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.

Mainehealth (NPI 1760436216)

Field	Value
Entity Type	Organization
Organization	Mainehealth
Address	22 Bramhall St
City	Portland
State	ME
ZIP	04102
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 20, 2006

Payer Source	Total Paid
Medicaid	$142.6M
Medicare	$0

Key Findings

MAINEHEALTH is effectively a single‑payer Medicaid provider in the available data: there is no Medicare billing on file and reported Medicaid revenue totals $142.6M. This concentration makes Medicaid the principal source of fee‑for‑service revenue in the dataset and means analyses of clinical volume and business lines should be driven by Medicaid activity.

Revenue is highly concentrated in a small set of outpatient and emergency codes: the top three Medicaid codes (G0463, 99284, 99285) together account for 54.8% of the provider’s total Medicaid revenue. Individually these codes generate $22.6M (G0463, 23.3%), $16.6M (99284, 17.1%), and $14.1M (99285, 14.5%), indicating a reliance on outpatient clinic and higher‑acuity emergency department E/M services for the majority of Medicaid dollars.

The code mix and claim volumes point to very high emergency department throughput and hospital outpatient clinic activity: G0463 shows 318.8K claims, 99284 has 105.2K claims, and 99285 has 53.8K claims, while additional ED codes (99283, 99282, G0381–G0383) also appear with large claim counts. These volumes — together with high ranks and percentiles for core ED codes — indicate MAINEHEALTH operates a high‑volume acute care and ED hub for Medicaid patients rather than a low‑acuity ambulatory clinic.

MAINEHEALTH is a dominant in‑state provider for multiple high‑acuity ED codes and infusion/infusion‑related administration: 99284 and 99285 both rank #1 in‑state at the 100th percentile and are described as "extreme outlier" volumes, and 96374 (IV push administration) ranks #1 of 34 providers and is also an "extreme outlier." These rankings signal market leadership in emergency and infusion services within Maine’s Medicaid population.

The provider’s service mix also reflects substantial oncology and procedural ambulatory care: high‑cost drug and oncology codes appear (J9271 pembrolizumab $5.5M, J1745 infliximab $2.5M, 96413 chemotherapy $1.9M, 77386 IMRT $2.6M, 78815 PET $1.3M). Coupled with large counts for infusion administration codes (96374: 25.3K claims; 96365: 17.2K claims), this pattern is consistent with an on‑site infusion/oncology suite and radiation services supporting cancer care for Medicaid patients.

Beyond ED and oncology, MAINEHEALTH provides a range of procedural and diagnostic services at scale: imaging and diagnostic procedure volumes include 74177 CT Abd/Pelvis (12.4K claims), 71046 chest x‑ray (30.8K claims), and 43239 endoscopic biopsy (3.8K claims), each with notable in‑state percentile rankings. These lines reinforce its role as a full‑service acute hospital that funnels high outpatient diagnostic and procedural volume through its facilities.

There are notable specialty and pediatric procedural services within the Medicaid mix: G0330 facility services for dental rehabilitation ($1.1M) and 42820 tonsil/adenoid removal ($1M) both rank #1 in‑state, indicating MAINEHEALTH provides OR‑based dental and pediatric ENT procedures for Medicaid patients that are not widely available across other Maine providers. These services diversify revenue beyond ED and oncology and suggest capability for monitored anesthesia and pediatric surgery.

MAINEHEALTH has long tenure in the data, with its NPI enumerated on 2006-05-20 (~20 years ago), which, combined with the provider’s dominant statewide ranks on multiple high‑volume codes, suggests an established market position and longstanding referral or catchment patterns for Medicaid acute care and specialty services in Portland and the surrounding region.

Medicaid: Complete Services Breakdown

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

887 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	318,820	$70	$22.6M
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.	105,210	$160	$16.6M
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.	53,830	$260	$14.1M
J9271	Injection, pembrolizumab, 1 mg	830	$6,700	$5.5M
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.	41,470	$110	$4.6M
J1459	Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg	3,060	$920	$2.8M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	25,250	$100	$2.6M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	11,010	$230	$2.6M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1,180	$2,080	$2.5M
G0383	Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	15,030	$160	$2.4M

Showing 1–10 of 887

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

Mainehealth — 15 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

887 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	3	10	1,500	$4,760	$6.4M
96165	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	5	10	22,450	$200	$5M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	3	60	18,740	$60	$4.6M
J1459	Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg	1	10	1,620	$980	$1.6M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	1	10	7,510	$230	$1.6M
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.	1	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.	1	60	4,690	$180	$1.5M
Q9991	Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg	2	10	630	$1,490	$1.4M
G0383	Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	1	10	7,680	$160	$1.2M
G0382	Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is…	1	10	9,500	$110	$1.1M

Showing 1–10 of 887

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mainehealth	ME	Community/Behavioral Health Agency	$0	$115M
Mainehealth	ME	General Acute Care Hospital	$0	$70.7M
Mainehealth	ME	General Acute Care Hospital	$0	$40M
Mainehealth	ME	General Acute Care Hospital	$0	$31.5M
Mainehealth	ME	General Acute Care Hospital	$0	$22.7M
Mainehealth	ME	Rural Health Clinic/Center	$0	$16.7M
Mainehealth	ME	Multi-Specialty Clinic/Center	$0	$10.9M
Mainehealth	ME	Rural Health Clinic/Center	$0	$10M
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.8M
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.6M

Nearby Providers

Other providers in the same ZIP code as Mainehealth, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shalom House, Inc.	ME	Mental Illness Community Based Residential Treatment Facility	$0	$81.9M
Mercy Hospital	ME	General Acute Care Hospital	$0	$35.5M
Maxim Healthcare Services, Inc.	ME	Home Health Agency	$0	$28.1M
Quality Care Access, LLC	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$17.2M
Portland Community Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$12.9M
Al-shawk Home Healthcare, LLC	ME	Personal Care Attendant	$0	$7M
Maine Eye Center, PA	ME	Ophthalmology Physician	$0	$6.1M
Hand Of Mercy Health Care, LLC	ME	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.1M
Mainehealth	ME	General Acute Care Hospital	$0	$5.5M
Merrimack River Medical Services, Inc.	ME	Substance Use Disorder Rehabilitation Clinic/Center	$253.7K	$4.6M

Mainehealth — Billing Profile & Reimbursement Data

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Mainehealth — 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