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

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

Spectrum Health Hospitals (NPI 1922090554)

Field	Value
Entity Type	Organization
Organization	Spectrum Health Hospitals
Address	100 Michigan St Ne
City	Grand Rapids
State	MI
ZIP	49503
Taxonomy	General Acute Care Hospital
NPI Enumerated	August 19, 2005

Payer Source	Total Paid
Medicaid	$243.2M
Medicare	$0

Key Findings

This facility is effectively a Medicaid-focused hospital: Total Medicare revenue: none (no Medicare billing on file) while total Medicaid revenue is $243.2M, indicating near–exclusive reliance on Medicaid as the payer source visible in claims data. Analysts should treat Medicaid as the primary driver of billing and utilization for this entity when modeling payer mix or forecasting revenue exposure.

Revenue is highly concentrated in emergency department E/M services: the top three Medicaid codes 99284 ($30.1M, 19.1%), 99285 ($27.3M, 17.3%), and 99283 ($19.8M, 12.6%) together account for 48.9% of this provider’s total Medicaid revenue. This level of concentration shows that nearly half of Medicaid dollars flow from ED evaluation-and-management visits, making ED throughput the single largest revenue lever.

Operational profile points to a high-volume emergency and observation center: 99284 ranks #10 of 477 in-state (98th percentile; extreme outlier), 99285 ranks #15 of 404 (97th percentile; notably above typical state volume), 99283 ranks #6 of 447 (99th percentile; extreme outlier), and G0378 (hospital observation, per hour) is #1 of 100 (100th percentile; extreme outlier). Together, these rankings and high claim counts (e.g., 242.4K claims for G0463 and 37.6K claims for G0378) indicate substantial ED visits with downstream observation-unit utilization.

Service-line breadth extends beyond emergency care into infusion, therapy, and testing: high volumes and revenues appear for 96374 (83.1K claims, $7.7M; ranks #2 of 148, 99th percentile; extreme outlier), 97110 (142.9K claims, $4M; ranks #3 of 547, 100th percentile; extreme outlier), and Q5104 (3.4K claims, $3.6M; ranks #1 of 8, 100th percentile). These codes point to sizeable infusion/biologic administration, outpatient physical therapy, and specialty drug billing alongside ED activity.

The provider is a statewide leader on multiple specific services and diagnostics: U0004 (COVID testing) is #1 of 39 (100th percentile; extreme outlier) with 90.1K claims and $5.4M revenue, 87637 (multiplex respiratory PCR) is #1 of 126 (100th percentile; extreme outlier) with $2.6M revenue, and 97110 and G0378 both sit in the 100th percentile. These top-rank positions across lab, therapy, and observation services indicate the hospital is a dominant in-state source for high-volume testing and post-ED care.

Though ED/observation codes dominate revenue, the hospital also generates material Medicaid revenue from higher-acuity procedures and imaging: 42820 (tonsil/adenoid removal) produced $8.4M (rank #3 of 50, 96th percentile), 74177 (CT abdomen/pelvis with contrast) produced $3.4M (rank #8 of 229, 97th percentile), and 93306/93303 (echocardiography variants) together account for multimillion-dollar revenues. This mix supports classification as a full-service acute-care hospital with operative, imaging, and cardiology capabilities in addition to ED throughput.

Given the concentration in ED codes (48.9% from the top three codes) and multiple #1 or top-percentile rankings, payers and network managers should expect that contract rates and utilization management efforts with this hospital will be heavily influenced by emergency, observation, and high-volume outpatient services. Any changes to ED admission/observation policy or COVID/respiratory testing reimbursement could materially shift the hospital’s Medicaid revenue profile.

The provider has a long-tenured NPI (2005-08-19 (~21 years ago)), which combined with $243.2M in Medicaid revenue and repeated top-percentile rankings suggests an established, high-capacity acute-care presence in the state rather than a new or marginal entrant. That longevity reinforces the interpretation that the observed high volumes reflect sustained operational scale rather than a transient spike.

Medicaid: Complete Services Breakdown

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

1025 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.	145,640	$210	$30.1M
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.	73,520	$370	$27.3M
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.	154,790	$130	$19.8M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	242,360	$60	$14.8M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	3,220	$2,620	$8.4M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	83,120	$90	$7.7M
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	90,130	$60	$5.4M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	142,950	$30	$4M
G0378	Hospital observation service, per hour	37,600	$100	$3.9M
Q5104	Injection, infliximab-abda, biosimilar, (renflexis), 10 mg	3,360	$1,070	$3.6M

Showing 1–10 of 1025

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Spectrum Health Hospitals — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

1025 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	9	10	90	$6,340	$5.2M
J2350	Injection, ocrelizumab, 1 mg	3	10	60	$18,390	$4.9M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	10	150	5,330	$50	$2.8M
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.	15	400	1,510	$190	$2.6M
J1569	Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg	3	10	460	$1,360	$2.6M
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.	10	480	1,350	$110	$1.7M
J3380	Injection, vedolizumab, intravenous, 1 mg	3	10	360	$2,850	$1.6M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	10	10	440	$970	$1.4M
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.	6	450	1,540	$90	$1.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	2	150	7,610	$90	$1.2M

Showing 1–10 of 1025

Related Providers

Other providers that share a Tax Identification Number (TIN) with Spectrum Health Hospitals, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spectrum Health Primary Care Partners	MI	Internal Medicine Physician	$0	$219.9M
Spectrum Health Hospitals	MI	Hospitalist Physician	$0	$25.2M
Spectrum Health Primary Care Partners	MI	Urgent Care Clinic/Center	$0	$14.5M
Spectrum Health Hospitals	MI	Air Ambulance	$413.8K	$1.1M
Jeremiah Johns	MI	Emergency Medicine Physician	$432.1K	$0
Enid Ling-stowers	MI	Emergency Medicine Physician	$253.4K	$67.6K
Rima Shah	MI	Internal Medicine Physician	$264.5K	$0
Harvinder Singh	MI	Cardiovascular Disease Physician	$249K	$0
Sampson Ho	MI	Physical Medicine & Rehabilitation Physician	$115.7K	$0
Stephane Leung Wai Sang	MI	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	$71.3K	$0

Nearby Providers

Other providers in the same ZIP code as Spectrum Health Hospitals, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kent County Cmh Authority	MI	Community/Behavioral Health Agency	$0	$97.6M
Saint Mary's Health Services	MI	General Acute Care Hospital	$0	$92M
Cancer & Hematology Centers Of Western Mi, P.C.	MI	Specialist	$0	$59.5M
Cherry Street Services, Inc.	MI	Federally Qualified Health Center (FQHC)	$0	$50.9M
Ecs Western Michigan PC	MI	Emergency Medicine Physician	$0	$50.6M
Neo Natal Associates Plc	MI	Neonatal-Perinatal Medicine Physician	$0	$27.7M
Life Ems Inc	MI	Land Ambulance	$3.1M	$22M
Cherry Street Services, Inc.	MI	Federally Qualified Health Center (FQHC)	$0	$24.6M
Paramed Inc	MI	Ambulance	$1.8M	$21.1M
Advantage Health Saint Mary's Medical Group	MI	Multi-Specialty Clinic/Center	$0	$21.9M

Spectrum Health Hospitals — 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