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

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

St. Mary's Medical Center, Inc (NPI 1952333205)

Field	Value
Entity Type	Organization
Organization	St. Mary's Medical Center, Inc
Address	901 45th St
City	West Palm Beach
State	FL
ZIP	33407
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 7, 2006

Payer Source	Total Paid
Medicaid	$61.5M
Medicare	$0

Key Findings

This provider is effectively single-payer at scale: total Medicare revenue is listed as none (no Medicare billing on file) while total Medicaid revenue is $61.5M. The absence of any Medicare billing on file means Medicaid dynamics will disproportionately determine cash flow and contracting leverage for the organization.

Revenue is highly concentrated in a small set of Medicaid codes: the precomputed top‑3 Medicaid codes account for 48.8% of this provider's total Medicaid revenue, driven primarily by 90999 (25.6% of Medicaid revenue), 99283 (13.1%), and 99284 (10.1%). That concentration indicates a small number of service lines produce nearly half of Medicaid dollars for this hospital.

Operationally the code mix points to a high-volume emergency department and acute care throughput: 99283 (67K claims, $7M revenue, ranks #40 of 701 in-state, 94th percentile), 99284 (50.6K claims, $5.4M revenue, ranks #40 of 739, 95th percentile), 99285 (18.1K claims, $2.8M revenue, 86th percentile) and 99282 (13.9K claims, $1.7M revenue, 90th percentile) together represent substantial ED activity and are major contributors to Medicaid revenue. This pattern is consistent with an acute care hospital that handles a large number of ED evaluations at multiple decision-making levels.

Dialysis and ESRD-related services form another clear service-line focus: 90999 (33.9K claims, $13.6M revenue, 25.6% of Medicaid revenue) is the single largest Medicaid revenue driver, and related drug/supply codes such as J0882 (5.2K claims, $1.9M revenue, ranks #2 of 47 in-state, 98th percentile; labeled an "extreme outlier") and J2916 (4K claims, $1.3M revenue, ranks #3 of 24, 91st percentile) signal substantial in‑house dialysis/ESRD therapy and associated medication administration. The combination of dialysis procedure revenue plus high darbepoetin utilization signals a significant dialysis program or large ESRD patient panel.

Competitive standing across in-state peers is mixed by code: for 90999 the provider ranks #33 of 461 (93th percentile) — described as typical/unremarkable volume despite being the largest revenue line — while for supportive drugs/testing the provider is an outlier: J0882 ranks #2 of 47 (98th percentile, extreme outlier) and U0002 (COVID testing) ranks #4 of 402 (99th percentile, extreme outlier). These rank patterns indicate the hospital is a major provider for certain ESRD-related and pandemic-era testing services, even if its procedure ranks for some codes are described as typical.

The organization also shows substantial ancillary breadth beyond ED and dialysis: high-volume lab and imaging codes appear across the top list, including 80053 (30.4K claims, $1.1M revenue, 85th percentile), 81001 (36.2K claims, $651.3K revenue, 94th percentile), 70450 (7.5K claims, $1.5M revenue, 84th percentile) and 97110 (17.2K claims, $1.7M revenue, 93th percentile). These entries reflect a full-service hospital footprint with significant diagnostic, laboratory, rehabilitation, and imaging throughput supporting inpatient and outpatient care.

From a revenue‑risk and contracting perspective, the combination of no Medicare billing and heavy Medicaid concentration—$61.5M total Medicaid revenue with 48.8% coming from the top three codes—creates exposure to Medicaid payment policy and utilization shifts in a few service lines. That concentration also presents potential negotiation focus points for payers and population‑health programs targeting ED utilization, dialysis reimbursement, or high-cost ESRD drugs.

The provider has an established presence: its NPI was enumerated on 2006-07-07 (~20 years ago), indicating two decades of operation under the current national enrollment and a likely well-entrenched local referral footprint in West Palm Beach, FL.

Medicaid: Complete Services Breakdown

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

294 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	33,930	$400	$13.6M
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.	67,010	$100	$7M
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.	50,590	$110	$5.4M
J1270	Injection, doxercalciferol, 1 mcg	14,360	$350	$5M
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.	18,060	$160	$2.8M
J0882	Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)	5,230	$360	$1.9M
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.	13,910	$120	$1.7M
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…	17,170	$100	$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.	7,530	$200	$1.5M
J2916	Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg	3,990	$330	$1.3M

Showing 1–10 of 294

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Florida Distribution

St. Mary's Medical Center, Inc — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Florida

Full comparison — all codes billed, vs. Florida median

294 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	33	460	12,420	$140	$2M
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.	40	700	2,400	$80	$1.2M
J1270	Injection, doxercalciferol, 1 mcg	55	200	7,800	$120	$1.1M
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.	40	740	2,180	$70	$1.1M
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.	90	660	1,900	$70	$743.6K
J0606	Injection, etelcalcetide, 0.1 mg	23	20	2,160	$260	$689.7K
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.	33	320	1,970	$90	$463.1K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	49	60	100	$710	$379K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	48	80	230	$400	$331.4K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	166	2,250	1,250	$50	$324.4K

Showing 1–10 of 294

Nearby Providers

Other providers in the same ZIP code as St. Mary's Medical Center, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
All Vip Care, Inc.	FL	In Home Supportive Care Agency	$0	$46.1M
Hospice Of Palm Beach County, Inc.	FL	Community Based Hospice Care Agency	$0	$23.7M
Vip Kidz LLC	FL	Medically Fragile Infants and Children Day Care	$0	$15.2M
Continental Dialysis Care Center LLC	FL	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$14.1M
Mega Nursing Services Inc	FL	Home Health Agency	$0	$11.2M
Florida Community Health Centers, Inc.	FL	Federally Qualified Health Center (FQHC)	$0	$11.2M
Florida Department Of Health	FL	Public Health or Welfare Agency	$0	$10.2M
Passionate Care Services LLC	FL	Home Health Agency	$0	$8.7M
Florida Department Of Health	FL	Clinical Medical Laboratory	$108.3K	$3.2M
Jyoti Mohanty	FL	Interventional Cardiology Physician	$1.8M	$0

St. Mary's Medical Center, Inc — Billing Profile & Reimbursement Data

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St. Mary's Medical Center, Inc — 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