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

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

Sentara Hospitals (NPI 1811957681)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sentara Hospitals
Address	830 Kempsville Rd
City	Norfolk
State	VA
ZIP	23502
Taxonomy	General Acute Care Hospital
NPI Enumerated	March 24, 2006

Payer Source	Total Paid
Medicaid	$79.7M
Medicare	$0

SENTARA HOSPITALS in Norfolk has no Medicare billing on file and is effectively a single-payer (Medicaid) hospital in the available dataset, with Total Medicaid revenue reported as $79.7M and Total Medicare revenue recorded as none. This makes Medicaid the sole reported source of fee-for-service revenue in this profile and frames all downstream observations around Medicaid activity and market position.

Revenue concentration is dominated by a small set of emergency and infusion-related codes: the top three Medicaid codes account for 48.0% of the provider’s total Medicaid revenue, indicating that nearly half of the $79.7M is driven by a concentrated mix of high-volume ED E/M and IV fluid administration services. That concentration signals a clinical footprint weighted toward acute, emergency, and inpatient-support procedures rather than a broad outpatient clinic mix.

Emergency department evaluation-and-management codes are the single largest drivers of revenue: 99283 ($12.6M, 18.7% of Medicaid revenue), 99284 ($10.5M, 15.7%), and 99285 ($6.7M, 10.0%) together form a major portion of the top revenue-producing services. This pattern indicates a high ED throughput with a mix of low-to-high complexity visits and supports an operational focus on emergency care capacity and throughput management.

The provider is a clear statewide outlier on several high-volume ED and supportive-care codes. SENTARA ranks at very high percentiles for key codes: 99283 ranks #16/626 (98th percentile, labeled an extreme outlier), 99284 ranks #18/620 (97th percentile, notably above typical), and 96361 ranks #6/90 (94th percentile, notably above typical). These placements position the hospital as a major regional center for emergency visits and IV hydration services relative to in-state peers.

High volumes of infusion and supportive therapies are prominent: 96361 ($9.2M, 13.6% of Medicaid revenue) and related infusion administration codes (96360, 96365, 96366) appear throughout the top-25 list, reflecting substantial use of IV fluids and medication infusions. Combined with high ED E/M volumes, this suggests the hospital treats a large number of acute medical and dehydration/infusion cases requiring time-based IV services.

Several ancillary imaging and therapy services show typical-to-elevated volumes consistent with a full-service acute hospital: CT and CTA codes (74177, 74176, 71275, 70450) and advanced imaging (78815 PET/CT at $1.5M) are present in the top-25, indicating on-site diagnostic imaging capability supporting emergency and inpatient workflows. These revenue lines are generally in the 71st–94th percentile ranges, which is consistent with an acute-care hospital that maintains comprehensive imaging and diagnostic services.

Operational metrics indicate high utilization of therapy and testing services that support both acute and post-acute care: physical therapy exercise and evaluation codes (97110, 97530, 97161) and diagnostic testing (80307 drug screens) are in the top-25 with elevated in-state percentiles (many at or above the 95th percentile). This suggests integrated rehab and utilization of point-of-care testing as part of ED, inpatient, or observation pathways.

Tenure is long-standing: the NPI was enumerated on 2006-03-24 (approximately 20 years ago), indicating the provider has an established operating history in the market. That tenure, combined with the high percentile rankings on multiple high-volume codes, supports the interpretation that SENTARA is an entrenched acute-care provider with sustained Medicaid activity.

While several codes are extreme or notable outliers in-state (for example J3490 ranks #3/125 at the 98th percentile as an extreme outlier and 94640 ranks #5/214 at the 98th percentile), most high-revenue imaging and therapy codes are in the typical-to-notably-above range rather than extreme outliers. This mixed statistical footprint indicates dominant ED and infusion volumes alongside expected hospital-level diagnostic and therapy services, rather than broad, uniform extreme outlier behavior across all service lines.

Medicaid: Complete Services Breakdown

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

388 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	79,000	$160	$12.6M
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.	66,290	$160	$10.5M
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.	33,000	$280	$9.2M
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.	40,090	$170	$6.7M
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.	22,480	$150	$3.3M
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.	16,980	$180	$3M
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…	57,840	$50	$2.8M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	16,530	$160	$2.6M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	18,170	$130	$2.3M
G0378	Hospital observation service, per hour	7,590	$240	$1.8M

Showing 1–10 of 388

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Sentara Hospitals — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

388 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	6	90	9,030	$280	$3.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	19	70	3,200	$110	$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.	25	340	160	$130	$1.3M
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.	16	630	90	$140	$1.1M
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.	10	140	3,240	$160	$1M
G0378	Hospital observation service, per hour	22	80	3,650	$160	$1M
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.	18	620	70	$120	$1M
A6253	Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing	2	10	4,420	$210	$918.9K
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.	11	180	2,950	$140	$783.2K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	34	260	3,950	$80	$769.6K

Showing 1–10 of 388

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tremont Road Dental Super, P.C.	VA	General Practice Dentistry	$0	$63.5M
Sentara Medical Group	VA	Family Medicine Physician	$0	$48.7M
Emergency Physicians Of Tidewater	VA	Emergency Medicine Physician	$0	$47.9M
Community Alternative Inc	VA	Community/Behavioral Health Agency	$0	$44.3M
Life's Journey	VA	Adult Mental Health Clinic/Center	$0	$24.4M
Keys To Success Family & Developmental Services	VA	Community/Behavioral Health Agency	$0	$16.1M
Advantage Home Care, LLC	VA	Home Health Agency	$0	$15.7M
National Counseling Group, Inc	VA	Mental Health Counselor	$0	$14.5M
Childrens Medical Group Inc	VA	Pediatrics Physician	$0	$9.1M
Pediatric Services Of America, LLC	VA	Nursing Care Agency	$0	$9.1M

Sentara Hospitals — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sentara Hospitals	VA	General Acute Care Hospital	$0	$88M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$78.5M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$57.9M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$52.3M
Sentara Hospitals	VA	General Acute Care Hospital	$0	$21.9M
Sentara Hospitals	VA	Air Ambulance	$977.3K	$170.6K
Michele Henry	VA	Chiropractor	$16.7K	$0