Loading...
NPI 1528054681 · Winchester, VA · Land Ambulance
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Valley Regional Enterprises Inc is a land ambulance provider located in Winchester, Virginia. This profile covers 6 Medicare and 12 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 | Valley Regional Enterprises Inc |
| Address | 190 Prosperity Dr Ste 4 |
| City | Winchester |
| State | VA |
| ZIP | 22602 |
| Taxonomy | Land Ambulance |
| NPI Enumerated | September 23, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $7.5M |
| Medicare | $2.4M |
VALLEY REGIONAL ENTERPRISES INC is operating as a land ambulance provider with its NPI enumerated ~21 years ago, indicating long tenure in the market and an established operational history that supports both emergency and non-emergency transport services. The presence of high-volume mileage code billing (A0425) and multiple ALS/BLS transport codes (A0428, A0426, A0427, A0429) across payers is consistent with an ambulance-centric service line that handles both stretcher and specialty care transports.
Medicare revenue for this provider totals $2.4M while Medicaid revenue totals $7.5M, so Medicaid is the larger revenue source by scale; this is effectively a dual-payer operation with a Medicaid-dominant revenue profile rather than single-payer dependence. The Medicaid total of $7.5M is more than triple the Medicare total of $2.4M, demonstrating heavier reliance on state programs for volume and revenue.
Revenue concentration is high on both payers: the top 3 Medicare codes account for 87.6% of Medicare revenue, and the top 3 Medicaid codes account for 77.2% of Medicaid revenue. This concentration indicates the provider’s financial performance is heavily driven by a small set of transport and mileage codes—particularly ground mileage and BLS/ALS transport—so business risk or growth will be sensitive to reimbursement or demand changes for these specific services.
A0425 (ground mileage) is a dominant revenue driver for both payers: it generates $1.1M (45.3% of Medicare revenue) and $3.5M (47.0% of Medicaid revenue). On Medicare A0425 ranks #82 of 8,934 providers nationally and is labeled an extreme outlier (99th percentile), indicating unusually high mileage billing compared with national peers; on Medicaid it ranks #18 in-state (94th percentile), which is high but described as typical for state-level volumes. This suggests the provider operates with unusually large mileage accumulation on Medicare claims relative to most national peers, while also being a major mileage biller within its state Medicaid market.
Competitively, the provider is a major state-level participant for several Medicaid codes: A0428 ranks #7 in-state (92nd percentile) and A0426 ranks #2 in-state (96th percentile), and A0434 ranks #1 in-state (100th percentile) for specialty care transport — the latter two rankings are described as notably above typical state volume, indicating strong local market share for ALS non-emergency and specialty care transports. For Medicare, the provider is an extreme outlier on A0425 and A0426 (both 99th percentile ranks), and ranks highly for A0428 as well (94th percentile), which together point to unusually large Medicare volumes in core ambulance services compared with national peers.
The code mix shows both emergency and non-emergency capabilities: Medicaid and Medicare top codes include A0428 (BLS non-emergency), A0426 (ALS non-emergency) and A0427/A0429 (ALS/BLS emergency), plus non-emergency stretcher and wheelchair van codes (T2005, A0130). This mix implies the provider operates a blended service model that handles scheduled/non-urgent transports, higher-acuity ALS transports, and specialty/stretcher transports rather than exclusively 911 emergency response.
Specific statistical outlier signals should be noted for oversight or contracting: on Medicare, A0425 and A0426 are flagged as "extreme outlier" volumes relative to national peers, while on Medicaid the provider is ranked at or near the top for several codes (A0426 at 96th percentile, A0434 at 100th percentile). Those labels indicate the provider’s reported volumes for those services materially exceed typical peer levels and merit closer benchmarking when assessing network adequacy, rate-setting, or utilization management.
Operationally, the heavy share of revenue from mileage and BLS/ALS transports implies cost structure and pricing sensitivity tied to trip length, crew skill mix, and frequency of non-emergency scheduled transports. Payers and analysts should expect that contracting decisions or reimbursement changes affecting mileage (A0425) or non-emergency transport reimbursement (A0428/A0426/T2005) will disproportionately affect the provider’s revenue given the precomputed top-3 concentrations.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 137,280 | $10 | $1.1M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 3,710 | $200 | $757.7K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 1,100 | $250 | $268.3K |
| A0434 | Specialty care transport (sct) | 270 | $650 | $174.2K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 290 | $360 | $105.6K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 70 | $320 | $22.1K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 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.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 30,400 | $120 | $3.5M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 18,710 | $90 | $1.6M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 3,540 | $170 | $616.5K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 3,860 | $150 | $570.8K |
| T2005 | Non-emergency transportation; stretcher van | 1,180 | $370 | $433K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 2,560 | $120 | $304.5K |
| A0434 | Specialty care transport (sct) | 780 | $260 | $206.2K |
| A0130 | Non-emergency transportation: wheelchair van | 3,740 | $50 | $187.1K |
| S0215 | Non-emergency transportation; mileage, per mile | 120 | $80 | $10K |
| T2049 | Non-emergency transportation; stretcher van, mileage; per mile | 1,180 | $1 | $2.4K |
Showing 1–10 of 12
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
12 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T2005 | Non-emergency transportation; stretcher van | 49 | 120 | 760 | $250 | $656.3K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 7 | 70 | 1,160 | $80 | $511.5K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 54 | 200 | 1,250 | $90 | $326K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 79 | 220 | 1,390 | $80 | $307.1K |
| A0130 | Non-emergency transportation: wheelchair van | 128 | 390 | 1,430 | $50 | $278.2K |
| A0425 | Ground mileage, per statute mile | 18 | 270 | 2,410 | $20 | $166.7K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 2 | 30 | 250 | $130 | $149.4K |
| S0215 | Non-emergency transportation; mileage, per mile | 479 | 560 | 890 | $30 | $113.2K |
| A0434 | Specialty care transport (sct) | 1 | 10 | 80 | $200 | $43.4K |
| T2049 | Non-emergency transportation; stretcher van, mileage; per mile | 49 | 120 | 760 | $1 | $12.3K |
Showing 1–10 of 12
Other providers in the same ZIP code as Valley Regional Enterprises Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Crossroads Treatment Center Of Winchester, PC | VA | Substance Use Disorder Rehabilitation Clinic/Center | $90.6K | $14.1M |
| Ars Of Virginia LLC | VA | Methadone Clinic | $79.7K | $7.2M |
| Frederick County Bd Of Supervisors | VA | Land Ambulance | $1.2M | $1.1M |
| James Sluss | VA | Diagnostic Radiology Physician | $364K | $90K |
| Jordan Tran | VA | Family Medicine Physician | $124.9K | $0 |
| Jamie Simmers | VA | Optometrist | $80.7K | $24.3K |
| Garrison Morin | VA | Otolaryngology Physician | $27.1K | $0 |
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.