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.

Central Valley Specialty Hospital Inc (NPI 1578989703)

Field	Value
Entity Type	Organization
Organization	Central Valley Specialty Hospital Inc
Address	730 17th St
City	Modesto
State	CA
ZIP	95354
Taxonomy	General Acute Care Hospital
NPI Enumerated	March 12, 2014

Payer Source	Total Paid
Medicaid	$130.7M
Medicare	$0

Key Findings

CENTRAL VALLEY SPECIALTY HOSPITAL INC reports no Medicare billing on file and instead shows $130.7M in lifetime Medicaid revenue, making its public payer footprint effectively single-payer and heavily Medicaid-dependent. This concentration means any payer negotiations or policy changes affecting Medicaid reimbursement could have outsized impact on the provider's financial profile.

Revenue concentration is extremely high: the precomputed top-3 Medicaid codes (0120, 0121, 0129) account for 99.9% of the provider's total Medicaid revenue. In particular, 0120 generates $103.2M (78.9% of total Medicaid revenue), 0121 generates $24M (18.4%), and 0129 generates $3.4M (2.6%), showing that almost all Medicaid dollars flow through a very small set of codes.

Code-level competitive standing is uneven: 0120 is a statewide outlier — it ranks #1 of 40 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code) — indicating market dominance for that specific billed service. By contrast, 0121 ranks #6 of 74 providers in-state (93th percentile; typical, unremarkable volume for this code), and 0129 ranks #2 of 3 providers in-state (50th percentile; typical, unremarkable volume for this code), suggesting leadership only on the primary revenue-driving code.

Although many high-revenue codes lack public descriptions in this dataset (0120, 0121, 0129 are listed as "no description available"), the dollar-per-claim amounts reported (for example $25,141 avg paid/claim for 0120 and $15,042 avg paid/claim for 0121) imply these are high-dollar Medicaid line items or bundled services rather than routine E/M visits. The pattern — few claims delivering large average payments — is consistent with a specialized service line or facility-level reimbursement model rather than broad outpatient primary-care activity.

Operational and risk implications follow from the narrow code mix: reliance on a single extreme-outlier code (0120 at 78.9% of Medicaid revenue) creates revenue concentration risk and makes the provider sensitive to changes in coverage, prior authorization, or state policy targeting that code. Payer contracting or audits that affect reimbursement for 0120 would materially change the provider's financials given the $103.2M revenue tied to that code.

The provider’s recorded clinical mix includes typical inpatient evaluation-and-management volume but at very small scale relative to its Medicaid revenue: 99233 appears with 66 claims and $128 avg paid/claim for $8.4K total revenue and ranks #2166 of 2669 providers in-state (19th percentile; typical, unremarkable volume). This underscores that traditional E/M inpatient billing is not the primary revenue driver here.

Several codes show high claim counts paired with $0 average paid/claim (for example 0305: 3.5K claims $0 avg paid/claim, 0410: 2.8K claims $0 avg paid/claim — the latter ranks #3 of 57 providers in-state (96th percentile; notably above typical state volume for this code)). These zero-paid items suggest services billed but either not separately reimbursed, bundled into higher-paying claims, or recorded for administrative/encounter tracking rather than as standalone revenue sources.

Tenure data shows the provider's NPI was enumerated 2014-03-12 (~12 years ago), indicating it has been active long enough to establish entrenched Medicaid billing patterns; the combination of a decade-plus presence with an extreme outlier code position suggests an established specialty or program driving most of its Medicaid receipts.

Medicaid: Complete Services Breakdown

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
0120	N/A	4,110	$25,140	$103.2M
0121	N/A	1,600	$15,040	$24M
0129	N/A	280	$12,270	$3.4M
0250	N/A	3,800	$10	$34.2K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	70	$130	$8.4K
0301	N/A	3,740	$1	$7.5K
0420	N/A	1,730	$1	$6.9K
0300	N/A	3,960	$1	$4K
0270	N/A	3,790	$1	$3.8K
0320	N/A	1,690	$1	$1.7K

Showing 1–10 of 20

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

Central Valley Specialty Hospital Inc — 1 of 10 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

20 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
0120	N/A	1	40	110	$6,750	$3.9M
0121	N/A	6	70	130	$4,600	$2.6M
0129	N/A	2	10	280	$1,170	$1.9M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2,166	2,670	540	$40	$183.4K
0250	N/A	308	820	2,180	$10	$97.5K
0270	N/A	155	460	1,160	$10	$68.3K
0301	N/A	32	220	340	$10	$44.2K
0300	N/A	28	210	360	$10	$35.8K
0410	N/A	3	60	130	$20	$10.8K
0420	N/A	9	110	150	$10	$7.5K

Showing 1–10 of 20

Nearby Providers

Other providers in the same ZIP code as Central Valley Specialty Hospital Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Stanislaus County Bhrs	CA	Community/Behavioral Health Agency	$0	$163.6M
County Of Stanislaus	CA	Community/Behavioral Health Agency	$0	$63.5M
Golden Valley Health Center	CA	Federally Qualified Health Center (FQHC)	$0	$23.4M
Phi Health, LLC	CA	Air Ambulance	$2.3M	$9M
Manjit Dhillon	CA	Infectious Disease Physician	$887.1K	$0

Central Valley Specialty Hospital Inc — Billing Profile & Reimbursement Data

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Central Valley Specialty Hospital Inc — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References