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

Why is the Medicaid comparison limited to Hawaii 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. Hawaii (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.

Samuel Mahelona Memorial Hospital (NPI 1619038536)

Key Findings

Field	Value
Entity Type	Organization
Organization	Samuel Mahelona Memorial Hospital
Address	4800 Kawaihau Road
City	Kapaa
State	HI
ZIP	96746
Taxonomy	Critical Access Hospital
NPI Enumerated	December 13, 2006

Payer Source	Total Paid
Medicaid	$7M
Medicare	$0

SAMUEL MAHELONA MEMORIAL HOSPITAL is effectively a single‑payer facility in the data set: it has no Medicare billing on file and reports $7M in lifetime Medicaid revenue. Its NPI was enumerated on 2006-12-13 (~20 years ago), indicating an established presence in the community but limited visibility in federal Medicare claims data.

Revenue is highly concentrated in a few emergency department evaluation-and-management codes: the precomputed top three Medicaid codes (99283, 99282, 99284) account for 90.9% of the provider's Medicaid revenue. Specifically, 99283 shows 8.8K claims, $393 avg paid/claim, $3.5M revenue (49.3% of this provider's total Medicaid revenue); 99282 shows 5.8K claims, $275 avg paid/claim, $1.6M revenue (22.7%); and 99284 shows 2.1K claims, $618 avg paid/claim, $1.3M revenue (19.0%).

The code mix points to an emergency-department–centric operating model: the largest revenue drivers are ED E/M codes (99283, 99282, 99284, and to a lesser extent 99285), which suggests the hospital functions primarily as an access point for urgent and emergency care rather than as a procedure-focused center. Ancillary services such as therapeutic exercise (97110), manual therapy (97140), a small volume of CT imaging (74177), and basic labs contribute only minor shares of Medicaid revenue, reinforcing an ED‑led service-line profile.

Competitive standing across peers is modest and mixed by acuity: 99282 ranks #8 of 31 providers in-state (77th percentile; typical, unremarkable volume for this code), indicating relatively strong statewide volume for straightforward ED visits, while 99283 ranks #22 of 45 (52th percentile; typical, unremarkable volume for this code) and 99284 ranks #27 of 47 (43th percentile; typical, unremarkable volume for this code), which place the hospital near median peer activity for moderate ED acuity. High-acuity ED visits billed under 99285 are less prominent, with 503 claims and $504.5K revenue and a rank of #30 of 39 (24th percentile; typical, unremarkable volume for this code), suggesting limited share in the highest-acuity ED category.

The provider’s financial position is materially dependent on emergency department volumes: with 99283 alone representing $3.5M (49.3% of Medicaid revenue) and the top three ED codes totaling 90.9% of Medicaid receipts, any changes in ED utilization or Medicaid reimbursement policy for ED E/M services would disproportionately affect the hospital. This concentration raises business risk around payer policy and local ED demand compared with a more diversified mix of inpatient, surgical, or outpatient procedural revenue.

Several frequently billed procedure and lab codes show many claims but $0 or de minimis reported Medicaid revenue (for example, 96372: 2.5K claims, $0 avg paid/claim, $0 revenue; 80047: 1.6K claims, $0 avg paid/claim, $0 revenue; 85014: 1.6K claims, $0 avg paid/claim, $0 revenue). These patterns likely reflect bundled payment practices or state reporting conventions in Medicaid data rather than absent clinical activity, and they reduce apparent ancillary revenue despite meaningful service volumes.

While the hospital provides some outpatient therapy and diagnostic capacity, those lines are small revenue contributors: 97110 (therapeutic exercise) has 1.6K claims, $42 avg paid/claim, $68.4K revenue (1.0% of this provider's total Medicaid revenue) and CT abdomen/pelvis with contrast 74177 accounts for $24.7K (0.4% of Medicaid revenue). The presence of these codes indicates available allied health and imaging services that complement the ED, but they do not materially diversify the hospital’s Medicaid revenue base.

