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    OpenPayerNPI Medicare & MedicaidUrgent Care, Inc.- West Virginia
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    Urgent Care, Inc.- West Virginia — Billing Profile & Reimbursement Data

    NPI 1912133315 · South Charleston, WV · Urgent Care Clinic/Center

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    Urgent Care, Inc.- West Virginia is a urgent care clinic/center provider located in South Charleston, West Virginia. This profile covers 0 Medicare and 85 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
    OrganizationUrgent Care, Inc.- West Virginia
    Address4812 Maccorkle Avenue Sw
    CitySouth Charleston
    StateWV
    ZIP25309
    TaxonomyUrgent Care Clinic/Center
    NPI EnumeratedJune 1, 2009

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

    Payer SourceTotal Paid
    Medicaid$66.9M
    Medicare$0

    Key Findings

    This provider has no Medicare billing on file and reports total Medicaid revenue of $66.9M, making its footprint effectively single‑payer Medicaid in the available data rather than a mixed Medicare/Medicaid operation. The absence of Medicare claims combined with a sizable Medicaid revenue base suggests the provider’s business is concentrated on populations and services reimbursed through Medicaid.

    Revenue is highly concentrated in three codes that together account for 74.9% of the provider’s Medicaid revenue: 99214 ($19.8M, 30.2%), S9083 ($16.4M, 24.9%), and 99213 ($13.1M, 19.9%). This concentration indicates that outpatient evaluation-and-management visits and the global urgent care center fee are the primary drivers of the provider’s financial performance.

    The code mix and volumes indicate a high-throughput urgent care model: 99214 has 233.3K claims, 99213 has 207.3K claims, and S9083 has 183.8K claims, reflecting a heavy emphasis on established-patient and urgent care visits. The presence of many rapid diagnostic codes with large claim counts (for example, 87426 101.5K claims, 87804 150.8K claims, 87880 107.8K claims) supports an operational profile built around walk-in diagnostics, short-visit E/M encounters, and same-day testing.

    On statewide competitive standing, the provider is a dominant Medicaid volume participant for core urgent care and E/M codes: 99214 ranks #2 of 1031 providers in-state (100th percentile; extreme outlier) and 99213 ranks #3 of 1273 providers in-state (100th percentile; extreme outlier). S9083 is listed as #1 of 1 providers in-state (0th percentile; no state peer volume comparison available), indicating the provider uniquely bills the global urgent care center fee in the state data and further supporting a leading market position for urgent care services.

    Diagnostic and point-of-care testing are meaningful ancillary revenue streams and are also outlier services in-state. Codes for SARS–CoV–2 testing and other rapid assays show high state ranks and material revenue contributions—87426 $2.8M (rank #1 of 194, 100th percentile; extreme outlier), 87880 $2.3M (rank #1 of 330, 100th percentile; extreme outlier), and 87804 $2.0M (rank #1 of 313, 100th percentile; extreme outlier)—consistent with a testing-forward urgent care operation.

    The provider also bills notable volumes for pediatric and preventive visits and basic procedures, indicating broad episodic care offerings beyond brief urgent visits. Examples include 99393 (6K claims, $452.2K revenue; rank #7 of 186, 97th percentile; extreme outlier), 99394 (5.6K claims, $433K revenue; rank #1 of 177, 100th percentile; extreme outlier), and injection code 96372 (24.3K claims, $437.8K revenue; rank #2 of 309, 100th percentile; extreme outlier), which together point to routine well-child, adolescent visits and on-site therapeutic injections as part of the service mix.

    Despite its ~17‑year NPI tenure (NPI enumerated 2009-06-01, ~17 years ago), the provider has not recorded Medicare revenue, which is notable given the length of enrollment. This long tenure combined with an exclusively Medicaid revenue profile suggests a stable, Medicaid‑focused urgent care operation rather than recent market entry or transitional billing behavior.

    The unit economics shown in the top codes reflect a high-volume, lower‑per‑claim reimbursement model consistent with urgent care: 99214 average paid/claim $85, S9083 average paid/claim $89, and 99213 average paid/claim $63 alongside very large claim counts (233.3K, 183.8K, and 207.3K respectively). These figures indicate the provider’s financial model depends on scale and throughput rather than high-margin, low-volume procedures, reinforcing the characterization of a high-capacity urgent care provider in the Medicaid market.

    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.

    85 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    99214The 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…233,300$90$19.8M
    S9083Global fee urgent care centers183,820$90$16.4M
    99213The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…207,280$60$13.1M
    99203The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…55,790$80$4.2M
    87426The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…101,470$30$2.8M
    87880The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.107,810$20$2.3M
    87804The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.150,820$10$2M
    99204The provider sees a new 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 provider…12,900$100$1.3M
    87811The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…34,620$20$796.2K
    99393The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.6,030$80$452.2K

    Showing 1–10 of 85

    • More pages

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. West Virginia median

    85 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    S9083Global fee urgent care centers110183,820$90$16.4M
    99213The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…31,2701,240$30$245K
    99214The 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…21,030890$50$221K
    J2405Injection, ondansetron hydrochloride, per 1 mg41601,930$30$161.2K
    71046In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…161401,090$20$104.5K
    99204The provider sees a new 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 provider…6340140$90$97.5K
    S9088Services provided in an urgent care center (list in addition to code for service)1320190$20$89.8K
    99392Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…52150520$50$76.2K
    36415In this procedure, the provider inserts a needle into a vein to collect a blood sample.97330790$10$64.1K
    99215The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…25190110$70$63.4K

    Showing 1–10 of 85

    • More pages

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Urgent Care, Inc.- West Virginia, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Sherri LillyVAPhysician Assistant$90.4K$0
    Linda EldMNNurse Practitioner$20.9K$67.8K
    Tommy HolbrookWVFamily Medicine Physician$60.2K$0
    Frederick BrautiganWVEmergency Medicine Physician$53K$0
    Brandon PurdyMDFamily Nurse Practitioner$48.9K$0
    Brittany AllenWVFamily Nurse Practitioner$31.2K$0
    Jodi LawWVFamily Nurse Practitioner$26.4K$0
    Trena HodgesVAFamily Nurse Practitioner$25.2K$0
    Heather GibbonsOHFamily Nurse Practitioner$25.1K$0
    Troy SedlmeyerWVFamily Medicine Physician$20.6K$1.4K

    Nearby Providers

    Other providers in the same ZIP code as Urgent Care, Inc.- West Virginia, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Herbert J. Thomas Memorial Hospital AssociationWVGeneral Acute Care Hospital$0$26.1M
    Mountaineer Family Medicine, Inc.WVFamily Medicine Physician$0$19.5M
    Ths Physician Partners IncWVInternal Medicine Physician$0$9.2M
    Appalachian Medical LLCWVDurable Medical Equipment & Medical Supplies$0$8M
    Pulmonary Associates Of Char LLCWVPulmonary Disease Physician$0$5.5M
    Maccorkle Emergency Physicians PLLCWVEmergency Medicine Physician$0$4.4M
    Patel & Patel Md IncWVObstetrics & Gynecology Physician$0$4M
    Wecare Medical LLCWVOxygen Equipment & Supplies (DME)$0$3.7M
    Woman Care Clinic IncWVObstetrics & Gynecology Physician$0$3.5M
    Lincoln County Primary Care Center, Inc.WVFederally Qualified Health Center (FQHC)$0$2.7M

    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. West Virginia Providers
    7 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. West Virginia Distribution
    Urgent Care, Inc.- West Virginia — 14 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — West Virginia