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NPI 1710370390 · Middletown, CT · Land Ambulance
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Middlesex Hospital is a land ambulance provider located in Middletown, Connecticut. This profile covers 5 Medicare and 5 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Middlesex Hospital |
| Address | 28 Crescent St |
| City | Middletown |
| State | CT |
| ZIP | 06457 |
| Taxonomy | Land Ambulance |
| NPI Enumerated | March 6, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $2M |
| Medicare | $1.4M |
Taxonomy and code mix indicate a ground-ambulance operation: the provider is listed as Land Ambulance and its highest-revenue CPT/HCPCS codes are core ambulance transports (A0428, A0429, A0427) plus ground mileage (A0425) and occasional specialty care transport (A0434). This composition suggests routine provision of both emergency (ALS and BLS emergency) and non-emergency ground transport services rather than ancillary or hospital-based inpatient procedures.
Revenue concentration is high across both payers: the top 3 Medicare codes account for 75.2% of Medicare revenue, driven by A0428 (27.7%), A0425 (25.9%), and A0429 (21.5%). Likewise, the top 3 Medicaid codes account for 80.6% of Medicaid revenue, concentrated in A0429 (32.6%), A0427 (27.9%), and A0425 (20.0%), indicating the business is highly dependent on a narrow set of transport services.
Payer mix favors Medicaid in scale: reported lifetime revenue is $1.4M from Medicare versus $2M from Medicaid, so Medicaid represents the larger share of public-payer revenue for this provider. The provider is therefore not single-payer; it maintains meaningful billing activity in both programs but derives a greater dollar volume from Medicaid.
Medicare competitive standing is mixed but not dominant nationally: A0425 ranks #365 of 8934 (96th percentile) and A0429 ranks #646 of 7808 (92th percentile), while A0428 and A0427 sit at #430 of 2772 (84th percentile) and #1233 of 6841 (82th percentile) respectively, each labeled 'typical, unremarkable volume' for the code. These ranks suggest established national participation—notable in some measures like mileage—but not a market‑dominant position among Medicare ambulance billers.
Medicaid (in‑state) competitive profile also shows strengths and limitations: A0425 ranks #18 of 128 (87th percentile) indicating relatively strong in‑state mileage billing, while A0429 and A0427 rank #34 of 122 (73th percentile) and #21 of 80 (75th percentile) and are described as 'typical, unremarkable volume.' Overall, the provider appears to be a solid regional participant with particular strength on mileage reimbursements but not clearly dominant across all top Medicaid transport codes.
Ground mileage (A0425) is a notable operational and revenue driver for both payers: it generated $365.2K (25.9% of Medicare) and $404.1K (20.0% of Medicaid). Given its high national and state percentiles, mileage reimbursement is an important, recurring component of this provider’s business model rather than a marginal revenue source.
A discrepancy between Medicare and Medicaid exists for non‑emergency BLS (A0428): A0428 produces $390.2K (27.7% of Medicare) and $361.5K (17.9% of Medicaid), yet the in‑state Medicaid rank for A0428 is #13 of 17 (25th percentile) and is labeled 'typical, unremarkable volume.' This suggests that while A0428 is a top Medicare revenue driver, the provider ranks relatively low among local peers for Medicaid non‑emergency BLS transports, pointing to payer-specific utilization or contracting differences.
Tenure and stability: the provider’s NPI was enumerated on 2015-03-06 (~11 years ago), indicating roughly a decade of billing under this identifier. Coupled with concentrated revenue in a small set of ambulance codes, the pattern is consistent with a focused, stable land‑ambulance operator serving both emergency and non‑emergency transport needs over multiple years.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 1,720 | $230 | $390.2K |
| A0425 | Ground mileage, per statute mile | 52,170 | $10 | $365.2K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 850 | $360 | $302.9K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 620 | $430 | $264.7K |
| A0434 | Specialty care transport (sct) | 120 | $740 | $84.6K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 4,330 | $150 | $657.9K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 3,350 | $170 | $562.8K |
| A0425 | Ground mileage, per statute mile | 12,240 | $30 | $404.1K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 7,230 | $50 | $361.4K |
| S0215 | Non-emergency transportation; mileage, per mile | 2,650 | $10 | $29.1K |
How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Connecticut median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 13 | 20 | 17,430 | $80 | $2.7M |
| S0215 | Non-emergency transportation; mileage, per mile | 13 | 20 | 10,360 | $20 | $2.6M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 34 | 120 | 1,930 | $180 | $1.3M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 21 | 80 | 900 | $190 | $1.3M |
| A0425 | Ground mileage, per statute mile | 18 | 130 | 2,510 | $10 | $141.8K |
Other providers in the same ZIP code as Middlesex Hospital, ranked by combined Medicare and Medicaid revenue.
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