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 New Jersey for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

Prime Healthcare Services - Saint Clare's LLC (NPI 1598144362)

Field	Value
Entity Type	Organization
Organization	Prime Healthcare Services - Saint Clare's LLC
Address	25 Pocono Rd
City	Denville
State	NJ
ZIP	07834
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 26, 2015

Payer Source	Total Paid
Medicaid	$90.2M
Medicare	$0

Key Findings

This provider is effectively single‑payer in operation: there is no Medicare billing on file and its entire documented lifetime public‑payer activity is Medicaid revenue totaling $90.2M. The absence of Medicare claims suggests analyses of commercial or Medicare-dependent lines will need external data sources, as Medicaid dominates the public payer footprint.

Revenue concentration is high in a small set of services: the precomputed top three Medicaid codes account for 35.8% of the provider's total Medicaid revenue, indicating that a relatively narrow mix of high‑value emergency and transport services drives a large share of Medicaid dollars. Those top individual contributors include A0427 ($10.8M, 14.2%), 99284 ($8.8M, 11.6%), and A0429 ($7.7M, 10.1%).

The code mix points to an emergency/acute care and transport‑heavy operation with significant behavioral health activity. High volumes and revenues for ambulance and transport codes (A0427, A0429, A0428, A0425, A0998) alongside strong emergency department E/M codes (99284, 99283, 99285) indicate reliance on ED visits and EMS throughput, while sizable Medicaid revenue in H0035 ($5.8M, 7.7%), 90834 ($4.2M, 5.5%) and 90791 ($2.5M, 3.3%) signals meaningful investment in partial hospitalization, psychotherapy, and psychiatric evaluation services.

Competitive standing is mixed by service line: the provider is a major statewide participant for several ambulance and psychiatric billing types but not universally dominant across ED codes. For example, A0429 ranks #11 of 264 providers in‑state at the 96th percentile (notably above typical state volume), and A0425 is at the 94th percentile, while 90791 ranks #1 of 549 providers (100th percentile, extreme outlier), indicating exceptional scale in psychiatric evaluations. In contrast, ED codes such as 99284 (80th percentile), 99283 (75th), and 99285 (78th) reflect substantial but not top‑tier statewide positioning.

Several services are statistical outliers in the state Medicaid universe: 90791 is labeled an "extreme outlier, far above typical state volume," and multiple codes are "notably above typical state volume" including A0429 (96th percentile), 90834 (95th), A0425 (94th), and 99214 (98th percentile for office/outpatient evaluation). These outlier designations suggest the provider captures outsized share for select psychiatric and transport services relative to in‑state peers.

Clinical acuity is reflected beyond ED visits by notable critical care and observation billing: 99291 (critical care) accounts for $935.7K (1.2% of Medicaid revenue) and G0378 (hospital observation service) accounts for $2.2M (2.9%), supporting that the facility provides higher‑intensity inpatient/ED care in addition to ambulatory and behavioral health services. This mix is consistent with a general acute care hospital that also maintains emergency, observation, and critical care capacity.

The provider has an established presence: its NPI was enumerated on 2015-05-26 (~11 years ago), giving it nearly a decade-plus of Medicaid billing history to have built the observed specialization in emergency transport and behavioral health. That tenure, combined with the 35.8% revenue concentration in the top three codes, suggests institutional programs (EMS linkages and psych services) rather than short‑term case mix variation drive results.

Operational and contracting implications: payers evaluating this entity should expect heavy Medicaid spend tied to ambulance transports and ED throughput and should prioritize review of network adequacy and reimbursement arrangements for high‑volume transport codes (A0429, A0427, A0428) and behavioral health per‑diem/psychotherapy codes (H0035, S9480, 90834, 90837). Given the provider’s lack of Medicare billing, Medicaid policy changes or managed‑care arrangements will disproportionately affect its reimbursement base.

Medicaid: Complete Services Breakdown

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

282 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	12,190	$880	$10.8M
99284	The 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.	25,380	$350	$8.8M
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	35,940	$210	$7.7M
99283	The 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.	23,490	$280	$6.6M
99285	The 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.	16,100	$400	$6.5M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	33,400	$180	$5.8M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	37,370	$110	$4.2M
A0428	Ambulance service, basic life support, non-emergency transport, (bls)	14,130	$280	$3.9M
S9480	Intensive outpatient psychiatric services, per diem	4,430	$780	$3.5M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	19,150	$130	$2.5M

Showing 1–10 of 282

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

Prime Healthcare Services - Saint Clare's LLC — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

282 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	33	80	6,290	$690	$6.6M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	69	170	21,080	$100	$4.2M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	53	130	3,180	$60	$4.2M
99283	The 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.	66	260	4,240	$220	$4.1M
99284	The 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.	66	320	580	$230	$4M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	11	30	9,660	$310	$3.4M
S9480	Intensive outpatient psychiatric services, per diem	11	30	3,840	$770	$3.3M
99285	The 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.	62	280	920	$200	$2.6M
T2034	Crisis intervention, waiver; per diem	12	20	2,220	$860	$2.3M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	32	150	3,680	$30	$1.5M

Showing 1–10 of 282

Related Providers

Other providers that share a Tax Identification Number (TIN) with Prime Healthcare Services - Saint Clare's LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prashant Desai	FL	Radiation Oncology Physician	$411.9K	$0
Sheikh Naeem	NJ	Cardiovascular Disease Physician	$192.7K	$0

Nearby Providers

Other providers in the same ZIP code as Prime Healthcare Services - Saint Clare's LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Special Homes Of New Jersey, Inc.	NJ	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$59.5M
Dawn Center For Independent Living, Inc.	NJ	Case Management Agency	$0	$10.3M
Resource Center For The Chemically Dependent, Inc.	NJ	Methadone Clinic	$313.3K	$9.6M
Seth Levy	NJ	Internal Medicine Physician	$373.3K	$0
Slobodan Miric	NJ	Neurology Physician	$141.8K	$194.9K
Gregg Zimmerman	NJ	Urology Physician	$293K	$0
Michael Russoniello	NJ	Pulmonary Disease Physician	$269.3K	$0
Amitabh Hajela	NJ	Nephrology Physician	$265.6K	$0
Stephanie Levey	NJ	Ophthalmology Physician	$245.5K	$15.7K
Robert Alexander	NJ	Pulmonary Disease Physician	$253K	$0

Prime Healthcare Services - Saint Clare's LLC — Billing Profile & Reimbursement Data

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Prime Healthcare Services - Saint Clare's LLC — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References