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    OpenPayerNPI Medicare & MedicaidMethodist Healthcare - Memphis Hospitals
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    Methodist Healthcare - Memphis Hospitals — Billing Profile & Reimbursement Data

    NPI 1558365890 · Memphis, TN · General Acute Care Hospital

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    Methodist Healthcare - Memphis Hospitals is a general acute care hospital provider located in Memphis, Tennessee. This profile covers 0 Medicare and 358 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationMethodist Healthcare - Memphis Hospitals
    Address1265 Union Ave
    CityMemphis
    StateTN
    ZIP38104
    TaxonomyGeneral Acute Care Hospital
    NPI EnumeratedJune 1, 2005

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$105.6M
    Medicare$0

    Key Findings

    This provider is effectively a single-payer Medicaid operation: Medicare revenue is listed as none (no Medicare billing on file) while total Medicaid revenue is $105.6M, so all observed legacy billing and volumes are driven by Medicaid activity. Analysts should treat this profile as Medicaid-centric when benchmarking payer mix or projecting reimbursement exposure.

    Revenue is highly concentrated in emergency department E/M services: the top three Medicaid codes (99284, 99283, 99285) account for 85.0% of the provider's total Medicaid revenue, with 99284 representing $41.9M (42.4%), 99283 $22.9M (23.1%), and 99285 $19.4M (19.6%). This concentration indicates that a very large share of dollars flow through ED evaluation-and-management encounters rather than elective or outpatient procedural lines.

    The code mix and volumes point to an ED- and acute-care operating model: 99284 (153.6K claims), 99283 (143.8K claims), and 99285 (60.7K claims) are the dominant drivers by claim count and revenue, consistent with a high-throughput emergency department handling a broad spectrum of acuity. Supporting codes such as G0463 (243.9K claims, $3.9M) and G0378 (7.3K claims, $1.4M) further suggest substantial outpatient clinic and observation-unit activity tied to the ED.

    State-level competitive standing is dominant for core ED services: the provider ranks #3 of 611 in the state for 99283 at the 100th percentile (extreme outlier) and #9 of 625 for 99284 at the 99th percentile (extreme outlier), while 99285 ranks #13 of 565 at the 98th percentile (notably above typical state volume). These rank/percentile positions indicate the provider is a major statewide player for emergency care volumes and is far above typical peers on the most revenue-producing codes.

    High ancillary diagnostic throughput complements the ED volumes: massive claim counts appear for lab and diagnostic codes—85025 (324.5K claims, $973.4K), 80053 (265.1K claims, $795.3K), 93005 (83.8K claims, $335.3K), and 36415 (330.2K claims, $330.2K)—many of which are labeled as extreme outlier or at the 100th percentile in-state. This pattern signals sustained front-door diagnostic utilization (CBCs, CMPs, EKGs, blood draws) consistent with high ED patient throughput and rapid diagnostic workflows.

    Infectious disease and imaging utilization are also elevated: COVID testing codes such as 87635 (27.6K claims, $745.9K) and multiplex 87637 (4.4K claims, $358K) rank in high percentiles statewide, and imaging CT codes like 70450 (11.8K claims, $485.6K) and 74177 (7.6K claims, $396.8K) appear at typical-to-high volumes. These volumes reinforce the characterization of a busy acute care hub that manages both infectious workups and advanced imaging for symptomatic patients.

    Operational and reimbursement sensitivity is concentrated: because 85.0% of Medicaid revenue is tied to three ED E/M codes, changes in ED reimbursement policy, Medicaid patient volumes, or coding guidelines for E/M visits would disproportionately affect overall revenue. Analysts should prioritize monitoring state Medicaid ED payment rules and utilization trends when modeling future revenue for this provider.

    The provider is an established entity with a long tenure: the NPI was enumerated 2005-06-01 (~21 years ago), indicating an enduring presence in the Memphis market and supporting the interpretation that the observed high volumes reflect sustained market position rather than a short-term surge. That tenure, combined with the statewide rank outliers, supports classifying the facility as a longstanding, high-volume acute care hospital in Tennessee.

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    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

    Medicaid: Complete Services Breakdown

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

    358 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    99284The 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.153,650$270$41.9M
    99283The 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.143,820$160$22.9M
    99285The 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.60,710$320$19.4M
    G0463Hospital outpatient clinic visit for assessment and management of a patient243,910$20$3.9M
    G0378Hospital observation service, per hour7,340$190$1.4M
    99282The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.15,870$70$1.1M
    85025A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…324,450$1$973.4K
    96374The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.47,190$20$849.3K
    80053The 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.265,080$1$795.3K
    87635Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…27,630$30$745.9K

    Showing 1–10 of 358

    • More pages

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. Tennessee median

    358 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    G0463Hospital outpatient clinic visit for assessment and management of a patient3601,340$50$1.1M
    99284The 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.9630510$120$1.1M
    99283The 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.3610570$110$884.4K
    41899Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.2930410$520$719.2K
    99285The 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.13570640$100$637.8K
    92507The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…1332302,130$40$616.8K
    93303The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…12301,060$130$484.1K
    69436This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.3570160$500$421.5K
    97530The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.2623401,400$40$354.2K
    96413Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…5401,860$70$294.9K

    Showing 1–10 of 358

    • More pages

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Methodist Healthcare - Memphis Hospitals, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Methodist Healthcare - Memphis HospitalsTNChildren's Hospital$0$84.4M
    Ut Lebonheur Pediatric Specialists, Inc.TNPediatrics Physician$0$63.8M
    Primary Care Group LLCTNFamily Medicine Physician$0$23.5M
    Methodist Healthcare - Olive Branch HospitalMSGeneral Acute Care Hospital$0$18.1M
    Alliance Health Services Inc.TNDurable Medical Equipment & Medical Supplies$0$11.2M
    Methodist Inpatient Physicians LLCTNInternal Medicine Physician$0$4.8M
    Lebonheur Patient TransportationTNLand Ambulance$0$4.5M
    Specialty Physician Group LLCTNCardiovascular Disease Physician$0$3.3M
    Methodist Healthcare - Memphis HospitalsTNChildren's Hospital$0$3.3M
    Ut Methodist Physicians LLCTNInternal Medicine Physician$0$2.7M

    Nearby Providers

    Other providers in the same ZIP code as Methodist Healthcare - Memphis Hospitals, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Well Child Inc.TNNurse Practitioner$0$19.8M
    Bhg Reference Lab, LLCTNClinical Medical Laboratory$0$14M
    Wci School Health Services, PLLCTNFamily Nurse Practitioner$0$10.4M
    Memphis Radiological, P.C.TNDiagnostic Radiology Physician$0$9.1M
    Memphis Medical Center Air Ambulance Service, Inc.TNAir Ambulance$0$6.5M
    Southern College Of OptometryTNOptometrist$0$5.4M
    Satellite Healthcare Of Poplar Avenue LLCTNEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center$0$5.2M
    Phillip R. Bowden, M.d.,p.a.TNGastroenterology Physician$0$4.6M
    Memphis Recovery Centers, Inc.TNSubstance Abuse Rehabilitation Facility$0$4.6M
    Bianca SweetenTNPediatrics Physician$0$3.2M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    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.

    Medicaid Revenue by Year vs. Tennessee Providers
    7 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. Tennessee Distribution
    Methodist Healthcare - Memphis Hospitals — 17 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Tennessee