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    OpenPayerNPI Medicare & MedicaidDuke University Health System, Inc.
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    Duke University Health System, Inc. — Billing Profile & Reimbursement Data

    NPI 1871592113 · Durham, NC · General Acute Care Hospital

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    Duke University Health System, Inc. is a general acute care hospital provider located in Durham, North Carolina. This profile covers 0 Medicare and 93 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationDuke University Health System, Inc.
    Address3643 N Roxboro St
    CityDurham
    StateNC
    ZIP27704
    TaxonomyGeneral Acute Care Hospital
    NPI EnumeratedJuly 19, 2005

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$11.6M
    Medicare$0

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    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

    Medicaid: Complete Services Breakdown

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

    93 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    99285The 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.19,450$240$4.7M
    99283The 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.25,130$110$2.8M
    99284The 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.13,130$160$2M
    80053The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.35,680$10$321.1K
    85025A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…29,780$10$208.5K
    93005The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…11,820$20$189.1K
    U0003Infectious 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…1,720$100$171.5K
    96374The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.4,700$20$98.8K
    36415In this procedure, the provider inserts a needle into a vein to collect a blood sample.43,830$1$87.7K
    G0480Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…1,860$50$83.8K

    Showing 1–10 of 93

    • More pages

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. North Carolina median

    93 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    99284The 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.1183306,130$130$2.7M
    U0003Infectious 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…57160840$70$2.3M
    99283The 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.733206,160$120$2.1M
    99285The 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.512802,690$130$1.6M
    80307The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.2043601,830$40$819.8K
    87491The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.143190530$20$635.1K
    87591The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.141190560$20$609.8K
    G0480Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…48150860$50$586.6K
    0241UN/A1271401,140$150$510.8K
    87389The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an…80100400$10$440.2K

    Showing 1–10 of 93

    • More pages

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Duke University Health System, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Private Diagnostic Clinic, PLLCNCGeneral Practice Physician$0$46.5M
    Duke University Health System, Inc.NCGeneral Acute Care Hospital$0$44.4M
    Duke Health Integrated Practice, Inc.NCGeneral Practice Physician$0$36.3M
    Duke University Affiliated Physicians, Inc.NCEmergency Medicine Physician$0$11.6M
    Duke University Health System, Inc.NCParenteral & Enteral Nutrition Supplies (DME)$0$8.3M
    Duke University Health System IncNCGeneral Acute Care Hospital$0$7.9M
    Duke University Health System, Inc.NCInternal Medicine Physician$0$7.6M
    Majda HadziahmetovicNCOphthalmology Physician$2.3M$0
    Michael AllinghamNCRetina Specialist (Ophthalmology) Physician$1.7M$0
    Associated Health Services, Inc.NCAmbulatory Surgical Clinic/Center$1.6M$102.4K

    Nearby Providers

    Other providers in the same ZIP code as Duke University Health System, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Emergeortho PANCOrthopaedic Surgery Physician$0$20.9M
    Private Diagnostic Clinic, PLLCNCPediatrics Physician$0$17.5M
    Sunrise Clinical Associates, PLLCNCCommunity/Behavioral Health Agency$0$16.5M
    County Of Durham Finance DeptNCLand Ambulance$2.4M$11.3M
    Rapha Healthcare Services,llcNCMulti-Specialty Clinic/Center$0$13.6M
    Php Of Nc, IncNCDevelopmentally Disabled Services Day Training Agency$0$12.7M
    Bayada Home Health, Care, Inc.NCHome Health Agency$0$11.6M
    John DellabadiaNCNeurology Physician$232.2K$808.8K
    Durham Diagnostic Imaging LLCNCDiagnostic Radiology Physician$559.7K$0
    David SappenfieldNCRetina Specialist (Ophthalmology) Physician$512.7K$0

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicaid Revenue by Year vs. North Carolina Providers
    3 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. North Carolina Distribution
    Duke University Health System, Inc. — 3 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — North Carolina