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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Carolinas Medical Center (NPI 1699979732)

Key Findings

Field	Value
Entity Type	Organization
Organization	Carolinas Medical Center
Address	1025 Morehead Medical Dr
City	Charlotte
State	NC
ZIP	28204
Taxonomy	Surgical Critical Care Physician
NPI Enumerated	June 13, 2007

Payer Source	Total Paid
Medicaid	$52.9M
Medicare	$0

This provider effectively operates as a Medicaid-focused practice: there is no Medicare billing on file and total Medicaid revenue is $52.9M, indicating near-total reliance on Medicaid as the payer for this NPI. Analysts should treat CAROLINAS MEDICAL CENTER as functionally single‑payer in the available claims data rather than a mixed Medicare/Medicaid operation.

Revenue is concentrated in a small set of high-volume evaluation and management codes: the top three Medicaid codes (99284, 99285, and 99232) together account for 38.9% of the provider's total Medicaid revenue. Specifically, 99284 generated $8.5M (16.9%), 99285 generated $6.8M (13.5%), and 99232 generated $4.3M (8.5%), highlighting a heavy dependence on ED and inpatient E/M services.

The code mix points to a hospital-based, high-acuity service footprint. Prominent ED codes (99284 and 99285) and subsequent inpatient care codes (99232, 99233) alongside critical care code 99291 indicate the provider is delivering substantial emergency, inpatient, and critical care services consistent with the Surgical Critical Care Physician taxonomy.

Neonatal and newborn care are a meaningful secondary service line: codes such as 99469 ($3.2M, 6.3%), 99479 ($2.4M, 4.8%), 99480 ($2M, 4.0%), and 99460 ($1.5M, 2.9%) appear high in the revenue mix. Several of these neonatal codes rank at or near the top statewide (99479 and 99480 rank #1 of 22, 99460 ranks #1 of 113), signaling a notable NICU/newborn care role in the provider's operations.

Multiple individual codes are statistical outliers in-state, demonstrating a dominant local market position for specific services. For example, 99232 ranks #4 of 514 (99th percentile; extreme outlier), 99215 ranks #4 of 1128 (100th percentile; extreme outlier), and 99291 ranks #3 of 144 (99th percentile; extreme outlier), each indicating volumes far above typical state peers for those services.

Emergency department activity skews toward higher-acuity visits: 99284 produced $8.5M and ranks #14 of 325 (96th percentile; notably above typical state volume), while 99285 produced $6.8M and ranks #13 of 281 (96th percentile; notably above typical state volume). Lower-acuity ED codes (e.g., 99283) appear in the list but at more typical statewide levels, implying case-mix skewed to moderate and high complexity.

Operationally, high revenue from time- and complexity-based E/M codes — including discharge management codes 99239 ($1.4M, rank #2 of 199, 99th percentile; extreme outlier) and 99238 ($1.2M, rank #2 of 240, 100th percentile; extreme outlier) — suggests significant inpatient throughput and clinician time per encounter. Combined with the critical care and ED volumes, this pattern points to sustained demand for intensive, resource-heavy inpatient and emergency services.

The provider has an established tenure in the market, with NPI enumerated on 2007-06-13 (~19 years ago). Coupled with $52.9M in Medicaid revenue and numerous top statewide ranks (multiple 99th–100th percentile placements), the data characterize CAROLINAS MEDICAL CENTER as an established, large Medicaid provider in North Carolina for emergency, inpatient, critical care, and neonatal services.

Medicaid: Complete Services Breakdown

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

120 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	102,400	$80	$8.5M
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.	63,840	$110	$6.8M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	92,430	$50	$4.3M
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…	67,020	$60	$4M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	36,150	$90	$3.2M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	11,680	$270	$3.2M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	26,370	$90	$2.4M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	34,860	$70	$2.4M
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	23,660	$80	$2M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	6,940	$280	$1.9M

Showing 1–10 of 120

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Carolinas Medical Center — 19 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

120 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	14	330	6,130	$130	$2.7M
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.	81	320	6,160	$120	$2.1M
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.	13	280	2,690	$130	$1.6M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3	20	2,430	$300	$1.5M
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	3	10	1,880	$290	$1.4M
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	20	3,950	$100	$740.3K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	24	30	50	$620	$410.2K
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	150	1,340	$80	$395.9K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	1	20	2,270	$90	$369.8K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	27	60	1,440	$110	$309.4K

Showing 1–10 of 120

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carolinas Medical Center	NC	General Acute Care Hospital	$0	$178.2M
The Charlotte-mecklenburg Hospital Authority	NC	General Acute Care Hospital	$0	$58.1M
The Charlotte-mecklenburg Hospital Authority	NC	General Acute Care Hospital	$0	$56.5M
The Charlotte-mecklenburg Hospital Authority	NC	General Acute Care Hospital	$0	$42.8M
The Charlotte-mecklenburg Hospital Authority	NC	General Acute Care Hospital	$0	$38.1M
Carolinas Physicians Network Inc	NC	Psychologist	$0	$29.4M
The Charlotte-mecklenburg Hospital Authority	NC	General Acute Care Hospital	$0	$20.7M
Carolinas Medical Center	NC	Psychiatric Hospital Unit	$0	$20.6M
The Charlotte-mecklenburg Hospital Authority	NC	General Acute Care Hospital	$0	$20.1M
Carolinas Medical Center	NC	Pediatrics Physician	$0	$17.8M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Presbyterian Hospital	NC	General Acute Care Hospital	$0	$33.5M
Maxim Healthcare Services, Inc.	NC	Home Health Agency	$0	$27.9M
Carolina Asthma And Allergy Center PA	NC	Allergy & Immunology Physician	$0	$18.8M
Carolina Medicorp Enterprises, LLC	NC	Urgent Care Clinic/Center	$0	$13.3M
Carolinas Physicians Network Inc.	NC	Vascular Surgery Physician	$0	$8.9M
Hazem El-gamal	NC	MOHS-Micrographic Surgery Physician	$1M	$0
Noelle Williams	NC	Radiation Oncology Physician	$713K	$0
Jahan Mohiuddin	NC	Radiation Oncology Physician	$566.7K	$0
Marc Carruth	NC	MOHS-Micrographic Surgery Physician	$499.3K	$0
Joanna Young	NC	Internal Medicine Physician	$459.9K	$0

Carolinas 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