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NPI 1740735513 · Greenville, SC · Land Ambulance
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Prisma Health-upstate is a land ambulance provider located in Greenville, South Carolina. This profile covers 7 Medicare and 8 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 | Prisma Health-upstate |
| Address | 10 Quest Dr |
| City | Greenville |
| State | SC |
| ZIP | 29605 |
| Taxonomy | Land Ambulance |
| NPI Enumerated | August 22, 2016 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.5M |
| Medicaid | $3.7M |
PRISMA HEALTH-UPSTATE appears to be a land-ambulance operator whose Medicare billing is dominated by advanced life support, basic life support, and mileage codes — the provider reports $4.5M in total Medicare revenue with A0427, A0428, and A0425 each contributing about $1.2M. That code mix (ALS 1 emergency, BLS non‑emergency, and ground mileage) signals core pre-hospital transport operations that bill both emergency and non-emergency runs.
Medicaid billing is similarly concentrated in ambulance/mileage services: total Medicaid revenue is $3.7M and the top three Medicaid codes A0427 ($1.5M, 41.0%), A0429 ($1.0M, 27.3%), and A0425 ($803.6K, 21.7%) together account for 90.0% of Medicaid revenue. This concentration points to a business model heavily reliant on a small set of transport services rather than a broad mix of ancillary ambulance procedures.
The provider shows a concentrated revenue dependence in both payers: precomputed measures report that the top 3 Medicare codes account for 76.5% of Medicare revenue and the top 3 Medicaid codes account for 90.0% of Medicaid revenue. Such concentration raises operational sensitivity to reimbursement or utilization shifts for a few key HCPCS codes, especially A0427/A0429 and A0425 which drive most dollars.
On Medicare measures PRISMA is a high-volume national performer for several codes: A0425 (Ground mileage) is an extreme outlier, ranking #74 of 8934 providers nationally (99th percentile); A0427 ranks #213 of 6841 (97th percentile) and A0428 ranks #99 of 2772 (96th percentile). Those rank/percentile positions indicate PRISMA operates at substantially higher-than-typical national volume for core ambulance and mileage services, making it a major national participant for those Medicare codes.
State-level competitive standing on Medicaid is strong for mileage and emergency transport but mixed across codes. PRISMA ranks in the top decile in-state for A0425 (rank #7 of 108, 94th percentile) and is a top in-state performer for A0427 (rank #9 of 90), while A0429 is a solid but more modest in-state participant (rank #18 of 85, 80th percentile); additionally, A0434 (Specialty care transport) is listed #1 of 3 in-state, suggesting a unique but narrow position in specialty transport.
A0425 shows a pronounced statistical signal: on Medicare it is called out as an "extreme outlier, far above typical national volume" with 144.2K claims, $8 avg paid/claim, and $1.2M in revenue. That volume profile is consistent with either a very large geographic service footprint or operational emphasis on long-mileage transports, and it materially shapes the provider's Medicare revenue mix.
Tenure data indicate that the entity's NPI was enumerated on 2016-08-22 (~10 years ago), so these high-volume ambulance operations have been in the market for about a decade under this enumeration. That length of activity supports interpretation of the billing patterns as established operational behavior rather than very recent changes.
Beyond high-volume mileage and emergency transport, the provider posts substantial counts for both ALS and BLS on both payers (Medicare: A0427 3.1K claims and A0428 5.9K claims; Medicaid: A0427 13.1K claims and A0429 10.8K claims), reinforcing that PRISMA runs a mix of emergency ALS and BLS services across payers. Analysts should treat reimbursement or utilization shifts in those core codes as having outsized impact given the provider's concentration and role as a high-volume outlier on Medicare and a top-tier performer in-state for several Medicaid codes.
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 |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 3,140 | $380 | $1.2M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 5,880 | $200 | $1.2M |
| A0425 | Ground mileage, per statute mile | 144,160 | $10 | $1.2M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 2,470 | $320 | $783K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 550 | $240 | $130.3K |
| A0433 | Advanced life support, level 2 (als 2) | 150 | $550 | $82.7K |
| A0434 | Specialty care transport (sct) | 120 | $640 | $75.8K |
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.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 13,120 | $120 | $1.5M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 10,780 | $90 | $1M |
| A0425 | Ground mileage, per statute mile | 34,940 | $20 | $803.6K |
| A0434 | Specialty care transport (sct) | 1,100 | $240 | $260.3K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 1,140 | $50 | $60.5K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 8,130 | $10 | $48.8K |
| A0382 | Bls routine disposable supplies | 300 | $0 | $0 |
| A0398 | Als routine disposable supplies | 110 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other South Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Carolina median
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 18 | 90 | 1,720 | $90 | $577.3K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 9 | 90 | 1,720 | $110 | $525.8K |
| A0425 | Ground mileage, per statute mile | 7 | 110 | 3,520 | $20 | $193.8K |
| A0434 | Specialty care transport (sct) | 1 | 10 | 40 | $230 | $91.4K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 4 | 10 | 170 | $80 | $68.3K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 4 | 50 | 830 | $10 | $31.6K |
| A0398 | Als routine disposable supplies | 5 | 10 | 150 | $1 | $10 |
| A0382 | Bls routine disposable supplies | 2 | 10 | 220 | $0 | $0 |
Other providers in the same ZIP code as Prisma Health-upstate, ranked by combined Medicare and Medicaid revenue.
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