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NPI 1821135963 · Danville, KY · General Acute Care Hospital
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Ephraim Mcdowell Regional Medical Center Incorporated is a general acute care hospital provider located in Danville, Kentucky. This profile covers 0 Medicare and 338 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Ephraim Mcdowell Regional Medical Center Incorporated |
| Address | 217 S 3rd St |
| City | Danville |
| State | KY |
| ZIP | 40422 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | January 30, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $60M |
| Medicare | $0 |
This provider is effectively single‑payer in the datasets: there is no Medicare billing on file and all reported lifetime federal revenue is Medicaid, totaling $60M. The absence of any Medicare claims suggests payer mix and financial exposure are highly concentrated on Medicaid reimbursement streams rather than a balanced Medicare/Medicaid mix.
Revenue concentration is high within a small set of service lines: the precomputed top three Medicaid codes account for 33.5% of the provider's total Medicaid revenue, driven by 74177 (16.1%), 99285 (9.4%), and 99284 (8.0%). This indicates a substantial portion of Medicaid dollars are tied to high‑value CT imaging and high/moderate level emergency department evaluation and management services.
The procedural mix points to a hospital with heavy emergency and advanced imaging activity: 74177 has 7.8K claims and $6.3M revenue, 70450 appears with $1.5M revenue, and CTA chest 71275 contributes $927.8K. Coupled with 93306 (echocardiography) at $2.3M and 78452 (cardiac SPECT) at $1.3M, the data support a clinical profile that includes diagnostic radiology and cardiac imaging capacity alongside acute care throughput.
Emergency department throughput is a core operational driver: high‑acuity ED code 99285 shows 20.7K claims and $3.7M revenue, 99284 shows 21.9K claims and $3.1M revenue, and 99283 shows 26.2K claims and $2.7M revenue. These large claim volumes and combined multi‑million dollar revenues confirm ED services are a major revenue center for the provider under Medicaid.
Rehabilitation and therapy services are a notable ancillary business line: 97110 appears with 23K claims and $1.9M revenue (4.8% of Medicaid revenue) and 97530 with 19.3K claims and $1.8M revenue (4.5%), each ranking in the 96th percentile in‑state and labeled notably above typical state volume. This suggests a substantial outpatient or rehabilitative service footprint relative to peers.
There are clear statewide strengths and a specific outlier: the provider ranks #1 of 16 in‑state for 47563 (laparoscopic cholecystectomy) at $671.4K revenue and is described as notably above typical state volume, indicating local market leadership for that surgical procedure. For many other high‑revenue codes (e.g., 99285 at the 84th percentile, 74177 at the 75th percentile, 93306 at the 83rd percentile) the provider sits in the upper half of in‑state activity, consistent with a major regional participant rather than a low‑volume facility.
Cardiology and cardiac testing comprise a meaningful revenue slice: 93306 (echocardiography) at $2.3M (6.0%) and 78452 (cardiac SPECT) at $1.3M (3.3%) plus ECG code 93005 at $624.2K indicate established diagnostic cardiology services. The presence of both noninvasive cardiac imaging and nuclear cardiology in the top codes suggests inpatient and outpatient cardiology throughput supporting Medicaid revenue.
Tenure and operational history: the provider's NPI was enumerated on 2007-01-30 (~19 years ago), indicating long‑standing enrollment and multi‑year presence in the market; coupled with the mix of ED, imaging, surgical, and rehab volumes, this tenure is consistent with a mature regional acute‑care hospital with diversified clinical operations.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
338 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 7,790 | $810 | $6.3M |
| 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. | 20,740 | $180 | $3.7M |
| 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. | 21,890 | $140 | $3.1M |
| 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. | 26,150 | $100 | $2.7M |
| 93306 | The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent… | 4,610 | $510 | $2.3M |
| 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… | 22,990 | $80 | $1.9M |
| 97530 | The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity. | 19,250 | $90 | $1.8M |
| 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. | 5,910 | $260 | $1.5M |
| 87633 | The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for… | 4,180 | $360 | $1.5M |
| 74176 | The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs. | 2,610 | $570 | $1.5M |
Showing 1–10 of 338
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
338 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 97535 | A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease. | 182 | 310 | 830 | $120 | $3.7M |
| 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. | 67 | 280 | 7,150 | $150 | $3M |
| 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. | 39 | 240 | 4,710 | $150 | $2.6M |
| 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. | 54 | 280 | 5,700 | $120 | $2M |
| 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. | 45 | 180 | 1,870 | $280 | $1.5M |
| G0378 | Hospital observation service, per hour | 19 | 90 | 2,770 | $190 | $1.3M |
| 0202U | This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the… | 19 | 30 | 2,320 | $290 | $1.2M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 17 | 80 | 7,740 | $30 | $1.1M |
| C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) | 28 | 40 | 550 | $910 | $1.1M |
| 74176 | The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs. | 84 | 170 | 2,610 | $250 | $1M |
Showing 1–10 of 338
Other providers in the same ZIP code as Ephraim Mcdowell Regional Medical Center Incorporated, ranked by combined Medicare and Medicaid revenue.
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