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

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

Summerlin Hospital Medical Center L L C (NPI 1831189638)

Key Findings

Field	Value
Entity Type	Organization
Organization	Summerlin Hospital Medical Center L L C
Address	657 Town Center Dr
City	Las Vegas
State	NV
ZIP	89144
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 24, 2005

Payer Source	Total Paid
Medicaid	$30.3M
Medicare	$0

SUMMERLIN HOSPITAL MEDICAL CENTER L L C is effectively a single-payer Medicaid facility in the available data: it has no Medicare billing on file while reporting Total Medicaid revenue of $30.3M. The absence of any Medicare activity suggests the provider’s revenue base and service focus in the dataset are concentrated on Medicaid beneficiaries rather than mixed Medicare/Medicaid operations.

Revenue concentration is high: the precomputed top 3 Medicaid codes account for 43.2% of the provider’s total Medicaid revenue. The largest single contributor is 99285 (ED high-complexity visit) with $5.2M (22.2% of Medicaid revenue), followed by G0378 (hospital observation per hour) at $2.5M (10.8%) and 99284 (ED moderate-complexity visit) at $2.4M (10.2%); this code mix points to emergency and observation care as the dominant revenue drivers.

The code mix and top services indicate the hospital operates a high-volume emergency/acute care and imaging practice: multiple high-volume ED E/M codes (99285, 99284, 99283, 99282) combined with strong CT and CTA volumes (74177, 74176, 71275, 70450) show the facility receives many acute presentations that require advanced imaging and short-term observation. This pattern aligns with a general acute care hospital serving urgent and emergent needs.

Competitive standing within Nevada is solid but not monopolistic for its leading codes: 99285 ranks #14 of 352 providers statewide (96th percentile) and 99284 ranks #24 of 398 (94th percentile), indicating above-typical statewide volumes for high-acuity ED visits while remaining one of several major ED providers. G0378’s rank (#6 of 38, 86th percentile among observation-reporting providers) indicates strong positioning in observation services relative to peers who bill that code.

Several codes are flagged as notably above typical state volume and should be noted as operational emphases: 99283 is described as notably above typical state volume (34.7K claims, $1.9M), 96360 is noted as notably above typical state volume (9.1K claims, $290.5K), and Q9967 is described as notably above typical state volume (15.4K claims, $216K). These labels suggest the hospital is a higher-than-typical user of certain IV/contrast and lower-acuity ED-related services compared with in-state peers.

Service-line breadth beyond ED/observation is meaningful: high counts for infusion/IV administration codes (96374, 96375, 96361, 96360) and therapy/rehabilitation codes (97530, 97110) indicate ongoing inpatient or outpatient procedural and supportive care volumes. This supports an operational profile that includes not only acute ED throughput but also significant procedural and ancillary service activity tied to hospitalization and recovery.

Procedures with high per-claim payment and smaller claim counts point to specialty procedural capacity: 54161 (foreskin excision) and 54300 (chordee repair) together amount to meaningful revenue shares (3.4% and 1.4% respectively) and rank in the upper percentiles statewide, suggesting a noteworthy pediatric/urology surgical volume within the hospital’s case mix. Likewise, nuclear cardiology (78452) and CTA/CT imaging codes indicate availability of advanced diagnostic imaging services.

The provider has long tenure in the NPI registry, enumerated on 2005-10-24 (~21 years ago), which supports interpretation of observed patterns as established service lines rather than transient activity. This longevity combined with concentrated Medicaid revenue and high ED/observation coding suggests a stable, Medicaid-focused acute care hospital footprint in Las Vegas.

From a payer or network perspective, SUMMERLIN HOSPITAL’s heavy Medicaid orientation and concentration in ED, observation, and imaging services imply it is a key in-state partner for Medicaid populations requiring urgent and diagnostic services. Its statewide percentile ranks on core codes show it is a major Medicaid acute-care site in Nevada, and payers should treat it as a significant provider for emergency, observation, imaging, and infusion service lines.

Medicaid: Complete Services Breakdown

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

291 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.	45,860	$110	$5.2M
G0378	Hospital observation service, per hour	21,570	$120	$2.5M
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.	26,490	$90	$2.4M
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.	9,190	$230	$2.1M
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.	34,650	$50	$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.	32,020	$30	$864.6K
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.	9,160	$90	$805.7K
54161	The provider excises the foreskin of a patient older than 28 days; the provider uses a technique other than a clamp, other devices, or dorsal slit.	2,140	$370	$793.9K
71275	In this procedure, the provider performs a computed tomographic angiography, or CTA imaging of the chest to get detailed images of the blood vessels but not the heart. He performs this study using a…	2,970	$240	$716K
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.	3,940	$160	$646.8K

Showing 1–10 of 291

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nevada Distribution

Summerlin Hospital Medical Center L L C — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nevada

Full comparison — all codes billed, vs. Nevada median

291 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	6	40	4,770	$110	$1.2M
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.	14	350	240	$110	$685.4K
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…	24	150	1,060	$50	$482K
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.	24	400	200	$90	$442.5K
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.	13	140	210	$140	$421K
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.	16	310	680	$50	$373.3K
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…	14	60	680	$60	$364.3K
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	29	30	410	$110	$350.1K
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…	66	90	190	$160	$332.4K
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.	17	390	200	$60	$289.8K

Showing 1–10 of 291

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pokroy Medical Group Of Nevada, Ltd.	NV	Neonatal-Perinatal Medicine Physician	$0	$33.7M
Shelin Agrawal And Hyer PLLC	NV	Diagnostic Radiology Physician	$0	$20.4M
Reliant Physicians (kumar) PLLC	NV	Hospitalist Physician	$0	$16.8M
Desert Valley Pediatrics, LLP	NV	Pediatrics Physician	$0	$9.7M
Sunshine Valley Health Care-wesley J. Robertson M.d. Prof. Corp.	NV	Pediatrics Physician	$0	$6.3M
Orthopedic Motion, Inc	NV	Specialist	$0	$3.2M
Amir Z Qureshi Md Ltd	NV	Internal Medicine Physician	$0	$2.4M
Greater Las Vegas Dialysis LLC	NV	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.2M
Retina Consultants Of Nevada LLP	NV	Ophthalmology Physician	$0	$2M
Brian Vicuna	NV	Medical Oncology Physician	$1.8M	$35.9K

Summerlin Hospital Medical Center L L C — Billing Profile & Reimbursement Data

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Summerlin Hospital Medical Center L L C — 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
Spring Valley Medical Center	NV	General Acute Care Hospital	$0	$33.5M
Centennial Hills Hospital Medical Center	NV	General Acute Care Hospital	$0	$25.1M