of 319 providers in-state (96th percentile; notably above typical state volume). This suggests the provider records a high number of low-paid established outpatient evaluation-and-management visits relative to most peers in Vermont, even if those visits are not the primary revenue driver.

Beyond the dominant visit codes, the provider shows above-typical state volumes for several preventive and pediatric well-visit codes: 99393 is $3.9K and ranks #2 of 43 (98th percentile; notably above typical), and 99394 is $1.8K and ranks #2 of 34 (97th percentile; notably above typical). These rankings indicate a comparatively strong presence in child/adolescent preventive care encounters, even though those services contribute only a small share of overall Medicaid revenue.

Behavioral and developmental screening activity is visible but revenue-light: codes such as 96110 ($9.1K), 96161 ($5.1K), and 96127 ($2.2K) appear with hundreds to low thousands of claims, showing the provider conducts standardized developmental and caregiver risk screenings. The presence of psychotherapy codes (90832/90837/90834) alongside these screening codes suggests integrated behavioral health or co-located mental health services at the clinic level, albeit not a major source of Medicaid revenue.

There is substantial recorded immunization activity with minimal or zero recorded Medicaid payments: 90471 shows 10.4K claims at $0 revenue and ranks #3 of 88 (98th percentile; notably above typical), and 90472 shows 4.1K claims at $0 revenue and ranks #4 of 30 (90th percentile; notably above typical). This pattern indicates high immunization throughput in the claims dataset but little to no paid Medicaid reimbursement captured for those vaccination line items in this dataset.

The provider’s NPI was enumerated on 2006-11-01 (~20 years ago), indicating long-standing enrollment and a multi-year presence in the state’s provider network. That tenure, combined with top-state rankings on several child/preventive and encounter codes, positions the organization as an established regional clinic-level provider with concentrated Medicaid-driven revenue rather than a diversified procedural or Medicare-serving institution.

Medicaid: Complete Services Breakdown

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

42 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	63,460	$40	$2.7M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	24,790	$1	$24.8K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	690	$30	$20.8K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	1,290	$10	$9.1K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	5,560	$1	$5.6K
96161	The provider administers a questionnaire aimed at helping to identify a specific health risk to a patient's caregiver, analyzes the results, assigns a score, and documents the findings. Use this code…	1,710	$1	$5.1K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	810	$10	$4.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,860	$1	$3.9K
90832	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…	1,090	$1	$3.3K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3,010	$1	$3K

Showing 1–10 of 42

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Northeastern Vermont Regional Hospital, Inc — 3 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

42 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	8	70	11,650	$150	$3.3M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	50	320	680	$30	$146.1K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	395	670	760	$70	$143.9K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	13	320	760	$20	$88.2K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	48	110	170	$70	$38.6K
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…	134	170	360	$20	$35.9K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	5	40	170	$40	$31.6K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	26	40	130	$40	$25.3K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	5	40	280	$20	$19.5K
90832	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…	30	110	260	$20	$19.5K

Showing 1–10 of 42

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
University Of Vermont Medical Center Inc	VT	Internal Medicine Physician	$0	$17.6M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$3.4M
James Stafford	TX	Radiation Oncology Physician	$1.5M	$0
Northeastern Vermont Regional Hospital, Inc	VT	Rural Health Clinic/Center	$0	$1.3M
Northeastern Vermont Regional Hospital Inc.	VT	Primary Care Clinic/Center	$0	$821.4K
University Of Vermont Medical Center Inc	VT	General Acute Care Hospital	$0	$780.5K
Paul Unger	VT	Hematology & Oncology Physician	$744.6K	$0
Northeastern Vermont Regional Hospital Inc	VT	Rural Health Clinic/Center	$0	$703.3K
University Of Vermont Health Network Specialty Care Transport, LLC	VT	Land Ambulance	$144K	$510.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Darren Boles Dds PLLC	VT	Dental Clinic/Center	$0	$5.2M
Baart Behavioral Health Services, Inc.	VT	Substance Use Disorder Rehabilitation Clinic/Center	$559K	$3.5M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$2.5M
Caledonia-essex Area Ambulance Service, Inc.	VT	Land Ambulance	$406.4K	$1.6M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$1.8M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$1.3M
Jason Parks	VT	Radiation Oncology Physician	$1.2M	$0
Shippee Family Eye Care PC	VT	Optometrist	$0	$1M
St Johnsbury Psychology Associates, PLLC	VT	Clinical Psychologist	$0	$807.7K
Vermont Radiologists	VT	Diagnostic Radiology Physician	$0	$795.5K

Northeastern Vermont Regional Hospital, Inc — Billing Profile & Reimbursement Data

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Northeastern Vermont Regional Hospital, 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