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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Health Care Alliance, Inc. (NPI 1730128760)

Key Findings

Field	Value
Entity Type	Organization
Organization	Health Care Alliance, Inc.
Address	105 S Eisenhower Dr
City	Beckley
State	WV
ZIP	25801
Taxonomy	Emergency Medicine Physician
NPI Enumerated	June 5, 2006

Payer Source	Total Paid
Medicaid	$25M
Medicare	$0

HEALTH CARE ALLIANCE, INC. is effectively a single-payer Medicaid biller at scale: it reports $25M in total Medicaid revenue and has no Medicare billing on file. The absence of Medicare activity combined with sizeable Medicaid receipts indicates the provider’s revenue base is concentrated in state Medicaid flows rather than in dual Medicare/Medicaid mixes.

Revenue is highly concentrated in three emergency department E/M codes: 99285 ($12.7M, 50.8%), 99284 ($8.2M, 32.9%), and 99283 ($2.8M, 11.1%), which together account for 94.8% of this provider’s total Medicaid revenue. This concentration shows the business is overwhelmingly driven by ED evaluation-and-management services rather than office-based or ancillary lines.

The code mix and top-paid codes indicate an emergency department operational profile with a high proportion of moderate-to-high acuity visits. 99285 and 99284 are the top revenue drivers (average paid/claim $143 and $104 respectively), and the presence of 99291 (3.6K claims, $146 avg paid/claim, $526.3K revenue) and procedure codes such as 31500 and 92950 confirm occasional critical-care and airway/resuscitation activity, but these are small contributors to total revenue.

STATE competitive standing for high-acuity ED care is dominant: 99285 ranks #1 of 132 providers in-state (100th percentile; extreme outlier) and 99284 ranks #2 of 168 providers in-state (99th percentile; extreme outlier). Those rankings indicate this provider operates at volumes far above typical in-state peers for the same ED visit levels, positioning it as a major statewide provider of high-acuity emergency services.

Lower-acuity ED volume and ancillary services are present but much smaller in share: 99283 ranks #5 of 163 (98th percentile; notably above typical state volume) and EKG interpretation 93010 appears as a routine ancillary (14.5K claims, $30 avg paid/claim, $433.9K revenue) at a typical-to-high percentile (7 of 152, 96th percentile). Overnight facility service 99053 (9K claims, $27 avg paid/claim, $244K revenue) also appears and ranks #2 of 9 in-state (88th percentile), supporting that the site operates extended or 24-hour coverage.

Payment-per-claim patterns align with clinical acuity: the top three ED codes carry average paid/claim values of $143 (99285), $104 (99284), and $59 (99283), which combined with very large claim counts produce the bulk of Medicaid revenue. These per-claim rates, paired with extreme volume for high-acuity codes, are the primary drivers of the provider’s $25M Medicaid footprint.

Tenure and presence: the provider’s NPI was enumerated on 2006-06-05 (~20 years ago), indicating long-established operations in the market. That duration, plus the outsized state rankings for core ED codes, suggests an entrenched emergency care presence rather than a recent or transient entrant.

Because Medicaid represents virtually all reported billing revenue and Medicare activity is absent, the provider’s financial exposure is concentrated on Medicaid reimbursement policies and state-level payer dynamics. This single-payer concentration heightens sensitivity to Medicaid rate changes or state programmatic shifts that affect ED reimbursement and high-acuity visit coding.

Medicaid: Complete Services Breakdown

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	89,050	$140	$12.7M
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.	79,230	$100	$8.2M
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.	46,930	$60	$2.8M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	3,610	$150	$526.3K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	14,460	$30	$433.9K
99053	The provider renders overnight services at a 24 hour facility.	9,040	$30	$244K
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.	1,120	$30	$31.4K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	380	$60	$21.9K
12001	This CPT code is used for the simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including the hands and feet) that are 2.5 cm or less in…	470	$30	$13K
31500	The provider inserts a flexible tube into the trachea (windpipe) typically via the mouth in an emergency situation to maintain an open airway in a patient with a compromised airway.	110	$90	$9.1K

Showing 1–10 of 22

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Health Care Alliance, Inc. — 4 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

22 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	1	130	2,090	$210	$1.5M
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	170	3,350	$120	$1.1M
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.	5	160	3,690	$80	$714.8K
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…	1,136	1,270	1,240	$30	$245K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	6	60	170	$130	$189.3K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	80	100	3,310	$10	$140.7K
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.	53	100	1,200	$50	$135.9K
99053	The provider renders overnight services at a 24 hour facility.	2	10	250	$30	$99K
S9088	Services provided in an urgent care center (list in addition to code for service)	18	20	190	$20	$89.8K
99292	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	4	10	120	$80	$57.7K

Showing 1–10 of 22

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Raleigh General Hospital LLC	WV	General Acute Care Hospital	$0	$36.4M
Community Health Systems, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$35M
Fmrs Health Systems Inc	WV	Community/Behavioral Health Agency	$0	$27M
Jan-care Ambulance Of Raleigh County Inc	WV	Land Ambulance	$1.9M	$20.8M
Appalachian Regional Healthcare, Inc	WV	General Acute Care Hospital	$0	$18.3M
Raleigh County Commission On Aging, Inc.	WV	Home Health Agency	$0	$16.7M
Mountain State Home Health Care Inc	WV	Nursing Care Agency	$0	$16.5M
Family Options Providers, LLC.	WV	Community/Behavioral Health Agency	$0	$16.1M
Raleigh County Commission On Aging, Inc.	WV	Home Health Agency	$0	$13.8M
Community Health Systems, Inc.	WV	Obstetrics & Gynecology Physician	$0	$11.9M

Health Care Alliance, Inc. — Billing Profile & Reimbursement Data

Sign up for Health Care Alliance, Inc. — Billing Profile & Reimbursement Data policy alerts

Health Care Alliance, Inc. — Billing Profile & Reimbursement Data

Sign up for Health Care Alliance, Inc. — Billing Profile & Reimbursement Data policy alerts

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Michael Johnson	WV	Family Medicine Physician	$155.9K	$0
Michael Londner	VA	Emergency Medicine Physician	$89.2K	$0
David Deuell	WV	Emergency Medicine Physician	$63.4K	$0
Lonnie Berry	WV	Emergency Medicine Physician	$61.5K	$0
Joshua Muyderman	DE	Emergency Medicine Physician	$23.2K	$0