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

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

Umass Memorial Medical Center, Inc. (NPI 1831151455)

Field	Value
Entity Type	Organization
Organization	Umass Memorial Medical Center, Inc.
Address	55 Lake Avenue
City	Worcester
State	MA
ZIP	01655
Taxonomy	General Acute Care Hospital
NPI Enumerated	April 6, 2006

Payer Source	Total Paid
Medicaid	$490.8M
Medicare	$0

Key Findings

UMASS MEMORIAL MEDICAL CENTER, INC. is effectively a Medicaid-focused provider: there is no Medicare billing on file and total Medicaid revenue is $490.8M. The NPI was enumerated 2006-04-06 (~20 years ago), indicating long-tenured participation in the public payer space rather than a recent entrant.

Revenue is highly concentrated in a small set of outpatient and emergency evaluation-and-management services: 99214 alone accounts for $61.6M (20.4% of Medicaid revenue), 99212 accounts for $29.3M (9.7%), and 99285 accounts for $26M (8.6%); these three codes together account for 38.7% of this provider’s total Medicaid revenue. This concentration signals that a large share of Medicaid dollars flows through high-volume clinic/ambulatory and ED encounters.

The code mix points to an operational footprint centered on high-volume outpatient clinics and an active emergency department. High-volume outpatient E/M codes such as 99214 (459.6K claims) and 99212 (206.1K claims), together with G0463 (385.5K claims, $10.4M) and observation billing G0378 (36.3K claims, $4.3M), indicate sustained ambulatory throughput and clinic-based assessment activity.

Emergency and transport services are a material component of service delivery: ED-level E/M codes 99285 (139.9K claims, $26M), 99284 (91.2K claims, $14.7M), and 99283 (93K claims, $14.9M) are all high-volume, and ambulance codes A0429 (59.4K claims, $12.8M) and A0427 (35K claims, $7.3M) together represent a notable share of revenue. These patterns are consistent with a large acute-care hospital that also functions as a regional ED and transport hub.

Infusion and specialty therapy lines are significant revenue drivers beyond E/M care: chemotherapy/infusion codes 96413 (27.3K claims, $8.6M) and 96415 (10.6K claims, $5.6M), biologic/injectable codes J1745 ($6.1M) and J2350 ($8.5M), and complex radiation delivery 77386 ($3.6M) show the hospital provides substantial oncology and infusion services. The presence of both high-volume infusions and add-on infusion hours indicates sustained oncology throughput and ancillary infusion resources.

High-volume laboratory and COVID testing appear as meaningful ancillary services: 87637 (54.3K claims, $6.5M) ranks #1 in-state and U0004 (78.3K claims, $5.2M) ranks #2 in-state, showing the hospital managed large testing volumes during relevant reporting periods. These test volumes likely reflect both inpatient/ED demand and outpatient screening programs tied to pandemic-era care.

Statewide competitive standing is dominant for many Medicaid codes: multiple codes are labeled “extreme outlier” or “notably above typical,” with top ranks including 99214 at #2 of 5039 providers (100th percentile) and 99212 at #1 of 953 providers (100th percentile). Across ED, outpatient, testing, and infusion codes the provider consistently ranks in the 98th–100th percentiles, signaling a major market position in Massachusetts Medicaid for those service lines.

Taken together, the data describe a long-established General Acute Care Hospital that operates at high Medicaid volume across ambulatory clinic visits, emergency care, ambulance transport, infusion/oncology, and lab testing. The lack of Medicare billing on file makes its public payer footprint effectively single-payer (Medicaid) in the available data, concentrating clinical and financial exposure to Medicaid reimbursement dynamics.

Medicaid: Complete Services Breakdown

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

1162 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	459,560	$130	$61.6M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	206,130	$140	$29.3M
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.	139,910	$190	$26M
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.	62,690	$370	$22.9M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	145,630	$130	$18.5M
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.	93,040	$160	$14.9M
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.	91,170	$160	$14.7M
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	59,420	$220	$12.8M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	385,540	$30	$10.4M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	67,300	$140	$9.5M

Showing 1–10 of 1162

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Umass Memorial Medical Center, Inc. — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

1162 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	10	10	470	$2,670	$6.3M
J9271	Injection, pembrolizumab, 1 mg	5	10	210	$5,200	$5.5M
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.	2	90	7,560	$350	$4.2M
J2350	Injection, ocrelizumab, 1 mg	2	10	130	$7,900	$3.9M
S9485	Crisis intervention mental health services, per diem	20	110	1,250	$540	$3.2M
J2506	Injection, pegfilgrastim, excludes biosimilar, 0.5 mg	3	10	590	$1,880	$2.8M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	2	10	1,380	$1,380	$2.7M
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	8	20	310	$260	$2.1M
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	83	90	26,920	$60	$1.8M
J2505	Injection, pegfilgrastim, 6 mg	3	10	650	$1,880	$1.8M

Showing 1–10 of 1162

Related Providers

Other providers that share a Tax Identification Number (TIN) with Umass Memorial Medical Center, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Umass Memorial Medical Center, Inc.	MA	General Acute Care Hospital	$0	$26.7M
David Morin	MA	Psychiatry Physician	$84.6K	$0
Erika Clark	MA	Clinical Neuropsychologist	$44.9K	$0
Pegah Afra	MA	Neurology Physician	$37.6K	$5.6K
Donna Reed	MA	Clinical Social Worker	$34.9K	$0
Clare Humphreys	MN	Clinical Neuropsychologist	$28.1K	$0

Nearby Providers

Other providers in the same ZIP code as Umass Memorial Medical Center, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Umass Memorial Medical Group Inc	MA	Internal Medicine Physician	$0	$98.5M
Hesham Malik	MA	Diagnostic Radiology Physician	$3.9M	$0
Bradley Switzer	MA	Internal Medicine Physician	$524.2K	$0
Ilsa Grunder	MA	Nurse Practitioner	$419.2K	$0
Erica Ghosh	MA	Diagnostic Radiology Physician	$286.3K	$110K
Matthew Peckham	MA	Diagnostic Radiology Physician	$348.3K	$1.1K
Umass Memorial Mri & Imaging Center, LLC	MA	Magnetic Resonance Imaging (MRI) Clinic/Center	$102.9K	$216.4K
Thomas Fitzgerald	MA	Radiation Oncology Physician	$293.9K	$0
Ryan Holstead	MA	Hematology & Oncology Physician	$270.2K	$7.6K
Robert Lee	MA	Diagnostic Radiology Physician	$269.3K	$0

Umass Memorial Medical Center, Inc. — Billing Profile & Reimbursement Data

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Umass Memorial Medical Center, Inc. — 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