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

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

Maine Coast Regional Health Facilities (NPI 1740249739)

Key Findings

Field	Value
Entity Type	Organization
Organization	Maine Coast Regional Health Facilities
Address	50 Union St
City	Ellsworth
State	ME
ZIP	04605
Taxonomy	General Acute Care Hospital
NPI Enumerated	March 20, 2006

Payer Source	Total Paid
Medicaid	$24.8M
Medicare	$0

MAINE COAST REGIONAL HEALTH FACILITIES is effectively single‑payer on file: there is no Medicare billing recorded and the provider’s entire documented federal payer revenue is Medicaid totaling $24.8M. This makes Medicaid the sole observable federal revenue stream and indicates any Medicare-facing growth or risk is not visible in the claims data provided.

Revenue is highly concentrated in a few outpatient and emergency services: the top three Medicaid codes (G0463, 99285, 99284) together account for 57.8% of the provider's Medicaid revenue. G0463 alone represents $8.1M (37.7% of Medicaid revenue), while 99285 and 99284 contribute $2.2M (10.2%) and $2.1M (9.9%) respectively, signaling the clinic/outpatient assessment visit plus high‑ and moderate‑acuity ED visits drive most Medicaid dollars.

The code mix points to a hospital operating a busy emergency department and substantial outpatient clinic activity. High volumes and revenue in ED evaluation/management codes 99285, 99284, and 99283 combined with the large G0463 outpatient clinic share suggest core service lines are ED care and hospital outpatient assessment/management rather than primarily inpatient or elective procedural services.

Ambulatory and primary‑care style E/M activity is also material: 99213 (37.9K claims, $1.1M, 5.1% of Medicaid revenue) ranks in the 96th percentile statewide and is described as notably above typical state volume, with 99214 also high (26.7K claims, $1.1M, 5.0% of Medicaid revenue). These high percentiles indicate the provider performs substantially more routine office/outpatient visits for established patients than most in‑state peers, reinforcing a mixed model of ED plus outpatient clinic throughput.

Service breadth across infusion, rehabilitation, imaging and diagnostics supports a full‑service community hospital operating model. High counts and revenue appear for infusion/IV medication codes (96374, 96365, 96375), physical and occupational therapy (97530, 97110), imaging (74177 CT abdomen/pelvis, 70450 CT head, 71046 chest radiograph), and diagnostic cardiology (93306), which together point to on‑site capabilities for acute, post‑acute and ambulatory procedures.

There are several codes where the provider’s statewide standing is meaningfully above peers for specific service lines: 99213 (96th percentile, notably above typical), 99214 (94th percentile) and vaccine administration 90471 (93rd percentile, notably above typical). Conversely, many high‑revenue ED and outpatient codes are characterized as typical, unremarkable volume for the state (e.g., G0463 at the 81st percentile, 99285 at the 58th percentile), indicating strong but not dominant market positions for core acute services.

A few niche or high‑relative‑rank items are present and may reflect service specialization or small‑sample effects: wound debridement 97602 ranks #1 of 2 providers in‑state (100th percentile) but is described as typical, unremarkable volume for the code in absolute terms, suggesting the top rank likely reflects a small in‑state provider set rather than large absolute volume. Similarly, COVID and respiratory panel codes (U0004, 87636) appear at modest state percentiles and represent routine diagnostic throughput rather than outlier activity.

The provider has been enumerated on the NPI since 2006‑03‑20 (~20 years ago), indicating an established presence in its market. Given the concentration of Medicaid revenue in clinic and ED codes and the absence of Medicare billing on file, competitive analysis and contract negotiation should focus on Medicaid rates, outpatient/ED throughput, and capacity for infusion, imaging and ambulatory services rather than Medicare inpatient or outpatient Medicare business.

Medicaid: Complete Services Breakdown

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

372 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	112,360	$70	$8.1M
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.	7,020	$310	$2.2M
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.	11,250	$190	$2.1M
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.	11,450	$110	$1.3M
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…	37,950	$30	$1.1M
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…	26,670	$40	$1.1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	7,170	$100	$730.9K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	12,580	$60	$717K
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.	2,830	$170	$466.5K
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.	5,580	$80	$446.1K

Showing 1–10 of 372

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Maine Coast Regional Health Facilities — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

372 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	11	60	18,740	$60	$4.6M
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.	28	60	9,550	$100	$1.5M
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.	24	60	4,690	$180	$1.5M
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.	29	50	11,590	$60	$942.4K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	11	30	6,230	$70	$515.4K
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.	23	60	2,380	$90	$345.7K
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…	25	30	880	$110	$338.4K
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.	20	30	200	$250	$316.8K
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.	28	40	5,020	$40	$302.3K
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.	11	40	3,970	$60	$299.5K

Showing 1–10 of 372

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Logan General Hospital LLC	WV	General Acute Care Hospital	$0	$43.5M
Logan General Hospital LLC	WV	Podiatrist	$0	$4.9M
Thomas Flynn	NY	Ophthalmology Physician	$1M	$0
Gabriel Thornton	GA	Critical Care Medicine (Internal Medicine) Physician	$241.4K	$0
Kozhaya Mallah	WV	Cardiovascular Disease Physician	$160.1K	$0
Ajit Chary	IL	Pulmonary Disease Physician	$101.4K	$0
Kamel Marzouk	WV	Pulmonary Disease Physician	$87.1K	$0
Peter Copithorne	ME	Orthopaedic Surgery Physician	$76K	$0
Susan Miller	ME	Family Medicine Physician	$65K	$0
Rodolfo Aldir	FL	Cardiovascular Disease Physician	$63.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kidspeace National Centers Of New England Inc	ME	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$16.8M
Kidspeace National Centers Of New England, Inc.	ME	Community/Behavioral Health Agency	$0	$15M
Kidspeace National Centers Of New England Inc	ME	Psychiatric Residential Treatment Facility	$0	$8.6M
Special Children's Friends, Inc.	ME	Early Intervention Provider Agency	$0	$8.1M
Emergency Medicine Services Of Maine, LLC	ME	Emergency Medicine Physician	$0	$5.4M
Coastal Med-tech Corp.	ME	Customized Equipment (DME)	$0	$2.4M
Total Renal Care Inc	ME	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.6M
Caring Hands Of Maine	ME	Dentist	$0	$1.3M
Cesc, LLC	ME	Ambulatory Surgical Clinic/Center	$617.6K	$534.5K
Bucksport Regional Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$562.4K

Maine Coast Regional Health Facilities — 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