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

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

North Shore Medical Center, Inc. (NPI 1730121633)

Key Findings

Field	Value
Entity Type	Organization
Organization	North Shore Medical Center, Inc.
Address	81 Highland Ave
City	Salem
State	MA
ZIP	01970
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 12, 2006

Payer Source	Total Paid
Medicaid	$137.7M
Medicare	$0

This provider is effectively a Medicaid-focused hospital: there is no Medicare billing on file and total Medicaid revenue is $137.7M, so the organization’s documented payer mix is dominated by Medicaid rather than a dual Medicare/Medicaid balance. The absence of Medicare lines suggests limited or no Medicare fee-for-service activity captured in the dataset.

Revenue is highly concentrated in a small set of Medicaid codes: the precomputed top three Medicaid codes account for 45.5% of the provider’s total Medicaid revenue. That concentration indicates a small number of service lines are driving nearly half of reported Medicaid receipts.

The billing profile points to a very busy emergency department as a primary service line. High-volume ED E/M codes include 99284 (111.3K claims, $17.7M revenue, 20.2% of Medicaid revenue), 99283 (63.6K claims, $9.6M revenue, 11.0%), and 99285 (45.7K claims, $8.5M revenue, 9.7%), together reflecting large ED throughput across low, moderate, and high decision-making complexity. Those volumes and per-claim amounts are consistent with an acute-care hospital that manages a substantial emergency caseload.

Infusion and dehydration treatment represent another major operational focus: 96361 appears as a top revenue driver with 35.2K claims, $12.6M revenue (14.3% of Medicaid revenue), and ranks strongly in-state. Additional IV/infusion related codes such as 96365 (18K claims, $2.4M) and 96360 (13.5K claims, $1.7M) reinforce that a meaningful share of clinical activity involves parenteral therapies and fluid management.

Several acute hospital services and procedural specialties also contribute materially to Medicaid revenue, showing a broad service mix beyond the ED. Notable examples include endoscopy/biopsy 43239 (4.6K claims, $2.6M), colonoscopy with polypectomy 45385 (3.5K claims, $2.4M), CT abdomen/pelvis 74177 (17K claims, $2.3M), and head CT 70450 (16.7K claims, $2M), which together indicate integrated diagnostic and procedural capacity typical of a general acute care hospital.

The provider’s competitive standing within Massachusetts is strong for several high-revenue codes. 99284 is labeled an "extreme outlier"—rank #9 of 827 providers in-state (99th percentile)—and other ED and procedure codes frequently sit in the top percentiles (for example, 99283 at the 97th percentile and 45385 at the 95th percentile), signaling that this facility is a major state-level provider for those services. Conversely, some high-count lab and testing codes (U0003, 80307, 87491, 87591) are described as "typical, unremarkable volume," implying routine testing throughput rather than exceptional dominance in those niches.

The mix of high-volume ED visits, substantial observation-hour billing (G0378: 27.3K claims, $5M, 5.7% of Medicaid revenue), and frequent diagnostic testing (U0003: 43.2K claims, $2.9M; 80307: 44.7K claims, $1.5M) suggests operational emphasis on acute evaluation, short-stay observation, and rapid diagnostics. This pattern aligns with emergency and short-term inpatient workflows rather than a predominance of long-term ambulatory specialty clinics.

The provider has an established operating history, with NPI enumeration on 2006-06-12 (~20 years ago), indicating long tenure in the market. Given the heavy Medicaid revenue concentration and the operational profile dominated by ED, infusion, observation, and procedural/diagnostic services, payer negotiations and cash-flow stability will be particularly sensitive to Medicaid reimbursement rates and policy changes affecting emergency and infusion-related care.

Medicaid: Complete Services Breakdown

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

636 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.	111,340	$160	$17.7M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	35,180	$360	$12.6M
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.	63,640	$150	$9.6M
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.	45,700	$190	$8.5M
G0378	Hospital observation service, per hour	27,320	$180	$5M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	43,250	$70	$2.9M
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.	4,630	$560	$2.6M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	17,990	$140	$2.4M
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	3,460	$700	$2.4M
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.	16,950	$140	$2.3M

Showing 1–10 of 636

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

North Shore Medical Center, Inc. — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

636 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	9	10	470	$2,670	$6.3M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	8	90	7,560	$350	$4.2M
S9485	Crisis intervention mental health services, per diem	40	110	1,250	$540	$3.2M
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…	36	50	1,870	$210	$1.4M
G0378	Hospital observation service, per hour	11	70	7,250	$100	$1.3M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	10	80	4,380	$140	$1.1M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	31	110	5,660	$30	$1.1M
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.	29	520	120	$130	$1M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	10	130	1,830	$60	$974.3K
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	18	60	1,750	$260	$907.4K

Showing 1–10 of 636

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lynn Community Health, Inc.	MA	Federally Qualified Health Center (FQHC)	$0	$138.3M
Mass General Brigham Medical Group Northern Massachusetts Inc	MA	Emergency Medicine Physician	$0	$30.2M
North Shore Medical Center, Inc.	MA	Psychiatric Hospital Unit	$0	$9.8M
James Mcintyre	MA	Radiation Oncology Physician	$327.2K	$0
Emad Younan	MA	Pain Medicine (Anesthesiology) Physician	$275.7K	$0
David Rabin	MA	Cardiovascular Disease Physician	$247.3K	$630
Anna Litvak	MA	Neurology Physician	$184.9K	$0
Scott Gonzales	MA	Anesthesiology Physician	$177.5K	$0
Richard Mugge	MA	Otolaryngology Physician	$159.5K	$0
James Demetroulakos	MA	Otolaryngology Physician	$154.7K	$2.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Justice Resource Institute, Inc.	MA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$186.1M
North Shore Community Health, Inc	MA	Federally Qualified Health Center (FQHC)	$0	$32.2M
East Point Adhc	MA	Adult Day Care Clinic/Center	$0	$22.9M
Stay Well Ahdc, Inc.	MA	Adult Care Home Facility	$0	$8.5M
Commonwealth Diagnostics International, Inc.	MA	Clinical Medical Laboratory	$609.6K	$73.7K
Ramakrishna Gaddipati	MA	Ophthalmology Physician	$393K	$0
Thomas Kingston	MA	Urology Physician	$341.3K	$0
Jannet Ung	MA	Ophthalmology Physician	$338.2K	$3K
Mark Laspina	MA	Urology Physician	$332.7K	$0
Robert Levy	MA	Ophthalmology Physician	$314.7K	$0

North Shore Medical Center, Inc. — 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