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

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

St Joseph Mercy Hospital (NPI 1780658443)

Key Findings

Field	Value
Entity Type	Organization
Organization	St Joseph Mercy Hospital
Address	5301 Huron River Drive
City	Ypsilanti
State	MI
ZIP	48197
Taxonomy	General Acute Care Hospital
NPI Enumerated	February 17, 2006

Payer Source	Total Paid
Medicaid	$65.2M
Medicare	$0

This provider reports no Medicare billing on file and $65.2M in lifetime Medicaid revenue, which makes its billing footprint effectively single‑payer (Medicaid) in the available data. Any analysis of revenue mix and competitive positioning should therefore be framed against Medicaid volumes and policies rather than Medicare benchmarks.

Revenue is highly concentrated in emergency department evaluation-and-management codes: the top three Medicaid codes 99285 ($12.9M, 25.4%), 99284 ($9.4M, 18.4%), and 99283 ($6M, 11.7%) together account for 55.5% of this provider's total Medicaid revenue. This concentration signals that over half of Medicaid dollars flow from ED visits alone rather than elective or outpatient procedural lines.

The code mix points to an operational profile of a full-service acute hospital with a high-volume emergency department plus significant outpatient diagnostics and infusion services. Supporting evidence includes a hospital outpatient clinic code G0463 ($4.1M, 8.1%), high-volume infusion/IV administration codes such as 96374 ($3.4M, 6.6%) and related IV administration series (96361, 96375, 96360, 96365), and imaging volumes including 74177 ($1.3M, 2.6%) and 70450 ($739.8K, 1.5%).

Against in-state peers the hospital operates as a high-volume but not dominant ED provider: 99285 ranks #55 of 404 (87th percentile; typical, unremarkable volume), 99284 ranks #51 of 477 (89th percentile; typical, unremarkable volume), and 99283 ranks #35 of 447 (92th percentile; typical, unremarkable volume). These ranks indicate the facility handles above-average ED volumes relative to many peers but does not occupy the very top tiers of state volume for these codes.

There are specific Medicaid line items where this provider is an outlier in state volume, notably high-end lab and drug-testing codes. G0480 (definitive drug testing) ranks #6 of 151 (97th percentile; notably above typical state volume) and 80307 (presumptive drug testing) ranks #9 of 235 (97th percentile; notably above typical state volume), while 99282 ranks #12 of 259 (96th percentile; notably above typical state volume); together these indicate an unusually large throughput of toxicology and basic ED-level testing.

The payer‑level acuity mix within the ED is broad: 99285 carries a higher per‑claim payment ($443 avg paid/claim) and represents the largest single Medicaid revenue line at $12.9M, while 99284 ($243 avg paid/claim) and 99283 ($130 avg paid/claim) show substantial mid- and lower-acuity volumes. Combined with observation services (G0378, $510.3K, 1.0%), this suggests a high-turnover ED that also routes patients into short-term observation rather than immediate inpatient admission in many cases.

Tenure and facility type support the operational picture: the NPI was enumerated on 2006-02-17 (~20 years ago) and the taxonomy is General Acute Care Hospital, consistent with a long-standing acute-care center serving a broad case mix including emergency, infusion, imaging, and laboratory services. This longevity is relevant when comparing ranks and volumes to newer entrants.

From a payer and operational risk perspective, the combination of $65.2M in Medicaid revenue with no Medicare billing on file creates concentration risk tied to Medicaid policies and contract rates, and the fact that 55.5% of Medicaid revenue is driven by three ED codes (99285, 99284, 99283) underscores exposure to shifts in ED utilization, reimbursement edits, or state-level outpatient payment reforms. The elevated state percentiles on drug-testing and presumptive testing (G0480, 80307) also highlight a service-line where capacity or pricing leverage could materially affect overall Medicaid revenue.

Medicaid: Complete Services Breakdown

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

503 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.	29,150	$440	$12.9M
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.	38,490	$240	$9.4M
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.	45,860	$130	$6M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	55,270	$80	$4.1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	35,870	$90	$3.4M
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.	20,290	$70	$1.4M
U0003	Infectious 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…	23,570	$60	$1.4M
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.	10,370	$130	$1.3M
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	24,260	$40	$873.3K
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.	24,990	$30	$824.6K

Showing 1–10 of 503

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

St Joseph Mercy Hospital — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

503 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	35	150	5,330	$50	$2.8M
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.	55	400	1,510	$190	$2.6M
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.	51	480	1,350	$110	$1.7M
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.	35	450	1,540	$90	$1.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	15	150	7,610	$90	$1.2M
G0378	Hospital observation service, per hour	19	100	2,820	$180	$1.1M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	6	10	1,870	$270	$984K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	10	30	300	$920	$652.6K
Q5104	Injection, infliximab-abda, biosimilar, (renflexis), 10 mg	7	10	170	$1,100	$643K
U0003	Infectious 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…	16	160	2,720	$60	$546.6K

Showing 1–10 of 503

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lisa Faia	MI	Retina Specialist (Ophthalmology) Physician	$1.7M	$0
Ashvani Dass	MI	Retina Specialist (Ophthalmology) Physician	$1.6M	$0
Irfan Hameed	TX	Interventional Cardiology Physician	$954.2K	$0
Tracey Venning	MI	Emergency Medicine Physician	$218.5K	$0
Alfred Mansour	MI	Clinical Psychologist	$174.1K	$0
Steven Anthony	FL	Orthopaedic Surgery Physician	$163.8K	$0
James Ramirez	MN	Dermatopathology (Pathology) Physician	$148.6K	$0
Chinmaya Shelgikar	MI	Vascular Surgery Physician	$139.4K	$0
Gary Sarafa	MI	Family Medicine Physician	$136.3K	$0
Michael Chartrand	NM	Internal Medicine Physician	$126.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Living Network	MI	Voluntary or Charitable Agency	$0	$129.4M
Synod Residential Services	MI	Mental Illness Community Based Residential Treatment Facility	$0	$15.1M
Home Sweet Home Care Services LLC	MI	Home Health Agency	$0	$14.9M
Dawn, Inc	MI	Substance Abuse Rehabilitation Facility	$0	$13.5M
Huron Valley Radiology PC	MI	Diagnostic Radiology Physician	$0	$12.5M
Michigan Learning Community, LLC	MI	Behavior Analyst	$0	$11.5M
Community Residence Corporation	MI	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$10.8M
Iha Health Services Corporation	MI	Hospitalist Physician	$0	$7.9M
Personal Touch Home Health Care Services Inc	MI	Home Health Agency	$0	$7.8M
Probility Therapy Services	MI	Physical Therapist	$0	$5.6M

St Joseph Mercy 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