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NPI 1891782595 · Anderson, SC · Ambulance
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Medshore Ambulance Service, LLC is a ambulance provider located in Anderson, South Carolina. This profile covers 7 Medicare and 7 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 | Medshore Ambulance Service, LLC |
| Address | 1011 Ella St |
| City | Anderson |
| State | SC |
| ZIP | 29621 |
| Taxonomy | Ambulance |
| NPI Enumerated | September 29, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $7M |
| Medicare | $6.4M |
MEDSHORE AMBULANCE SERVICE, LLC’s billing profile is consistent with a dedicated ambulance transport operator: high-volume basic life support non-emergency activity (A0428) and heavy usage of ground mileage (A0425) appear alongside significant advanced life support emergency billing (A0427 and A0429). Medicare rows show A0428 with 10.6K claims and $2.1M revenue, while Medicaid rows show A0429 with 36.6K claims and $2.8M revenue, indicating the firm’s core service lines are routine and emergency ambulance transports plus extensive mileage. These patterns align with an operation focused on patient movement rather than facility-based care.
Revenue concentration on a small set of ambulance codes is pronounced for Medicare: A0428, A0425, and A0427 together account for 79.3% of the provider’s total Medicare revenue. Each of those codes contributes a large share on its own (A0428 32.7%, A0425 23.9%, A0427 22.7%), which means Medicare receipts are heavily dependent on a narrow set of transport services rather than a diversified procedure mix.
On the Medicaid side the concentration is even greater: A0429, A0427, and A0425 together account for 94.6% of the provider’s total Medicaid revenue. A0429 alone is 40.5% of Medicaid revenue, A0427 is 32.5%, and A0425 is 21.6%, indicating Medicaid volume is overwhelmingly driven by emergency BLS/ALS transports and mileage.
In absolute scale this provider bills comparably to both payers: total Medicare revenue is $6.4M while total Medicaid revenue is $7M, so neither program is negligible and Medicaid is slightly larger by the stated totals. This dual-payer footprint implies operational exposure to both Medicare and Medicaid reimbursement environments and suggests contracting and compliance considerations should span both programs.
National and state competitive standing is strong and concentrated in key codes. For Medicare the provider ranks as an extreme or notable outlier on core codes (A0425 rank #39 of 8934, 100th percentile; A0428 rank #46 of 2772, 98th percentile; A0427 rank #173 of 6841, 97th percentile), while on Medicaid the provider is at or near the top in-state for the same mileage and transport codes (A0425 rank #1 of 108, 100th percentile; A0427 rank #2 of 90, 99th percentile; A0429 rank #4 of 85, 96th percentile). These rank/percentile placements indicate the provider is a dominant statewide player on Medicaid transport and represents an unusually large national Medicare billing footprint for several ambulance codes.
Claim-count signals point to very high utilization of mileage and basic ambulance services: Medicare shows 216.8K claims for A0425 and 10.6K claims for A0428, while Medicaid shows 107.4K claims for A0425 and 36.6K claims for A0429. Sustained five-figure claim volumes on mileage and BLS/ALS codes suggest either broad geographic coverage, frequent long-distance transfers, or both, and these operational characteristics drive the majority of revenue on both payers.
Several individual codes are flagged as statistical outliers in the provided comparators, which is important context for contract or audit review: A0425 and A0428 are described as "extreme outlier" nationally for Medicare and are also 100th-percentile in-state for Medicaid, while A0427 and A0429 are "notably above typical" or "extreme outlier" depending on payer and code. Those qualitative labels underscore that MEDSHORE’s billing patterns for mileage and emergency/basic transport are well above typical volumes observed in peer sets and merit focused competitive or utilization analysis.
The provider’s NPI was enumerated on 2005-09-29 (~21 years ago), indicating long tenure in the market. Combined with the concentrated revenue mix and top-tier rank positions, this tenure suggests an established ambulance operator with deep operational experience in transport and mileage-intensive services rather than a newly entered or diversified clinic-based provider.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 10,570 | $200 | $2.1M |
| A0425 | Ground mileage, per statute mile | 216,750 | $10 | $1.5M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 3,880 | $370 | $1.4M |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 3,440 | $310 | $1.1M |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 640 | $240 | $149.9K |
| A0433 | Advanced life support, level 2 (als 2) | 100 | $540 | $51.7K |
| A0434 | Specialty care transport (sct) | 70 | $650 | $43.4K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 7 CPT/HCPCS codes.
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.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 36,620 | $80 | $2.8M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 31,010 | $70 | $2.3M |
| A0425 | Ground mileage, per statute mile | 107,370 | $10 | $1.5M |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 36,180 | $10 | $217.1K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 3,250 | $50 | $156.1K |
| A0434 | Specialty care transport (sct) | 40 | $100 | $4.2K |
| A0888 | Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) | 190 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other South Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Carolina median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 4 | 90 | 1,720 | $90 | $577.3K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 2 | 90 | 1,720 | $110 | $525.8K |
| A0425 | Ground mileage, per statute mile | 1 | 110 | 3,520 | $20 | $193.8K |
| A0434 | Specialty care transport (sct) | 2 | 10 | 40 | $230 | $91.4K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 1 | 10 | 170 | $80 | $68.3K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 1 | 50 | 830 | $10 | $31.6K |
| A0888 | Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) | 1 | 10 | 50 | $1 | $80 |
Other providers in the same ZIP code as Medshore Ambulance Service, LLC, ranked by combined Medicare and Medicaid revenue.
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