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NPI 1750332706 · Somerset, KY · Land Ambulance
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City Of Somerset is a land ambulance provider located in Somerset, Kentucky. This profile covers 6 Medicare and 7 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 | City Of Somerset |
| Address | 301 Hail Knob Rd |
| City | Somerset |
| State | KY |
| ZIP | 42503 |
| Taxonomy | Land Ambulance |
| NPI Enumerated | May 15, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.8M |
| Medicare | $1.1M |
CITY OF SOMERSET’s billing profile is dominated by ambulance transport codes, with the leading Medicare codes listed as A0427, A0425 and A0428 and the Medicaid mix led by A0427, A0425 and A0429. The top codes across both payers are specific to advanced life support emergency transport, ground mileage, and basic life support transports, which indicates the operation functions primarily as a ground ambulance/EMS provider focused on point-to-point patient transports rather than ancillary services. This code mix points to a core business of emergency and non-emergency transport with significant mileage billing.
Revenue concentration is extreme for both payers: the top three Medicare codes account for 94.3% of Medicare revenue and the top three Medicaid codes account for 98.7% of Medicaid revenue. That degree of concentration means the provider’s financial performance is highly dependent on a very small set of transport and mileage codes, increasing sensitivity to rate changes or utilization shifts in those specific services.
On payer mix, CITY OF SOMERSET reports $1.1M in lifetime Medicare revenue versus $1.8M in lifetime Medicaid revenue, so Medicaid is the larger revenue source by scale. This makes the provider more dependent on state Medicaid payment policies and utilization patterns than on Medicare for overall revenue.
Looking at Medicare detail, A0427 generated $707.8K (1.9K claims, $370 avg paid/claim) and represents 62.6% of this provider’s Medicare revenue; it ranks #362 of 6841 nationally (95th percentile; typical, unremarkable volume for this code). The next Medicare drivers are A0425 (25.4K claims, $9 avg paid/claim, $228.3K) and A0428 (683 claims, $189 avg paid/claim, $129.1K), and together the top three Medicare codes drive the vast majority of Medicare receipts. These figures characterize the Medicare book as narrowly concentrated in high-dollar ALS emergency rides plus extensive mileage billing.
Medicaid activity is even more concentrated and regionally prominent: A0427 produced $959.7K on 17.8K claims ($54 avg paid/claim) and accounts for 52.2% of Medicaid revenue while ranking #9 of 176 in-state (95th percentile; notably above typical state volume). A0425 (27.6K claims, $20 avg paid/claim, $552.2K, 30.0%) and A0429 (6.2K claims, $49 avg paid/claim, $301.8K, 16.4%) round out the top three, which together equal 98.7% of Medicaid revenue; this indicates a dominant in-state role in Medicaid-funded ALS emergency and mileage billing.
In competitive terms the provider appears to be a modest-to-typical participant nationally on Medicare for its headline codes (percentile and descriptive labels for Medicare codes are mostly “typical, unremarkable volume”), but a materially stronger player within Kentucky Medicaid for A0427 where it is described as “notably above typical state volume” and ranks in the top 10 in-state. That dual posture—not dominant nationally but regionally significant for Medicaid emergency ALS—should inform benchmarking and network decisions.
The NPI was enumerated on 2006-05-15 (~20 years ago), indicating a longstanding presence in the local EMS ecosystem. Coupled with very high ground-mileage claim counts reported for A0425 (25.4K Medicare claims and 27.6K Medicaid claims), the pattern suggests a broad geographic service footprint or frequent short/long transports rather than a narrow clinic-to-hospital shuttle operation.
Several non-transport or low-revenue codes appear at minimal volumes, underscoring the focus on transport revenue: Medicaid shows A0998 at $1.1K (30 claims, rank #13 of 17 in-state, 19th percentile; typical, unremarkable volume) and T2005 at $770 (110 claims, rank #46 of 64 in-state, 29th percentile), while Medicare includes small contributions from codes like A0426 ($4.7K). These low-dollar items signal almost all billing weight rests with core transport and mileage services rather than ancillary response or stretcher-van lines.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 1,910 | $370 | $707.8K |
| A0425 | Ground mileage, per statute mile | 25,360 | $10 | $228.3K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 680 | $190 | $129.1K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 120 | $310 | $37.5K |
| A0433 | Advanced life support, level 2 (als 2) | 40 | $540 | $22.5K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 20 | $230 | $4.7K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 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.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 17,770 | $50 | $959.7K |
| A0425 | Ground mileage, per statute mile | 27,610 | $20 | $552.2K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 6,160 | $50 | $301.8K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 2,820 | $1 | $11.3K |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation | 1,230 | $10 | $11K |
| A0998 | Ambulance response and treatment, no transport | 30 | $40 | $1.1K |
| T2005 | Non-emergency transportation; stretcher van | 110 | $10 | $770 |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 9 | 180 | 3,250 | $60 | $321.8K |
| A0425 | Ground mileage, per statute mile | 14 | 190 | 5,590 | $20 | $225.7K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 21 | 170 | 1,580 | $50 | $186K |
| T2005 | Non-emergency transportation; stretcher van | 46 | 60 | 340 | $40 | $52.5K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 17 | 100 | 660 | $10 | $15.6K |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation | 27 | 90 | 530 | $10 | $7.4K |
| A0998 | Ambulance response and treatment, no transport | 13 | 20 | 90 | $20 | $7.2K |
Other providers in the same ZIP code as City Of Somerset, ranked by combined Medicare and Medicaid revenue.
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