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    OpenPayerNPI Medicare & MedicaidHolyoke Medical Center, Inc.
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    Holyoke Medical Center, Inc. — Billing Profile & Reimbursement Data

    NPI 1750395737 · Holyoke, MA · General Acute Care Hospital

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    Holyoke Medical Center, Inc. is a general acute care hospital provider located in Holyoke, Massachusetts. This profile covers 0 Medicare and 523 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationHolyoke Medical Center, Inc.
    Address575 Beech St
    CityHolyoke
    StateMA
    ZIP01040
    TaxonomyGeneral Acute Care Hospital
    NPI EnumeratedJuly 28, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$125.1M
    Medicare$0

    Key Findings

    HOLYOKE MEDICAL CENTER, INC. has no Medicare billing on file and records $125.1M in lifetime Medicaid revenue, making its current claims footprint effectively single‑payer Medicaid rather than a mixed Medicare/Medicaid profile. This absence of Medicare activity should be treated as a defining characteristic of its payer mix when comparing network exposure or reimbursement risk across peers.

    Revenue is highly concentrated in a small set of E/M and ED codes: the top three Medicaid codes (99212, 99283, 99284) together account for 45.6% of the provider's total Medicaid revenue. Individually these codes represent $15.5M (17.9%), $12.4M (14.3%), and $11.6M (13.4%) respectively, indicating that nearly half of Medicaid dollars flow through low‑ to moderate‑acuity outpatient and emergency evaluation/management services.

    The code mix signals a high‑volume emergency department and outpatient clinic operation: the highest revenue drivers are E/M codes used for established and emergency visits (99212, 99283, 99284), and supporting activity includes G0463 (hospital outpatient clinic visits) and high volumes of 99214/99213/99202. This pattern is consistent with a community acute care hospital that channels throughput through ED and outpatient assessment rather than specialty inpatient or Medicare outpatient billings.

    HOLYOKE shows a strong statewide competitive position on many front‑line E/M codes: 99212 ranks #6 of 953 providers in‑state (99th percentile, labeled an "extreme outlier"), 99202 ranks #2 of 276 (100th percentile, "extreme outlier"), and 99283 ranks #14 of 547 (98th percentile, "extreme outlier"). These ranks indicate the provider is a dominant volumetric player in Massachusetts for several foundational outpatient and ED services.

    Beyond E/M, the hospital maintains notable diagnostic and procedural capacity. Imaging and endoscopy codes such as 43239 (rank #6 of 123, 96th percentile), 74176 (rank #6 of 121, 96th percentile), and 45380 (rank #8 of 95, 93rd percentile) appear in the top revenue list, supporting a hypothesis of in‑house CT and endoscopy throughput that complements its ED/outpatient volumes.

    Infusion, infusion adjuncts, and therapy services form a meaningful secondary revenue stream: 96361 accounts for $7.7M (8.9% of Medicaid revenue) with 23K claims (rank #15 of 87, 84th percentile), 96365 appears with 10.7K claims and $1.7M revenue, and 97110 brings $3.5M across 59.4K claims (rank #16 of 746, 98th percentile). Together these entries suggest recurring therapeutic and infusion care workflows supporting ED and outpatient populations.

    The provider is an outlier in high‑volume infectious disease testing and newer tech codes: 87635 (SARS‑CoV‑2 NAAT) shows 29.9K claims with $1.3M revenue and ranks #6 of 717 (99th percentile, "extreme outlier"), while 0241U (new code, 17.7K claims, $1.2M, rank #3 of 91, 98th percentile) and U0003 (15.8K claims, $965.5K) reflect large throughput in newer or pandemic‑era testing channels. This indicates substantial testing capacity and uptake of novel codes during the measurement period.

    The provider's NPI was enumerated on 2006-07-28 (~20 years ago), signaling a long tenure in the market; coupled with repeated 99th and 98th percentile ranks across core outpatient and ED codes, HOLYOKE appears to be an entrenched regional site for Medicaid care delivery. However, the complete lack of Medicare billing on file means its clinical footprint and contracting considerations will be materially different from peer hospitals that serve mixed Medicare/Medicaid populations.

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    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

    Medicaid: Complete Services Breakdown

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

    523 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    99212The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…100,830$150$15.5M
    99283The 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.78,350$160$12.4M
    99284The 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.73,920$160$11.6M
    96361The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.23,030$330$7.7M
    97110Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…59,400$60$3.5M
    99285The 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.20,000$170$3.3M
    G0463Hospital outpatient clinic visit for assessment and management of a patient111,740$30$3.1M
    99214The 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…71,290$40$2.7M
    J2357Injection, omalizumab, 5 mg1,400$1,820$2.6M
    99202The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…14,480$170$2.5M

    Showing 1–10 of 523

    • More pages

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. Massachusetts median

    523 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    41899Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.510470$2,670$6.3M
    96361The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.15907,560$350$4.2M
    S9485Crisis intervention mental health services, per diem481101,250$540$3.2M
    J2357Injection, omalizumab, 5 mg7101,540$850$1.6M
    96413Chemotherapy 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…24501,870$210$1.4M
    G0378Hospital observation service, per hour39707,250$100$1.3M
    96365The 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.25804,380$140$1.1M
    G0463Hospital outpatient clinic visit for assessment and management of a patient121105,660$30$1.1M
    99285The 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.61520120$130$1M
    U0003Infectious 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…241301,830$60$974.3K

    Showing 1–10 of 523

    • More pages

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Holyoke Medical Center, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Sidney Kahn IvMAVascular & Interventional Radiology Physician$945K$0
    Yuyang ZhangMDDiagnostic Radiology Physician$920.4K$0
    Rachel NelsonTNDiagnostic Radiology Physician$383.2K$0
    Michael ChillMADiagnostic Radiology Physician$372.2K$410
    Alexander HarvinIADiagnostic Radiology Physician$353.1K$0
    Ghousia AlikhanMARheumatology Physician$329.8K$0
    Robert YohannanNYNephrology Physician$290.1K$0
    John NicasioMAEndocrinology, Diabetes & Metabolism Physician$280.9K$0
    Alice Mary Graham-brownMAPsychiatry Physician$155.1K$118.4K
    Scott WhiteILDiagnostic Radiology Physician$264.9K$0

    Nearby Providers

    Other providers in the same ZIP code as Holyoke Medical Center, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Commonwealth Of MassachusettsMACase Management Agency$0$249.7M
    Total Wellness Centers, LLCMAClinical Medical Laboratory$1.9M$77.2M
    River Valley Counseling Center, IncMAMental Health Clinic/Center (Including Community Mental Health Center)$0$64.7M
    Holyoke Health Center Inc.MACommunity Health Clinic/Center$0$59.3M
    Access Care Partners Inc.MAVoluntary or Charitable Agency$0$38.9M
    Access Care Partners Inc.MAVoluntary or Charitable Agency$0$34.2M
    New England Family Dentistry, PCMAPoint of Service$0$12.7M
    Holyoke Capital Jv, LLCMAPsychiatric Hospital$645.1K$11.5M
    The Mercy Hospital IncMAPsychiatric Hospital$0$11M
    Lakes/national Emergency Physicians IncMAEmergency Medicine Physician$0$10.6M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicaid Revenue by Year vs. Massachusetts Providers
    7 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. Massachusetts Distribution
    Holyoke Medical Center, Inc. — 12 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Massachusetts