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NPI 1710934617 · Roanoke, VA · Air Ambulance
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Carilion Clinic Patient Transportation, LLC is a air ambulance provider located in Roanoke, Virginia. This profile covers 7 Medicare and 9 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 | Carilion Clinic Patient Transportation, LLC |
| Address | 431 Mcclanahan St. Sw |
| City | Roanoke |
| State | VA |
| ZIP | 24014 |
| Taxonomy | Air Ambulance |
| NPI Enumerated | May 27, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $6.1M |
| Medicare | $2.6M |
Payer mix shows a Medicaid-heavy book of business: the provider reports $2.6M in total Medicare revenue versus $6.1M in total Medicaid revenue, so Medicaid is the larger payer by scale for this entity rather than it being effectively single‑payer. This split suggests contracts and utilization patterns oriented more toward state Medicaid programs while still maintaining meaningful Medicare activity.
Despite the listed taxonomy of Air Ambulance, the claim mix is dominated by ground-transport codes — notably A0425 (ground mileage), A0428 (BLS non-emergency), and A0427 (ALS 1 emergency) — indicating the operation functions largely as a ground ambulance/transport service with heavy mileage billing rather than an aero-medical fleet. The prominence of mileage and basic/advanced life support codes implies routine patient transfers and both non-emergency and emergency response capability.
Revenue concentration is high on Medicare: the top 3 Medicare codes account for 88.0% of this provider's total Medicare revenue, centered on A0425 (42.8% of Medicare revenue), A0428 (29.1%), and A0427 (16.1%). This concentration means Medicare performance and contract terms for those specific codes will disproportionately affect the provider's Medicare revenue stream.
Medicaid billing is also concentrated: the top 3 Medicaid codes account for 74.5% of this provider's total Medicaid revenue, led by A0425 (40.0% of Medicaid revenue), A0427 (17.5%), and A0428 (17.0%). State-level reimbursement and authorization practices for mileage and ALS/BLS transports therefore drive most of the provider's Medicaid receipts.
Nationally for Medicare, the provider is an extreme outlier on A0425 — ranking #62 of 8,934 providers (99th percentile) — indicating an unusually large volume or billing intensity for ground mileage compared with peers. By contrast, its A0428 and A0427 Medicare ranks (93rd and 90th percentiles respectively) are high but described as typical levels for established ambulance providers, so its unique footprint is primarily in mileage.
In-state competitive standing on Medicaid is strong for mileage and BLS: A0425 ranks #12 of 273 providers in-state (96th percentile; notably above typical state volume), while A0428 and A0427 rank at or above the 90th percentile in-state. These rankings mark the provider as a major Medicaid transport supplier in Virginia on mileage and a top-tier participant for basic and advanced life-support transports.
Operational mix reflects both non-emergency and emergency workflows: Medicare shows significant revenue from A0428 (3.7K claims) and A0427 (1.1K claims), while Medicaid volumes include large claim counts for A0428 (18.2K), A0427 (9.3K), and A0429 (8.1K). That distribution indicates a sustained pipeline of scheduled/non-emergency transports alongside substantial emergency activity, with mileage reimbursement amplifying revenues across both payers.
The provider has an established tenure — NPI enumerated/registered 2006-05-27 (~20 years ago) — which, combined with concentrated code-level revenue and high state/national ranks on mileage, suggests a long-standing operational footprint and likely embedded referral or contract relationships that support its high-volume ground-transport business.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 159,700 | $10 | $1.1M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 3,660 | $210 | $760.7K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 1,070 | $390 | $419.5K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 440 | $330 | $143.6K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 560 | $250 | $139.5K |
| A0434 | Specialty care transport (sct) | 30 | $690 | $17.2K |
| A0433 | Advanced life support, level 2 (als 2) | 20 | $550 | $12.7K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 7 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.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 39,320 | $60 | $2.4M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 9,350 | $110 | $1.1M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 18,180 | $60 | $1M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 8,070 | $100 | $822.9K |
| T2005 | Non-emergency transportation; stretcher van | 3,130 | $170 | $526.3K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 2,070 | $60 | $122K |
| A0433 | Advanced life support, level 2 (als 2) | 310 | $220 | $69K |
| T2049 | Non-emergency transportation; stretcher van, mileage; per mile | 3,130 | $1 | $9.4K |
| A0225 | Ambulance service, neonatal transport, base rate, emergency transport, one way | 30 | $110 | $3K |
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T2005 | Non-emergency transportation; stretcher van | 26 | 120 | 760 | $250 | $656.3K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 8 | 70 | 1,160 | $80 | $511.5K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 18 | 200 | 1,250 | $90 | $326K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 24 | 220 | 1,390 | $80 | $307.1K |
| A0425 | Ground mileage, per statute mile | 12 | 270 | 2,410 | $20 | $166.7K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 7 | 30 | 250 | $130 | $149.4K |
| A0433 | Advanced life support, level 2 (als 2) | 4 | 10 | 200 | $160 | $33.2K |
| T2049 | Non-emergency transportation; stretcher van, mileage; per mile | 26 | 120 | 760 | $1 | $12.3K |
| A0225 | Ambulance service, neonatal transport, base rate, emergency transport, one way | 3 | 10 | 30 | $110 | $11K |
Other providers in the same ZIP code as Carilion Clinic Patient Transportation, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Carilion Medical Center | VA | General Acute Care Hospital | $0 | $124.7M |
| Carilion Medical Center | VA | Multi-Specialty Clinic/Center | $0 | $73.4M |
| Carilion Medical Center | VA | Emergency Medicine Physician | $0 | $18.1M |
| Carilion Emergency Services, Inc. | VA | Urgent Care Clinic/Center | $0 | $11.1M |
| Quest Diagnostics Clinical Laboratories Inc | VA | Clinical Medical Laboratory | $3.9M | $186.2K |
| Mark Kochenderfer | VA | Hematology & Oncology Physician | $2.5M | $0 |
| Amanda Gillespie-twardy | VA | Hematology & Oncology Physician | $1.9M | $0 |
| Suzan Merten | VA | Hematology & Oncology Physician | $1.8M | $90 |
| Padmaja Mallidi | VA | Hematology & Oncology Physician | $1.7M | $0 |
| Fairlawn Surgery Center, LLC | VA | Ambulatory Surgical Clinic/Center | $997K | $572.4K |
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