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

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

Saint Mary's Hospital, Inc. (NPI 1760426969)

Field	Value
Entity Type	Organization
Organization	Saint Mary's Hospital, Inc.
Address	56 Franklin St
City	Waterbury
State	CT
ZIP	06706
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 16, 2006

Payer Source	Total Paid
Medicaid	$163.2M
Medicare	$0

Key Findings

SAINT MARY'S HOSPITAL, INC. has no Medicare billing on file and therefore its observed activity is effectively single‑payer in the dataset; all reported revenue is Medicaid‑sourced, totaling $163.2M. This concentration means analyses of competitive position and service mix should be interpreted through the Medicaid lens rather than a dual‑payer mix.

Revenue is highly concentrated in emergency department evaluation & management: the precomputed top three Medicaid codes (99285, 99284, 99283) account for 55.9% of the provider's total Medicaid revenue. Those three codes are 99285 ($35.6M, 27.7%), 99284 ($18.1M, 14.1%), and 99283 ($18M, 14.0%), indicating that a majority of billed Medicaid dollars derive from varying acuity levels of ED visits.

The code mix points to a hospital operating with a high‑throughput emergency department and supporting acute inpatient/critical services: large claim volumes and revenue for 99285/99284/99283 are complemented by 99291 (critical care) at $2.3M (1.8%), and by hospital outpatient clinic activity via G0463 (72.9K claims, $7.3M, 5.7%). Together these codes suggest integrated ED, observation/clinic, and critical care capacity driving Medicaid revenue.

On a competitive basis within Connecticut the facility shows above‑typical ED volume for several key codes: 99285 ranks #13 of 129 (91th percentile; notably above typical state volume) and 99283 ranks #10 of 114 (92th percentile; typical, unremarkable volume). These rankings indicate the hospital is a major state‑level participant for higher‑acuity ED care, rather than a low‑volume outlier.

SAINT MARY'S displays concentrated procedural strength in GI and general surgery relative to in‑state peers. High percentile rankings include 43239 ($4.8M, 3.7%) at the 95th percentile, 45385 ($2M, 1.6%) and 45378 ($1.8M, 1.4%) each at the 98th percentile, and 47562 ($2.1M, 1.7%) at the 90th percentile; 11042 ($2.3M, 1.8%) is labeled an extreme outlier (rank #2 of 66, 98th percentile), together signaling materially elevated volume in endoscopy, colon procedures, cholecystectomy, and wound debridement compared with state peers.

Infusion and imaging services are sizable revenue contributors supporting acute care throughput: 96374 ($6.3M, 4.9%) and 96365 ($2M, 1.6%) show high infusion activity consistent with ED and oncology support, while imaging codes such as 74177 ($2.6M, 2.1%), 70450 ($2M, 1.5%), and chest radiograph 71046 ($2.1M, 1.6%) reflect substantial diagnostic imaging volume tied to emergency and inpatient workups. This combination implies significant ancillary capacity co‑located with the ED and procedural services.

The provider also shows breadth across diagnostics and specialty services beyond ED and procedures: 93306 echocardiography ($2.2M, 1.7%), 78452 nuclear cardiology ($2M, 1.5%), polysomnography 95810 ($1.8M, 1.4%), and SARS‑CoV‑2 testing U0003 ($1.5M, 1.1%) indicate a wide outpatient/inpatient diagnostic footprint that supports diverse clinical pathways and payer billing streams within Medicaid.

SAINT MARY'S has an established NPI tenure (enumerated 2006-06-16, ~20 years ago), and combined with a $163.2M Medicaid revenue base and the concentrated ED/procedural profile above, the hospital functions as a long‑standing regional acute care provider within Connecticut's Medicaid network rather than a newly emergent facility. The data support characterizing it as a core Medicaid hospital with notable state‑level dominance in specific high‑volume ED and GI procedural codes.

Medicaid: Complete Services Breakdown

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

591 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.	74,610	$480	$35.6M
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.	56,690	$320	$18.1M
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.	80,790	$220	$18M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	72,900	$100	$7.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	42,550	$150	$6.3M
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.	9,610	$500	$4.8M
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.	21,180	$130	$2.8M
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.	14,630	$180	$2.6M
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	3,210	$730	$2.3M
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	14,000	$170	$2.3M

Showing 1–10 of 591

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Saint Mary's Hospital, Inc. — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

591 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2350	Injection, ocrelizumab, 1 mg	4	10	1,310	$17,340	$21.6M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	11	40	21,520	$90	$8M
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.	13	130	520	$330	$5.9M
J9271	Injection, pembrolizumab, 1 mg	5	10	210	$5,070	$5.8M
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.	21	130	690	$180	$4.7M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	8	40	23,540	$140	$3.7M
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.	10	110	1,520	$140	$3.4M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	57	70	3,710	$120	$1.6M
S9480	Intensive outpatient psychiatric services, per diem	44	60	5,640	$110	$1.3M
J2505	Injection, pegfilgrastim, 6 mg	8	10	130	$2,110	$1.2M

Showing 1–10 of 591

Related Providers

Other providers that share a Tax Identification Number (TIN) with Saint Mary's Hospital, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sara Miceli	CT	Physician Assistant	$25.9K	$0

Nearby Providers

Other providers in the same ZIP code as Saint Mary's Hospital, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Trinity Health Of New England Emergency Medical Services, Inc.	CT	Ambulance	$2.5M	$13M
Franklin Medical Group, PC	CT	Internal Medicine Physician	$0	$13.5M
Middle Ct Emergency Physicians LLC	CT	Emergency Medicine Physician	$0	$6.8M
Campion Ambulance Service Inc	CT	Ambulance	$0	$4.5M
Naugatuck Valley Radiological Associates PC	CT	Diagnostic Radiology Physician	$0	$2.1M
Brass Mill Mall Dental L.L.P	CT	General Practice Dentistry	$0	$1.3M
Joseph Pruner	CT	Internal Medicine Physician	$211.3K	$0
Monica Hughes	CT	Adult Health Nurse Practitioner	$176.2K	$0
Sarah Gao	CT	Therapeutic Radiology Physician	$169.7K	$0
Reza Pakdaman	CT	Diagnostic Radiology Physician	$160.6K	$0

Saint Mary's Hospital, Inc. — Billing Profile & Reimbursement Data

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Saint Mary's Hospital, Inc. — 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