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

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

Grossmont Hospital Corporation (NPI 1528041811)

Field	Value
Entity Type	Organization
Organization	Grossmont Hospital Corporation
Address	5555 Grossmont Center Dr
City	La Mesa
State	CA
ZIP	91942
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 21, 2005

Payer Source	Total Paid
Medicaid	$226.7M
Medicare	$0

Key Findings

GROSSMONT HOSPITAL CORPORATION reports no Medicare billing on file and $226.7M in lifetime Medicaid revenue, making its reported activity effectively single‑payer Medicaid at scale. Analysts should treat comparisons against Medicare peers as not applicable for this entity because there is no Medicare footprint to benchmark here.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 48.3% of the provider's total Medicaid revenue, driven by 99283 ($34.2M, 20.6%), 0450 ($31.9M, 19.3%), and 99499 ($13.9M, 8.4%). This concentration indicates a small set of services is responsible for nearly half of Medicaid income and should be the focus of utilization and contract reviews.

The code mix and descriptions point to a heavy emergency-department and acute diagnostic orientation: 99283 is an ED E/M code for low-level medical decision making and appears as the single largest revenue driver, while related ED codes 99284 and 99285 also appear in the top list. High volumes of rapid diagnostic and monitoring services—such as 93005 (ECG), 80053 (CMP), and 85025 (CBC)—support the interpretation that the hospital operates with substantial ED throughput and front-line acute care activity.

Diagnostic imaging and advanced imaging capacity are significant revenue contributors: 74177 (CT abdomen/pelvis with contrast) generated $12.4M (7.5%), 70450 (CT head without contrast) generated $5.7M (3.4%), and 71275 (CTA chest) generated $1.6M (1.0%). Coupled with PET/CT 78815 ($2.3M, 1.4%), these lines suggest robust on-site radiology and cross-sectional imaging services that support inpatient and ED case management.

Several codes show the provider is a statewide high-volume reporter for specific services: 99283 ranks #34 of 1570 providers in-state (98th percentile; extreme outlier) and 99499 ranks #3 of 307 (99th percentile; extreme outlier), indicating unusually large Medicaid volumes for those service categories relative to peers. Other codes that are described as extreme outliers or notably above typical—such as 0762 (rank #2 of 159, 99th percentile; extreme outlier) and 93005 (rank #7 of 760, 99th percentile; extreme outlier)—underscore that GROSSMONT is a dominant provider for particular procedural lines in California Medicaid.

The provider makes notable use of unspecified or catch‑all E/M and other service codes: 99499 ($13.9M, 8.4%) is the third-largest revenue source and 99199 ($7.7M, 4.6%) also appears in the top list, with 99499 ranked as an extreme outlier. This pattern of high revenue from unlisted or miscellaneous codes can reflect a mix of complex, heterogeneous encounters or services that do not map neatly to standard CPT descriptors and should be examined in utilization and coding analyses.

Infusional and procedure administration activity is material but not dominant: 96374 (IV push single medication) appears with $2.6M (1.6%) and 96375 (sequential IV push) with $2.3M (1.4%), both ranking notably above typical state volume for their categories. When combined with high imaging and laboratory throughput, these figures are consistent with an acute hospital that delivers both diagnostic workups and parenteral treatments in the ED/inpatient setting.

The provider has been NPI‑enumerated since 2005-11-21 (~21 years ago), indicating a longstanding presence in the market. Combined with $226.7M in lifetime Medicaid revenue and the concentrated, high-volume code mix, this tenure and scale suggest an established acute-care facility with entrenched Medicaid service patterns that will shape payer contracting and network deliberations.

Medicaid: Complete Services Breakdown

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

449 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.	77,720	$440	$34.2M
0450	N/A	110,850	$290	$31.9M
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	53,160	$260	$13.9M
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.	18,420	$670	$12.4M
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	11,450	$670	$7.7M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	171,210	$40	$6.8M
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.	22,910	$250	$5.7M
0762	N/A	11,660	$480	$5.6M
0360	N/A	5,990	$830	$5M
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…	74,850	$60	$4.3M

Showing 1–10 of 449

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

Grossmont Hospital Corporation — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

449 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
0450	N/A	48	450	16,140	$90	$3.6M
0121	N/A	17	70	130	$4,600	$2.6M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	14	20	880	$600	$2.4M
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	365	390	1,270	$220	$1.5M
0206	N/A	17	40	80	$2,760	$1.1M
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.	34	1,570	680	$110	$1.1M
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.	236	1,300	510	$100	$943K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	69	750	950	$50	$890K
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.	255	1,400	470	$80	$884.5K
99281	The provider sees a patient for the lowest level emergency department visit.	250	430	1,140	$90	$769.9K

Showing 1–10 of 449

Related Providers

Other providers that share a Tax Identification Number (TIN) with Grossmont Hospital Corporation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brian Miller	CA	Psychiatry Physician	$54.6K	$0

Nearby Providers

Other providers in the same ZIP code as Grossmont Hospital Corporation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hassan Kafri Md, Inc.	CA	Interventional Cardiology Physician	$0	$22.8M
Grossmont Surgery Center LP	CA	Ambulatory Surgical Clinic/Center	$1.2M	$6M
Paul Dato	CA	Urology Physician	$2M	$0
Kai Zu	CA	Hematology & Oncology Physician	$1.7M	$2K
Igor Medic	CA	Hematology & Oncology Physician	$1.3M	$0
Reema Batra	CA	Hematology & Oncology Physician	$1.2M	$1.5K
Nassir Azimi	CA	Cardiovascular Disease Physician	$1.1M	$0
Hassan Kafri	CA	Cardiovascular Disease Physician	$945.1K	$6.5K
Arudi Prabhakar	CA	Specialist	$845.6K	$0
Scott Brown	CA	Urology Physician	$577.1K	$0

Grossmont Hospital Corporation — Billing Profile & Reimbursement Data

Sign up for Grossmont Hospital Corporation — Billing Profile & Reimbursement Data policy alerts

Grossmont Hospital Corporation — Billing Profile & Reimbursement Data

Sign up for Grossmont Hospital Corporation — Billing Profile & Reimbursement Data policy alerts

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