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.

Middlesex Hospital (NPI 1760454334)

Field	Value
Entity Type	Organization
Organization	Middlesex Hospital
Address	28 Crescent St
City	Middletown
State	CT
ZIP	06457
Taxonomy	General Acute Care Hospital
NPI Enumerated	February 7, 2006

Payer Source	Total Paid
Medicaid	$116.1M
Medicare	$0

Key Findings

MIDDLESEX HOSPITAL’s reimbursement profile is effectively single‑payer: there is no Medicare billing on file and all reported facility revenue is Medicaid‑based, totaling $116.1M. This means the hospital’s financial exposure and utilization signal in these data reflect Medicaid patterns rather than a blended Medicare/Medicaid mix.

Revenue is highly concentrated in emergency department evaluation and management services: the top three Medicaid codes (99285, 99284, 99283) together account for 54.6% of the provider’s total Medicaid revenue. Individually those codes are $23.7M (26.3%), $12.8M (14.3%), and $12.6M (14.0%), indicating that high‑acuity, moderate, and low ED visits are the dominant revenue drivers.

The code mix indicates a hospital with heavy ED throughput and associated acute care activity. Alongside the three ED E/M codes, the presence of 99291 (critical care, $1.5M, 1.7%) and multiple infusion/IV administration codes such as 96374 ($4.8M, 5.3%) and 96360 ($1.4M, 1.5%) supports a profile of frequent high‑acuity encounters and time‑sensitive treatments typical of a general acute care hospital.

While the ED codes drive the bulk of revenue, MIDDLESEX shows above‑typical volumes in rehabilitation services: 97110 reports $5.2M (5.8%) and ranks #11 of 348 providers in‑state (97th percentile), flagged as notably above typical state volume. This suggests a substantial outpatient or inpatient therapy footprint that complements its ED/acute work.

Behavioral health and outpatient psychiatric services are another visible specialty area. Codes including H2019 ($3.7M, 4.1%), S9480 ($2.6M, 2.8%, rank #6 of 57 at the 91st percentile), 90834 ($2.5M, 2.8%, 97th percentile), and 90791 ($973.4K, 1.1%, 98th percentile) indicate sizable investment and utilization in psychotherapy, psychiatric evaluation, and intensive outpatient programming.

Competitive standing is mixed by service line: for the core ED E/M codes the hospital ranks in strong but not dominant statewide positions (99285 rank #17 of 129, 88th percentile; 99284 rank #25 of 127, 81st percentile; 99283 rank #15 of 114, 88th percentile), characterized in the data as typical or unremarkable volume for those codes. By contrast, the provider is a clear outlier in select non‑ED lines — e.g., 97110 and 90834 sit at the 97th percentile (notably above typical), and 90791 at the 98th percentile — signaling local strength in rehab and behavioral health relative to in‑state peers.

Ancillary diagnostics and pandemic testing are meaningful but secondary revenue contributors: U0003 (SARS‑CoV‑2 testing) appears at $1.5M (1.6%) and ranks #6 of 46 providers (89th percentile), while imaging codes such as 74177 ($2.2M, 2.5%) and 70450 ($1.4M, 1.5%) sit in typical statewide percentiles. These items support the ED and outpatient volumes rather than driving the overall Medicaid revenue base.

The provider has an established presence in the national registry with an NPI enumeration date of 2006-02-07 (~20 years ago), indicating long tenure in the market; combined with the concentration in ED revenue and notable strengths in rehab and behavioral health, this points to a mature acute hospital with significant ancillary service lines anchored by Medicaid reimbursement.

Medicaid: Complete Services Breakdown

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

506 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.	54,420	$440	$23.7M
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.	51,110	$250	$12.8M
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.	67,460	$190	$12.6M
97110	Therapeutic 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…	93,710	$60	$5.2M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	36,930	$130	$4.8M
H2019	Therapeutic behavioral services, per 15 minutes	14,530	$250	$3.7M
S9480	Intensive outpatient psychiatric services, per diem	24,110	$110	$2.6M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	35,020	$70	$2.5M
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.	12,880	$170	$2.2M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	2,880	$520	$1.5M

Showing 1–10 of 506

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

Middlesex Hospital — 3 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

506 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	16	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.	17	130	520	$330	$5.9M
H2019	Therapeutic behavioral services, per 15 minutes	10	20	10,120	$220	$4.8M
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.	25	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.	9	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.	15	110	1,520	$140	$3.4M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	9	10	2,820	$160	$1.6M
S9480	Intensive outpatient psychiatric services, per diem	6	60	5,640	$110	$1.3M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	11	30	17,770	$50	$1.1M
96413	Chemotherapy 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…	40	40	1,910	$190	$1.1M

Showing 1–10 of 506

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Middlesex Hospital	CT	Family Nurse Practitioner	$0	$7.5M
Middlesex Hospital	CT	Land Ambulance	$1.4M	$2M
Middlesex Hospital	CT	Home Health Agency	$0	$2.9M
Middlesex Hospital	CT	Family Medicine Physician	$0	$2.7M
Matthew Moyer	CT	Primary Care Nurse Practitioner	$220.7K	$0
Bikash Chapagain	CA	Nephrology Physician	$181.3K	$0
George Khouri	NC	Neurology Physician	$139.3K	$0
Meredith Lindner	CT	Internal Medicine Physician	$123K	$0
Zhenghao Zhang	MA	Internal Medicine Physician	$105.6K	$0
Jorge Donado	CT	Hospitalist Physician	$100.7K	$530

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Health Center Inc	CT	Federally Qualified Health Center (FQHC)	$0	$533.4M
Rushford Center Inc	CT	Substance Abuse Rehabilitation Facility	$0	$23M
Pursuecare, LLC	CT	Addiction Medicine (Preventive Medicine) Physician	$0	$9.8M
Gilead Community Services, Inc.	CT	Adult Mental Health Clinic/Center	$0	$8.9M
Mhs Primary Care, Inc	CT	Family Medicine Physician	$0	$5.4M
City Of Middletown	CT	Local Education Agency (LEA)	$0	$4.2M
Surgi-care, Inc	CT	Prosthetic/Orthotic Supplier	$0	$4.2M
Unison Health Services, Inc.	CT	Home Health Agency	$0	$3.8M
Healthdrive Behavioral Health Services, PLLC	CT	Geriatric Psychiatry Physician	$0	$3.2M
Dme Living Well, LLC	CT	Oxygen Equipment & Supplies (DME)	$0	$2.5M

Middlesex Hospital — 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