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

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

Albert Einstein Medical Center (NPI 1902805245)

Field	Value
Entity Type	Organization
Organization	Albert Einstein Medical Center
Address	5501 Old York Rd
City	Phila
State	PA
ZIP	19141
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 19, 2005

Payer Source	Total Paid
Medicaid	$81.1M
Medicare	$0

Key Findings

This provider is effectively single‑payer in scope: there is no Medicare billing on file while Medicaid revenue totals $81.1M, indicating that Medicaid is the dominant — and for federal payers apparently the only — source of fee‑for‑service claims in the dataset. Analysts should treat Medicare comparators as inapplicable for this entity and focus competitive and utilization analyses on Medicaid activity.

Revenue is highly concentrated in a small set of emergency‑and‑observation codes: the top three Medicaid codes (99283, 99284, G0378) together account for 49.0% of total Medicaid revenue. Individually those codes are 99283 $11.9M (17.5%), 99284 $10.8M (15.9%), and G0378 $10.6M (15.6%), which signals material dependence on ED visits and hospital observation hours for Medicaid revenue.

The claim mix points to a large, ED‑centric operating model with substantial use of hospital observation: 99283 and 99284 together drive more than a third of Medicaid revenue and G0378 (hospital observation service, per hour) contributes $10.6M with a high avg paid/claim of $1298. This pattern is consistent with heavy ED throughput coupled with frequent placement of patients in observation status rather than immediate inpatient admission.

On in‑state competitiveness the provider is a top outlier for multiple ED codes: 99283 ranks #8 of 1063 providers in‑state (99th percentile; extreme outlier), 99284 ranks #19 of 1604 (99th percentile; extreme outlier), and 99281 ranks #1 of 124 providers (100th percentile; extreme outlier). Those ranks indicate this hospital is a leading destination for Medicaid emergency visits in Pennsylvania and operates at volumes far above typical state peers for these services.

Behavioral‑health crisis services are also a material line: H2011 (crisis intervention, per 15 minutes) generates $8.4M (12.4% of Medicaid revenue) and ranks #4 of 66 providers in‑state (95th percentile; described as typical, unremarkable volume for this code). The combination of high ED volumes and substantial crisis‑intervention billing suggests a significant behavioral‑health demand funneling through the emergency/acute care setting.

The provider shows meaningful procedural and specialty service footprint beyond emergency care: high in‑state ranks on 45385 $1.9M (2.8%, #2 of 79; 99th percentile, extreme outlier) and 45378 $1.8M (2.7%, #1 of 62; 100th percentile, extreme outlier) indicate elevated endoscopy and polypectomy activity, while codes such as 43239 $1.1M and 62323 $1.2M show notable upper endoscopy and lumbar injection volumes. These procedural lines suggest the hospital supports integrated inpatient/ambulatory procedure workflows for gastroenterology, pain management, and other specialties.

High outpatient E/M throughput is evident in ambulatory codes with large claim counts and strong ranks: 99214 $2.4M (3.5%) ranks #27 of 8157 providers in‑state (100th percentile; extreme outlier), while 99213 and 99211 also appear with large claim volumes and top‑percentile ranks. This signals a sizable clinic/ambulatory practice footprint that complements the hospital’s ED and procedural volumes.

The provider has long tenure in the NPI registry (enumerated 2005‑07‑19, ~21 years ago), indicating a well‑established market presence. Combined with its high percentile ranks across emergency, observation and several procedural codes, the data support viewing this entity as a long‑standing, high‑volume Medicaid hospital system within Pennsylvania rather than a new or marginal entrant.

Medicaid: Complete Services Breakdown

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

445 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	57,010	$210	$11.9M
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.	56,140	$190	$10.8M
G0378	Hospital observation service, per hour	8,160	$1,300	$10.6M
H2011	Crisis intervention service, per 15 minutes	16,820	$500	$8.4M
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.	23,010	$170	$3.9M
99281	The provider sees a patient for the lowest level emergency department visit.	20,570	$150	$3.1M
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…	30,850	$80	$2.4M
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	1,400	$1,390	$1.9M
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	1,180	$1,560	$1.8M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	14,100	$100	$1.4M

Showing 1–10 of 445

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Albert Einstein Medical Center — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

445 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0378	Hospital observation service, per hour	6	150	510	$870	$1.4M
H2011	Crisis intervention service, per 15 minutes	4	70	2,210	$250	$1.3M
T1015	Clinic visit/encounter, all-inclusive	153	1,690	760	$170	$1.2M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	223	690	2,240	$80	$1M
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.	75	210	730	$40	$689.7K
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…	23	200	990	$70	$517.5K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	49	560	1,400	$90	$485.7K
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.	19	1,600	270	$120	$409.7K
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.	8	1,060	150	$130	$405.4K
19318	Breast reduction is the removal of excess breast tissue which results from top scarring, calcification, or architectural distortion.	1	10	280	$1,220	$338.5K

Showing 1–10 of 445

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Albert Einstein Medical Center	PA	Rehabilitation Hospital Unit	$0	$14.5M
Daniel Leichter	PA	Psychologist	$12.3K	$0

Nearby Providers

Other providers in the same ZIP code as Albert Einstein Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Patriot Home Care, Inc	PA	Home Health Agency	$0	$135.9M
Dr Warren E Smith Community Mental Health Mental Retardation & Substan	PA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$34.5M
Pathways To Housing PA, Inc.	PA	Case Management Agency	$0	$26.4M
Einstein Practice Plan Inc	PA	Emergency Medicine Physician	$0	$13.9M
Einstein Practice Plan Inc	PA	Diagnostic Radiology Physician	$0	$9.6M
Einstein Practice Plan Inc	PA	Pediatrics Physician	$0	$8M
Resources For Human Development, Inc.	PA	Case Management Agency	$0	$7.1M
Chad Home Health Agency, Inc.	PA	Home Health Agency	$0	$6M
Ruchika Patel	PA	Rheumatology Physician	$1.5M	$0
Denise Najjar	PA	Neuropathology Physician	$856.4K	$1.8K

Albert Einstein Medical Center — 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