Across the set of reported codes, none of the major revenue drivers are described as extreme outliers in the supplied labels; most are characterized as "typical, unremarkable volume for this code," which supports a conclusion that SAMUEL MAHELONA MEMORIAL HOSPITAL is a steady, locally focused ED-centric critical access provider rather than a dominant statewide player. Analysts should therefore treat this facility as an established community ED whose Medicaid financial profile hinges on sustained ED visit volumes and the state’s Medicaid payment conventions.

Medicaid: Complete Services Breakdown

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

43 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	8,780	$390	$3.5M
99282	The 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.	5,770	$280	$1.6M
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.	2,150	$620	$1.3M
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.	500	$1,000	$504.5K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	1,630	$40	$68.4K
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	10	$2,060	$24.7K
97032	Electrical stimulation therapy uses electricity to stimulate the muscles for the treatment of pain and other disorders associated with muscles. Electrodes are placed on the affected muscle areas and…	310	$70	$22.1K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	660	$20	$11.9K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	1,320	$1	$4K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	490	$1	$970

Showing 1–10 of 43

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Samuel Mahelona Memorial Hospital — 0 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

43 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	22	50	8,590	$340	$5.2M
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.	27	50	3,740	$290	$3.8M
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.	30	40	3,820	$330	$3.3M
99282	The 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.	8	30	2,660	$330	$1.5M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	36	40	1,050	$510	$1.3M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	45	110	1,000	$40	$108.5K
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	17	20	4,740	$20	$83.1K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	23	20	3,460	$20	$67.2K
85025	A 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…	85	90	1,810	$1	$65.6K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	45	50	1,250	$10	$60.5K

Showing 1–10 of 43

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kauai Veterans Memorial Hospital	HI	Critical Access Hospital	$0	$6.2M
Minghsun Liu	CA	Infectious Disease Physician	$952.7K	$418.7K
Samuel Mahelona Memorial Hospital	HI	Rural Health Clinic/Center	$0	$397.7K
Samuel Mahelona Memorial Hospital	HI	Rural Health Clinic/Center	$0	$342.5K
Brandon Mason	OK	Diagnostic Radiology Physician	$277.6K	$0
John Funai	HI	Cardiovascular Disease Physician	$166.3K	$0
Pradeep Bollu	SC	Neurology Physician	$137.1K	$0
Steven Fein	NY	Cardiovascular Disease Physician	$52.9K	$15.4K
Frederick Mechanik	CO	Primary Podiatric Medicine Podiatrist	$61.7K	$0
Micheal Johnson	FL	Diagnostic Radiology Physician	$60.7K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mark A. Baird D.d.s. Inc	HI	General Practice Dentistry	$0	$1.4M
Kapaa Pediatrics LLC	HI	Pediatrics Physician	$0	$349.1K
Jere Graham	HI	Adult Psychiatric/Mental Health Clinical Nurse Specialist	$17.6K	$186.9K
Kapaa Physical Therapy Inc	HI	Physical Therapist	$0	$141.6K
Longs Drug Stores California ,L.L.C.	HI	Pharmacy	$120.1K	$4.2K
Jeffrey Gatling	HI	Physical Therapist	$65.2K	$0
Amanda Gutierrez	HI	Orthopedic Physical Therapist	$57K	$0
Alana Goo-frazier	HI	Family Nurse Practitioner	$49.6K	$0
Ashok Kannan	HI	Geriatric Medicine (Internal Medicine) Physician	$43.3K	$0
Christopher Liloy	HI	Physical Therapist	$38.7K	$0

Samuel Mahelona Memorial Hospital — Billing Profile & Reimbursement Data

Sign up for Samuel Mahelona Memorial Hospital — Billing Profile & Reimbursement Data policy alerts

Samuel Mahelona Memorial Hospital — Billing Profile & Reimbursement Data

Sign up for Samuel Mahelona Memorial Hospital — Billing Profile & Reimbursement Data policy alerts

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