Loading...
NPI 1497864904 · Fairlee, VT · Land Ambulance
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Upper Valley Ambulance, Inc is a land ambulance provider located in Fairlee, Vermont. This profile covers 4 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 | Upper Valley Ambulance, Inc |
| Address | 5445 Lake Morey Road |
| City | Fairlee |
| State | VT |
| ZIP | 05045 |
| Taxonomy | Land Ambulance |
| NPI Enumerated | August 29, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $609.6K |
| Medicare | $231.2K |
Business mix is focused on emergency ground ambulance services: the top Medicare codes are A0427 (ALS 1 emergency), A0425 (ground mileage), and A0429 (BLS emergency) with A0427 generating $92.7K (40.1% of Medicare revenue), A0425 $91K (39.4%), and A0429 $37.4K (16.2%). The code mix — high shares for ALS emergency, mileage, and BLS emergency — is consistent with an operation that primarily provides ambulance transports rather than non-emergency or ancillary services.
Medicaid billing mirrors the Medicare service-line focus: the top Medicaid codes are the same three codes, with A0427 at $258.3K (42.4% of Medicaid revenue), A0425 $222.6K (36.5%), and A0429 $128.4K (21.1%). The identical top codes and their large shares indicate the provider runs a similar ALS/BLS emergency transport mix across both payers.
Revenue concentration is high within the top three codes for each payer: precomputed totals show the top 3 Medicare codes account for 95.6% of the provider's Medicare revenue and the top 3 Medicaid codes account for 99.9% of Medicaid revenue. This concentration implies that a very small set of transport services drive nearly all billed revenue for both Medicare ($231.2K total) and Medicaid ($609.6K total).
Payer mix is skewed toward Medicaid in scale: total Medicaid revenue ($609.6K) exceeds total Medicare revenue ($231.2K), so Medicaid is the larger revenue source for this provider. Given the larger Medicaid revenue base, analyst assessment of market exposure and reimbursement dependence should emphasize Medicaid payment patterns and in-state competitive dynamics.
Competitive standing on Medicare is modest-to-typical: A0427 ranks #2803 of 6841 nationally (59th percentile) and is labeled typical, A0425 ranks #2016 of 8934 (77th percentile) indicating above-median mileage billing among national peers, and A0429 ranks #3717 of 7808 (52th percentile) which is near median activity. Overall, the provider is not a dominant national player for these codes but shows relatively stronger positioning on mileage (A0425).
Competitive standing in-state for Medicaid is similarly modest: A0427 ranks #16 of 48 providers in-state (68th percentile), A0425 ranks #25 of 60 (59th percentile), and A0429 ranks #19 of 40 (54th percentile), all characterized as typical, unremarkable volume. These percentiles suggest the provider is a regular regional participant rather than a market leader within Vermont for ambulance services.
Operational detail: Medicare shows heavy mileage billing volume with 10.1K claims for A0425 at $9 avg paid/claim yielding $91K, while Medicaid reports 2.6K claims for A0425 at $86 avg paid/claim yielding $222.6K. The disparity in avg paid/claim for A0425 between Medicare ($9) and Medicaid ($86) is notable and could reflect payer rate differences or billing/reporting practices worth further review by analysts.
Administrative or low-pay items are present but immaterial: Medicaid records include 93005 with 13 claims at $0 avg paid/claim and $0 revenue, and A0394 with 14 claims producing $392 (0.1% of Medicaid revenue). These lines appear in filings but contribute negligible paid revenue and should be treated as marginal to the provider's financial profile.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 230 | $400 | $92.7K |
| A0425 | Ground mileage, per statute mile | 10,110 | $10 | $91K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 110 | $340 | $37.4K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 50 | $220 | $10.1K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 4 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 |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 1,030 | $250 | $258.3K |
| A0425 | Ground mileage, per statute mile | 2,590 | $90 | $222.6K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 600 | $220 | $128.4K |
| A0394 | Als specialized service disposable supplies; iv drug therapy | 10 | $30 | $390 |
| 93005 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 10 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Vermont providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Vermont median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 19 | 40 | 580 | $190 | $370.2K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 16 | 50 | 590 | $220 | $265.7K |
| A0425 | Ground mileage, per statute mile | 25 | 60 | 1,570 | $50 | $160.5K |
| A0394 | Als specialized service disposable supplies; iv drug therapy | 16 | 20 | 120 | $30 | $11.2K |
| 93005 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 16 | 20 | 260 | $10 | $5K |
Other providers in the same ZIP code as Upper Valley Ambulance, Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Wesley Wolter | VT | Addiction (Substance Use Disorder) Counselor | $0 | $65.5K |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.