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NPI 1548371362 · Morgantown, WV · Ambulance
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Monongalia Emergency Medical Services Inc is a ambulance provider located in Morgantown, West Virginia. This profile covers 6 Medicare and 10 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 | Monongalia Emergency Medical Services Inc |
| Address | 801 J D Anderson Dr |
| City | Morgantown |
| State | WV |
| ZIP | 26505 |
| Taxonomy | Ambulance |
| NPI Enumerated | August 31, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $11.3M |
| Medicare | $1.4M |
Business/service-line: Billing mix is characteristically ambulance-focused with heavy reliance on mileage and both basic life support (BLS) and advanced life support (ALS) emergency transports. Medicare top codes include A0425 (ground mileage), A0428 (BLS non-emergency), and A0429 (BLS emergency), while Medicaid top codes are dominated by A0429 (BLS emergency), A0427 (ALS 1 emergency), and A0425 (ground mileage); this pattern indicates core operations are emergency and transport-oriented rather than inpatient or clinic services. The prominence of mileage (A0425) alongside both BLS and ALS emergency codes suggests extensive field operations and long transport distances or broad geographic coverage in routine practice.
Revenue concentration — Medicare: The provider’s top three Medicare codes account for 78.5% of its total Medicare revenue, with A0425 contributing $431.1K (30.6% of Medicare revenue), A0428 contributing $343.3K (24.4%), and A0429 contributing $330.8K (23.5%). This concentration implies that a small set of transport-related services drive the majority of Medicare income, making overall Medicare revenue sensitive to changes in reimbursement or utilization for these specific ambulance codes.
Revenue concentration — Medicaid: The top three Medicaid codes account for 89.0% of total Medicaid revenue, with A0429 at $4.1M (36.1%), A0427 at $3.1M (27.2%), and A0425 at $2.9M (25.8%). Medicaid revenue is therefore even more concentrated than Medicare on emergency transport and mileage services, indicating the organization’s Medicaid business is highly dependent on high-volume emergency and ALS-level transports.
Payer mix and scale: This provider reports $1.4M in total Medicare revenue versus $11.3M in total Medicaid revenue, indicating Medicaid dominates the payer mix by a large margin and is the primary source of billed revenue. Analysts should treat this entity as effectively Medicaid-driven for revenue exposure and policy risk, while Medicare represents a modest portion of overall billed dollars.
Competitive standing — Medicare: For Medicare A0425 the provider ranks #300 of 8934 (97th percentile) and is described as notably above typical national volume for this code, while A0429 and A0428 also appear in high national percentiles (#458/7808 at 94th and #404/2772 at 85th respectively) though labeled typical or unremarkable volume. These rankings indicate the provider is a comparatively large national reporter of ambulance mileage and a meaningful, above-average participant in ambulance emergency services at the national level.
Competitive standing — Medicaid (in-state): In Medicaid the provider ranks at the top of state activity for several key codes — A0429 is #5 of 113 (96th percentile, notably above typical state volume), A0427 is #5 of 96 (96th percentile), and A0425 is #7 of 137 (96th percentile, notably above typical state volume). These high in-state percentiles position the provider as a major statewide participant in emergency ambulance services and mileage, suggesting market influence within West Virginia’s Medicaid ambulance network.
Statistical outliers and notable signals: The data flags A0425 as notably above typical national volume for Medicare and A0429 as notably above typical state volume for Medicaid, signaling unusually high mileage billing nationally and unusually high emergency BLS emergency transport volume in-state. These labeled standings should trigger closer review of operational drivers (coverage area, call volume, dispatch policies) rather than assumptions about coding accuracy, since the pattern is consistent across both payers and aligns with an ambulance-dominant service mix.
Tenure and operational longevity: The NPI was enumerated on 2006-08-31 (~20 years ago), indicating a long-standing operation in the market. For analysts assessing network stability or contracting risk, the provider’s multi-decade enrollment supports continuity of service and an established presence in local emergency transport capacity.
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 | 61,580 | $10 | $431.1K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 1,810 | $190 | $343.3K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 1,100 | $300 | $330.8K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 750 | $360 | $268.2K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 100 | $230 | $22.8K |
| A0433 | Advanced life support, level 2 (als 2) | 20 | $520 | $10.9K |
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.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 17,960 | $230 | $4.1M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 10,880 | $280 | $3.1M |
| A0425 | Ground mileage, per statute mile | 40,400 | $70 | $2.9M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 10,530 | $100 | $1M |
| A0998 | Ambulance response and treatment, no transport | 2,530 | $40 | $111.3K |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation | 2,680 | $20 | $48.3K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 270 | $130 | $35.8K |
| A0398 | Als routine disposable supplies | 100 | $70 | $6.6K |
| A0392 | Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances) | 20 | $110 | $2.5K |
| 94760 | The provider takes a single measurement of the patient’s oxygen saturation using a sensor on the ear or finger. | 50 | $30 | $1.2K |
How this provider's Medicaid billing volume and revenue compare to other West Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. West Virginia median
10 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 7 | 140 | 2,710 | $100 | $955.9K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 16 | 70 | 3,360 | $110 | $830K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 5 | 100 | 840 | $260 | $730.3K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 5 | 110 | 950 | $220 | $703.7K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 18 | 30 | 530 | $190 | $203K |
| A0998 | Ambulance response and treatment, no transport | 2 | 20 | 230 | $50 | $35.1K |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation | 2 | 10 | 220 | $20 | $18.7K |
| 94760 | The provider takes a single measurement of the patient’s oxygen saturation using a sensor on the ear or finger. | 56 | 70 | 220 | $10 | $15.1K |
| A0398 | Als routine disposable supplies | 1 | 10 | 60 | $60 | $3.3K |
| A0392 | Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances) | 4 | 10 | 30 | $1 | $840 |
Other providers in the same ZIP code as Monongalia Emergency Medical Services Inc, ranked by combined Medicare and Medicaid revenue.
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