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NPI 1538281167 · Prairie Du Chien, WI · Ambulance
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Tri-state Regional Ambulance, Inc. is a ambulance provider located in Prairie Du Chien, Wisconsin. This profile covers 7 Medicare and 13 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 | Tri-state Regional Ambulance, Inc. |
| Address | 122 S Illinois St |
| City | Prairie Du Chien |
| State | WI |
| ZIP | 53821 |
| Taxonomy | Ambulance |
| NPI Enumerated | April 4, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $753.4K |
| Medicaid | $486.2K |
This provider bills meaningfully to both Medicare and Medicaid: total Medicare revenue is $753.4K while total Medicaid revenue is $486.2K, so Medicare is the larger single payer but Medicaid represents a substantial portion of scale and should be treated as a material payer when assessing revenue risk and contract coverage. The operation is not single-payer concentrated on a scale basis.
Revenue concentration is high within ambulance-specific codes: the top three Medicare codes account for 73.3% of Medicare revenue and the top three Medicaid codes account for 72.2% of Medicaid revenue, indicating that a small set of transport and mileage codes drive most of the financials and that changes to reimbursement or utilization for those codes would disproportionately affect total revenue. This concentration heightens sensitivity to policy or rate changes impacting those specific CPT/HCPCS lines.
The gross service mix is consistent with a full-service ambulance operator that performs long-distance mileage billing and both advanced and basic life support in emergency and non-emergency settings. On Medicare the mileage code A0425 is the single largest driver with 44.6K claims, $8 avg paid/claim, $356.6K revenue (46.8% of this provider's total Medicare revenue), and the provider also reports A0434 (152 claims, $678 avg, $103.1K) and A0427 (252 claims, $389 avg, $98K), which together show a mix of high-reimbursing specialty/ALS transports alongside heavy mileage capture.
National competitive standing on Medicare is mixed by code: the provider ranks #450 of 8934 for A0425 (95th percentile) yet the record labels this as "typical, unremarkable volume for this code," indicating that while A0425 accounts for a large share of the provider's Medicare revenue, its volume is not flagged as anomalous relative to national peers; A0434 is #116 of 591 (81th percentile) and A0427 is #2665 of 6841 (61th percentile), consistent with a regional operator that is notable on a few lines but not a dominant national player. This suggests localized strength in mileage and select specialty transports rather than nationwide scale.
Within the state Medicaid market the provider is a steady, mid-tier participant for headline ambulance services: A0427 generates $146.1K (30.0% of Medicaid revenue) and ranks #55 of 166 in-state (67th percentile), while A0429 generates $112.7K (23.1%) and ranks #48 of 153 (69th percentile), and A0390 contributes $93.1K (19.1%) at #60 of 135 (56th percentile). Those mid-to-upper percentiles indicate typical, unremarkable in-state volumes for core ALS/BLS emergency transports rather than market dominance.
Medicaid billing shows significant reliance on mileage and ALS-specific mileage as revenue drivers alongside emergency transports: A0390 (ALS mileage) is 651 claims, $143 avg paid/claim, $93.1K revenue and A0425 (ground mileage) is 3.3K claims, $23 avg paid/claim, $76K revenue (15.6% of Medicaid revenue) and ranks #31 of 158 in-state (81th percentile). The presence of both ALS and mileage codes in the top contributors supports a business model that captures long or resource-intensive ambulance trips as a revenue strategy.
A few low-volume lines and reporting quirks are visible and merit scrutiny for operational interpretation rather than clinical concern: S0209 (wheelchair van mileage) contributes $17.1K to Medicaid revenue but ranks only #9 of 11 in-state (20th percentile), indicating limited NEMT/wheelchair van activity, and 93042 appears with 13 claims but $0 revenue and ranks #10 of 12 (9th percentile), which may reflect state-specific reimbursement rules or billing-only entries that do not produce payment. These items suggest niche services or administrative entries that are small relative to core ambulance billing.
The provider has long tenure in federal enrollment, with an NPI enumerated on 2007-04-04 (~19 years ago), which supports interpretation of the billing patterns as the output of an established ambulance operation rather than a new entrant; longevity combined with concentrated code reliance points to an experienced regional operator whose financial performance will be sensitive to reimbursement shifts in the small set of dominant transport and mileage codes.
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 |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 44,580 | $10 | $356.6K |
| A0434 | Specialty care transport (sct) | 150 | $680 | $103.1K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 250 | $390 | $98K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 250 | $320 | $79.7K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 280 | $250 | $68.5K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 210 | $200 | $43.5K |
| A0433 | Advanced life support, level 2 (als 2) | 20 | $540 | $12K |
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.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 1,620 | $90 | $146.1K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 1,430 | $80 | $112.7K |
| A0390 | Als mileage (per mile) | 650 | $140 | $93.1K |
| A0425 | Ground mileage, per statute mile | 3,310 | $20 | $76K |
| S0209 | Wheelchair van, mileage, per mile | 290 | $60 | $17.1K |
| A0380 | Bls mileage (per mile) | 230 | $50 | $12.1K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 310 | $40 | $11.7K |
| A0434 | Specialty care transport (sct) | 30 | $280 | $8.3K |
| T2003 | Non-emergency transportation; encounter/trip | 410 | $20 | $6.9K |
| A0398 | Als routine disposable supplies | 220 | $10 | $1.6K |
Showing 1–10 of 13
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
13 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 48 | 150 | 450 | $150 | $480.6K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 55 | 170 | 690 | $150 | $372.4K |
| A0434 | Specialty care transport (sct) | 15 | 20 | 80 | $260 | $242.7K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 24 | 30 | 700 | $40 | $231.9K |
| S0209 | Wheelchair van, mileage, per mile | 9 | 10 | 2,500 | $50 | $154.9K |
| T2003 | Non-emergency transportation; encounter/trip | 214 | 260 | 4,280 | $10 | $153.2K |
| A0380 | Bls mileage (per mile) | 57 | 110 | 290 | $30 | $113.7K |
| A0390 | Als mileage (per mile) | 60 | 140 | 440 | $50 | $103.4K |
| A0398 | Als routine disposable supplies | 32 | 40 | 740 | $10 | $35.6K |
| A0394 | Als specialized service disposable supplies; iv drug therapy | 30 | 40 | 340 | $20 | $30.4K |
Showing 1–10 of 13
Other providers in the same ZIP code as Tri-state Regional Ambulance, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Prairie Du Chien Memorial Hospital Association Inc | WI | Critical Access Hospital | $0 | $6.9M |
| Alan Weber | WI | Chiropractor | $43.5K | $102.3K |
| Walgreen Co | WI | Pharmacy | $136.2K | $660 |
| Walter Boisvert | WI | Family Medicine Physician | $97.1K | $0 |
| Carrie Kramer | WI | Surgery Physician | $10K | $0 |
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