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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Davis Memorial Hospital (NPI 1619964806)

Key Findings

Field	Value
Entity Type	Organization
Organization	Davis Memorial Hospital
Address	812 Gorman Ave
City	Elkins
State	WV
ZIP	26241
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 3, 2005

Payer Source	Total Paid
Medicaid	$20.1M
Medicare	$0

DAVIS MEMORIAL HOSPITAL is effectively a single‑payer Medicaid provider: there is no Medicare billing on file while total Medicaid revenue is $20.1M, so the facility’s reported Medicare footprint is absent and Medicaid dominates its recorded public-payer activity. This concentration in Medicaid revenue will meaningfully shape payer negotiations, risk exposure, and revenue sensitivity to state Medicaid policy changes.

Revenue concentration is high and ED‑centric: the top three Medicaid revenue codes are 99283 ($3.1M revenue, 24.0%), 99284 ($3M revenue, 23.6%), and 99285 ($622.7K revenue, 4.9%), which together account for 52.5% of the provider’s total Medicaid revenue. This demonstrates that emergency department E/M services drive a majority of reported Medicaid dollars.

The code mix and volumes indicate a hospital with a high‑throughput emergency department and on‑site diagnostic support: 99283 has 39.8K claims and 99284 has 26.2K claims, and the presence of high counts for lab and imaging codes (e.g., 85025 at 49.9K claims; 80048 at 28.4K claims; 74176 at 4.8K claims) suggests integrated ED plus immediate lab/CT capability to support acute care. Frequent administration codes such as J2405 (9.2K claims), J3010 (5.2K claims) and J2250 (5.7K claims) further imply routine procedural analgesia/antiemetic use consistent with active ED procedural workflows.

Competitive standing is uneven across acuity levels: for low‑acuity ED visits the provider is a strong state performer (99283 ranks #8 of 163 in‑state, 96th percentile, described as notably above typical state volume for this code), for moderate acuity it is a high‑volume but more typical performer (99284 ranks #18 of 168, 90th percentile, typical, unremarkable volume for this code), and for high‑acuity ED visits the provider is a modest participant (99285 ranks #61 of 132, 54th percentile, typical, unremarkable volume for this code). This pattern positions the hospital as a major destination for lower‑to‑moderate acuity ED care within the state but not a dominant center for the highest‑acuity emergency cases.

Several diagnostic and testing codes are statistical outliers or notably high relative to peers: 80048 (BMP) ranks #4 of 76 in‑state (96th percentile; notably above typical state volume for this code), 43239 (EGD biopsy) ranks #4 of 68 (96th percentile; notably above typical state volume for this code), and 87428 (SARS/flu antigen testing) ranks #3 of 93 (98th percentile; notably above typical state volume for this code). These labels indicate the provider runs well above typical state volumes for specific lab and endoscopy services, reinforcing an operational profile that pairs a busy ED with substantial on‑site testing and procedural capacity.

Despite ED dominance, revenue streams show modest diversification across labs, imaging and procedure codes: examples include 85025 (CBC) contributing $549.3K (4.3% of Medicaid revenue), 74176 (CT abdomen/pelvis without contrast) contributing $444.9K (3.5%), 80053 (CMP) $421.7K (3.3%), 43239 $359.1K (2.8%), and 74177 $309.4K (2.4%). These mid‑single‑digit contributors indicate the hospital derives meaningful secondary revenue from diagnostics and procedures, which reduces but does not eliminate the financial concentration in ED E/M codes.

Operational and resource implications are clear from claim volumes and therapy/infusion usage: the combination of large ED claim counts (39.8K for 99283 and 26.2K for 99284), frequent IV/infusion administration codes (96374 and 96375 with 9.9K and 8.8K claims respectively), and multiple imaging and lab high‑volume codes implies sustained demand for ED nursing, lab staffing, imaging technologists, and infusion/medication administration workflows. These utilization patterns suggest capacity and staffing priorities should focus on ED throughput, rapid lab turnaround, and CT/endoscopy scheduling to support the hospital’s dominant revenue drivers.

The provider has a long enrollment history: its NPI was enumerated on 2005-10-03 (approximately 21 years ago), indicating an established presence in the local market which aligns with its high in‑state ranks on multiple codes and sustained Medicaid billing activity. This tenure supports interpretation of the patterns above as stable operational characteristics rather than a short‑term fluctuation.

Medicaid: Complete Services Breakdown

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

290 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.	39,750	$80	$3.1M
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.	26,170	$120	$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.	2,720	$230	$622.7K
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…	49,940	$10	$549.3K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	4,780	$90	$444.9K
80053	The 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.	22,190	$20	$421.7K
80048	The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood…	28,390	$10	$369K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	3,560	$100	$359.1K
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.	1,800	$170	$309.4K
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…	8,760	$30	$280.3K

Showing 1–10 of 290

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Davis Memorial Hospital — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

290 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	61	130	2,090	$210	$1.5M
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	13	10	580	$1,120	$1.3M
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	18	20	1,050	$80	$1.3M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	15	40	820	$30	$1.2M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	15	40	820	$30	$1.2M
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.	18	170	3,350	$120	$1.1M
88175	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	5	20	70	$20	$832.7K
87624	The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result.	13	20	720	$20	$721.7K
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	160	3,690	$80	$714.8K
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.	32	80	950	$140	$559.5K

Showing 1–10 of 290

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Davis Memorial Hospital Group	WV	Rural Acute Care Hospital	$0	$906.2K
Kevin Cox	WV	Ophthalmology Physician	$241.6K	$64.7K
John Migliano	AZ	Hematology & Oncology Physician	$300.2K	$0
John Lobban	WV	Clinical Cardiac Electrophysiology Physician	$167.7K	$0
Jenny Cross	WV	Otolaryngology Physician	$167.4K	$0
Mary Dasher	WV	Certified Registered Nurse Anesthetist	$128.7K	$0
Patrick Brown	WV	Student in an Organized Health Care Education/Training Program	$106.5K	$0
Matthew Hofeldt	WV	Surgery Physician	$86K	$0
David Davis	WV	Hospitalist Physician	$75K	$0
Nirva Dube	WV	Internal Medicine Physician	$74.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Select In Home Services, Inc.	WV	Personal Care Attendant	$0	$25.7M
Ems, Inc.	WV	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$17.6M
Mountaineer Home Care Services LLC	WV	In Home Supportive Care Agency	$0	$12.4M
Youth Health Service, Inc	WV	Community/Behavioral Health Agency	$0	$9.8M
Appalachian Community Health Center	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8.6M
Wendy Collins	WV	Homemaker	$0	$7.6M
Valley Health Care, Inc	WV	Federally Qualified Health Center (FQHC)	$0	$7.6M
Randolph County Court Emergency Squad	WV	Land Ambulance	$1M	$5.3M
Drs Wilson And Martino Of Elkins	WV	General Practice Dentistry	$0	$5.8M
Alternative Home Care LLC	WV	Homemaker	$0	$5.1M

Davis Memorial Hospital — Billing Profile & Reimbursement Data

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Davis Memorial Hospital — 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