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

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

Pinelake Regional Hospital LLC (NPI 1891892741)

Key Findings

Field	Value
Entity Type	Organization
Organization	Pinelake Regional Hospital LLC
Address	1099 Medical Center Cir
City	Mayfield
State	KY
ZIP	42066
Taxonomy	Rural Acute Care Hospital
NPI Enumerated	September 20, 2006

Payer Source	Total Paid
Medicaid	$43.3M
Medicare	$0

This provider is effectively single-payer in the available data: there is no Medicare billing on file while total Medicaid revenue is $43.3M, indicating the hospital’s measurable billed activity in the dataset is almost entirely Medicaid-driven. Analysts should treat Medicare-related comparatives as not applicable for this entity.

Revenue concentration is high within emergency department E/M codes: the top 3 Medicaid codes by revenue (99284, 99283, 99285) account for 40.7% of total Medicaid revenue. Specifically, 99284 generated $5.8M (17.6%), 99283 generated $4.6M (14.0%), and 99285 generated $3.0M (9.1%), which collectively signal ED visits are the primary revenue drivers.

The code mix points to an ED-centered rural acute care operation with substantial on-site imaging and procedural capacity: notable imaging codes include 74176 ($2.6M, 7.9%), 74177 ($2.1M, 6.5%), and 70450 ($1.5M, 4.5%), while endoscopy (43239, $1.3M, 3.9%) and colonoscopy (45380, $460.7K, 1.4%) also contribute meaningfully to Medicaid revenue. This mix suggests the facility supports diagnostics and procedural care associated with emergency and acute presentations.

Competitive standing for the core ED codes is mostly modest-to-typical within Kentucky: 99284 ranks #55 of 282 (81st percentile), 99283 ranks #35 of 284 (88th percentile), and 99285 ranks #89 of 239 (63rd percentile), each labeled in the source as typical or unremarkable state volume. Those percentiles indicate steady ED volumes but not dominance statewide.

Several service lines show unusually high relative volume for the state: respiratory virus testing 87633 ranks #8 of 81 (91st percentile) and is labeled notably above typical state volume with $1.7M in revenue, therapeutic exercise 97110 ranks in the 96th percentile with $891.9K, blood draws 36415 rank in the 97th percentile with 122.9K claims and $368.7K, and injections 96372 rank in the 96th percentile with $554.5K. These labels and ranks point to operational strengths in high-throughput lab services, outpatient therapy, and frequent basic therapeutic/injection services.

Observation and short-stay services are present but not outsized: G0378 (hospital observation service per hour) produced $1.4M (4.4% of Medicaid revenue) and ranks #44 of 87 (50th percentile), which the data classifies as typical. This suggests the hospital operates observation capacity proportional to similar facilities rather than as a major observation hub.

The provider’s rural acute care taxonomy and long tenure in the NPI registry (NPI enumerated: 2006-09-20 (~20 years ago)) support interpretation of these patterns as established, steady-state operations rather than a new entrant. The stability implied by a ~20-year enumeration aligns with consistent, Medicaid-heavy service volumes across emergency, imaging, and ancillary lines.

Overall, statewide rank distributions and the mix of codes imply PINELAKE REGIONAL HOSPITAL LLC is a steady, ED-focused rural hospital with concentrated Medicaid revenue (top 3 codes = 40.7%) and notable high-volume ancillary services (several codes labeled notably above typical). The facility appears to be a reliable local provider with substantial throughput in emergency care, imaging, lab testing, and therapy, but it does not register as a dominant statewide leader across its highest-revenue codes.

Medicaid: Complete Services Breakdown

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

284 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	24,740	$230	$5.8M
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.	33,820	$140	$4.6M
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.	8,250	$370	$3M
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.	3,890	$670	$2.6M
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.	2,780	$770	$2.1M
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…	4,980	$340	$1.7M
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.	5,580	$260	$1.5M
G0378	Hospital observation service, per hour	2,770	$520	$1.4M
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	3,490	$360	$1.3M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	10,860	$110	$1.2M

Showing 1–10 of 284

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Pinelake Regional Hospital LLC — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

284 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	55	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.	89	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.	35	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.	74	180	1,870	$280	$1.5M
G0378	Hospital observation service, per hour	44	90	2,770	$190	$1.3M
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.	53	170	2,610	$250	$1M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	50	110	8,390	$50	$749.1K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	105	340	2,700	$40	$673.3K
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.	56	180	2,960	$110	$672.4K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	58	100	5,870	$70	$670.3K

Showing 1–10 of 284

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Purchase Area Agency On Aging	KY	Supports Brokerage Agency	$0	$30M
Pinnacle Treatment Centers, LLC D/b/a Recovery Works Paducah	KY	Substance Abuse Rehabilitation Facility	$0	$17.7M
Purchase Area Agency On Aging	KY	Supports Brokerage Agency	$0	$12.5M
Pinelake Physician Practice, LLC	KY	Internal Medicine Physician	$0	$4.6M
City Of Mayfield Office Of City Clerk	KY	Land Ambulance	$545.1K	$2M
Air Evac Ems Inc	KY	Air Ambulance	$772K	$828.9K
Tony Smith	KY	Optometrist	$32K	$273.2K
Richard Stone	KY	Family Medicine Physician	$240.7K	$1.6K
Roberto Dos Remedios	KY	Pulmonary Disease Physician	$220.5K	$0
Myra Irvin	KY	Internal Medicine Physician	$181K	$0

Pinelake Regional Hospital LLC — Billing Profile & Reimbursement Data

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Pinelake Regional Hospital LLC — 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

Nearby Providers

Frequently Asked Questions

References