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

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

Mercy Hospital (NPI 1629078712)

Key Findings

Field	Value
Entity Type	Organization
Organization	Mercy Hospital
Address	175 Fore River Pkwy
City	Portland
State	ME
ZIP	04102
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 29, 2005

Payer Source	Total Paid
Medicaid	$35.5M
Medicare	$0

This provider reports no Medicare billing on file and is effectively a single-payer (Medicaid) hospital by volume, with Total Medicaid revenue of $35.5M. Its NPI was enumerated 2005-07-29 (~21 years ago), indicating an established presence in the market.

Revenue is highly concentrated in a small set of outpatient and emergency codes: the precomputed top three Medicaid codes account for 56.6% of the provider's total Medicaid revenue, led by G0463 ($10.4M revenue, 160.5K claims, $65 avg paid/claim; 34.6% of total Medicaid revenue). This concentration indicates a heavy reliance on a few high-volume ambulatory/ED service lines.

The top-earning codes—G0463 (hospital outpatient clinic visit) and emergency department E/M codes 99284 ($3.8M, 31.1K claims, $123 avg paid/claim; 12.7% of total) and 99285 ($2.8M, 10.8K claims, $259 avg paid/claim; 9.3% of total)—point to an operational profile focused on hospital outpatient clinic throughput and moderate- to high-complexity ED care. Together these codes imply the facility functions as a high-volume site for acute outpatient evaluation and ED services rather than as a Medicare inpatient specialty center.

Competitive standing on the facility's leading Medicaid codes is generally modest-to-strong but not statewide-dominant: G0463 ranks #9 of 55 in-state (85th percentile; typical, unremarkable volume), 99284 ranks #12 of 61 (82th percentile; typical, unremarkable volume), and 99285 ranks #17 of 56 (71th percentile; typical, unremarkable volume). In other words, the hospital is a significant but not market-leading provider for these high-revenue ambulatory and ED services.

The provider is an outlier on several established outpatient visit and therapy codes, signaling a large ambulatory/clinic footprint: 99213 (63.2K claims, $28 avg paid/claim, $1.8M revenue; ranks #8 of 483, 99th percentile; extreme outlier, far above typical state volume) and 99214 (44.9K claims, $35 avg paid/claim, $1.6M revenue; ranks #11 of 461, 98th percentile; notably above typical state volume) together show unusually high volumes of established patient visits. High-ranked therapy codes such as 97110 (34.1K claims, $22 avg paid/claim, $749.1K revenue; rank #4 of 145, 98th percentile; notably above typical) and 97140 (22.2K claims, $18 avg paid/claim, $398.8K revenue; rank #2 of 94, 99th percentile; notably above typical) further confirm a robust outpatient rehabilitation service line.

Beyond visits, the breadth of billed services—including infusion/IV administration codes 96374 (8.4K claims, $96 avg paid/claim, $803.9K revenue) and 96365 (5.2K claims, $90 avg paid/claim, $471.7K revenue), endoscopy/colonoscopy codes 43239 and 45380, imaging CT 74177 and 70450, vaccination 90471, and SARS-CoV-2 testing U0004—indicates the hospital operates a comprehensive hospital-based outpatient and procedural platform that supports both acute and routine care needs. This mix suggests downstream ancillary revenue lines beyond ED visits.

Because 56.6% of Medicaid revenue is tied to the top three codes (G0463, 99284, 99285), the provider's financial performance is sensitive to changes in ED and outpatient clinic utilization or reimbursement for those services. Payers and network managers should view the hospital as having concentrated Medicaid exposure in ambulatory/ED care, which represents both a negotiating leverage point and a vulnerability to shifts in utilization management or care deflection programs.

Medicaid: Complete Services Breakdown

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

435 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	160,470	$70	$10.4M
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.	31,130	$120	$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.	10,780	$260	$2.8M
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.	26,790	$90	$2.3M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	63,160	$30	$1.8M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	44,890	$40	$1.6M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	8,370	$100	$803.9K
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…	34,050	$20	$749.1K
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.	2,300	$250	$576.8K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	1,090	$510	$556K

Showing 1–10 of 435

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Mercy Hospital — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

435 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	9	60	18,740	$60	$4.6M
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.	12	60	9,550	$100	$1.5M
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.	17	60	4,690	$180	$1.5M
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.	10	50	11,590	$60	$942.4K
J0585	Injection, onabotulinumtoxina, 1 unit	13	20	1,240	$380	$618.9K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	9	30	6,230	$70	$515.4K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	4	10	400	$400	$476.5K
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.	22	60	2,380	$90	$345.7K
96413	Chemotherapy 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…	13	30	880	$110	$338.4K
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.	6	30	200	$250	$316.8K

Showing 1–10 of 435

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Can Ilyas	ME	Hematology & Oncology Physician	$3.2M	$0
David Benton	ME	Hematology & Oncology Physician	$2.6M	$0
Matthew Dugan	ME	Hematology & Oncology Physician	$1.8M	$0
John Winters	ME	Hematology & Oncology Physician	$1.5M	$0
Devon Evans	ME	Hematology & Oncology Physician	$1.5M	$0
Brian Haney	ME	Hematology & Oncology Physician	$1.2M	$0
Yoko Fukuda	NH	Hematology & Oncology Physician	$945K	$0
Chiara Battelli	ME	Hematology & Oncology Physician	$301K	$0
Stephen Comeau	ME	Nephrology Physician	$239.8K	$0
Dingxin Qin	NH	Clinical Cardiac Electrophysiology Physician	$221.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mainehealth	ME	General Acute Care Hospital	$0	$142.6M
Shalom House, Inc.	ME	Mental Illness Community Based Residential Treatment Facility	$0	$81.9M
Maxim Healthcare Services, Inc.	ME	Home Health Agency	$0	$28.1M
Quality Care Access, LLC	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$17.2M
Portland Community Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$12.9M
Al-shawk Home Healthcare, LLC	ME	Personal Care Attendant	$0	$7M
Maine Eye Center, PA	ME	Ophthalmology Physician	$0	$6.1M
Hand Of Mercy Health Care, LLC	ME	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.1M
Mainehealth	ME	General Acute Care Hospital	$0	$5.5M
Merrimack River Medical Services, Inc.	ME	Substance Use Disorder Rehabilitation Clinic/Center	$253.7K	$4.6M

Mercy 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