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.

Mainegeneral Medical Center (NPI 1669423380)

Field	Value
Entity Type	Organization
Organization	Mainegeneral Medical Center
Address	35 Medical Center Pkwy
City	Augusta
State	ME
ZIP	04330
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 15, 2006

Payer Source	Total Paid
Medicaid	$168.1M
Medicare	$0

Key Findings

This provider effectively operates as a single-payer Medicaid entity: there is no Medicare billing on file (none) while Medicaid revenue totals $168.1M, so all reported federal fee-for-service activity is concentrated in Medicaid. Analysts should treat Medicaid as the primary and sole federal payer exposure in network and utilization analyses for this NPI.

Revenue is highly concentrated in a very small set of outpatient/E&M codes: the top three Medicaid codes (G0463, 99214, 99283) account for 53.4% of the provider’s total Medicaid revenue, with G0463 alone generating $47.3M (39.5% of Medicaid revenue). That concentration signals that changes to clinic visit reimbursement or utilization for these codes would materially affect overall revenue.

Service-line profile points to a large hospital outpatient clinic and high ED throughput: G0463 (hospital outpatient clinic visit) is the dominant revenue driver, and high volumes in 99213 (241.7K claims, $6.5M, 5.4%) and 99214 (214.5K claims, $8.4M, 7.0%) indicate extensive ambulatory evaluation-and-management activity. Coupled with substantial ED coding (99282–99285 series, including 99283 at 83.2K claims, $8.3M), the mix suggests the hospital runs a sizeable outpatient clinic and emergency department feeding a broad ambulatory practice.

The provider is a statewide volume leader across many Medicaid codes: G0463 ranks #1 of 55 providers in-state (100th percentile; extreme outlier), 99214 ranks #1 of 461 (100th percentile; extreme outlier), and multiple other codes (99213, 99283, 43239, 45385, 96365, G0480, 97110 and others) also rank #1 at the state level. These rank/percentile patterns indicate MAINEGENERAL MEDICAL CENTER is a dominant Medicaid provider in Maine for hospital outpatient visits, core E/M services, certain procedures, and therapy codes.

Oncology and infusion services are a meaningful secondary revenue stream: high-cost drug codes such as J9271 (pembrolizumab, $6.5M, 5.4%) and J3380 (vedolizumab, $4.9M, 4.1%) plus infusion/chemotherapy administration codes (96365 $1.8M, 96413 $1.8M) and PET/CT (78815 $1.7M) show a sizable cancer-treatment footprint. Notably, J3380 ranks #1 of 1 providers in-state (0th percentile; no state peer volume comparison available), indicating this provider may be the sole Medicaid reporter for that drug in Maine.

High procedural, imaging, and diagnostic throughput complements the clinic and ED activity: CT abdomen/pelvis 74177 ($2.2M), endoscopy 43239 ($1.6M) and colonoscopic removal 45385 ($1.6M) are all toward the top of state rankings (many at or near 100th percentile), which aligns with an integrated hospital that performs both outpatient diagnostics and interventional procedures. This breadth of services supports downstream revenue capture from imaging, endoscopy, and pathology.

There are pockets of typical or modest state participation in a few specialized codes: J9271 is ranked #2 of 3 in-state (50th percentile; labeled typical, unremarkable), and IMRT delivery 77386 ranks #3 of 4 (33rd percentile; typical), showing that while the provider dominates many routine outpatient and ED categories, its statewide position in some specialized radiation and high-cost drug codes is more moderate. These distinctions are important for payers modeling access to niche oncology or advanced-radiation services.

The NPI tenure is long-standing (NPI enumerated 2006-05-15, ~20 years ago), consistent with the scale and depth of reported Medicaid activity; analysts should view the provider as an established institutional participant when evaluating contract negotiations, network adequacy, and capacity planning for Maine’s Medicaid population.

Medicaid: Complete Services Breakdown

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

812 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	716,220	$70	$47.3M
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…	214,530	$40	$8.4M
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.	83,180	$100	$8.3M
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.	67,080	$120	$7.7M
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…	241,730	$30	$6.5M
J9271	Injection, pembrolizumab, 1 mg	1,500	$4,330	$6.5M
J3380	Injection, vedolizumab, intravenous, 1 mg	1,280	$3,870	$4.9M
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.	18,120	$250	$4.5M
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.	13,120	$170	$2.2M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	19,730	$100	$2M

Showing 1–10 of 812

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

Mainegeneral Medical Center — 17 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

812 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	2	10	1,500	$4,760	$6.4M
J3380	Injection, vedolizumab, intravenous, 1 mg	1	10	1,280	$3,870	$4.9M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	1	60	18,740	$60	$4.6M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	3	10	7,510	$230	$1.6M
J9299	Injection, nivolumab, 1 mg	2	10	430	$3,580	$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	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.	6	60	4,690	$180	$1.5M
Q9991	Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg	3	10	630	$1,490	$1.4M
J0178	Injection, aflibercept, 1 mg	11	10	1,710	$620	$1.2M
J2505	Injection, pegfilgrastim, 6 mg	2	10	590	$1,860	$1.1M

Showing 1–10 of 812

Related Providers

Other providers that share a Tax Identification Number (TIN) with Mainegeneral Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Brian Daikh	ME	Specialist	$1.2M	$0
Rachit Kumar	VA	Hematology & Oncology Physician	$802.4K	$0
Bo Pang	ME	Facial Plastic Surgery Physician	$434.3K	$0
Stephan Babirak	ME	Endocrinology, Diabetes & Metabolism Physician	$400K	$0
Mainegeneral Medical Center	ME	Family Medicine Physician	$0	$375.3K
Aamir Rai	TX	Anesthesiology Physician	$334.5K	$0
David Rancourt	MA	Internal Medicine Physician	$315.4K	$0
Jose Ventura	ME	Family Medicine Physician	$50.9K	$197.8K
Ellie Mueller	ME	Interventional Cardiology Physician	$201.2K	$0
James Johnston	MN	Orthopaedic Surgery Physician	$199K	$0

Nearby Providers

Other providers in the same ZIP code as Mainegeneral Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Motivational Services Inc	ME	Voluntary or Charitable Agency	$0	$92.2M
Employment Specialists Of Maine, Inc.	ME	Mental Illness Community Based Residential Treatment Facility	$0	$84.2M
Crisis And Counseling Centers, Inc.	ME	Mental Health Counselor	$0	$21M
Gallant Therapy Services	ME	Developmentally Disabled Services Day Training Agency	$0	$20.5M
Children's Center: Early Intervention And Family Support, Inc.	ME	Specialist	$0	$13.6M
Central Maine Area Agency On Aging	ME	In Home Supportive Care Agency	$0	$13.5M
Anglez Behavioral Health Services PA	ME	Case Management Agency	$0	$12.5M
Kennebec Pharmacy And Home Care LLC	ME	Parenteral & Enteral Nutrition Supplies (DME)	$0	$11.6M
Kennebec Home Care LLC	ME	Home Health Agency	$0	$9.6M
Central Maine Area Agency On Aging	ME	Case Management Agency	$0	$8.7M

Mainegeneral Medical Center — 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