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    OpenPayerNPI Medicare & MedicaidMontefiore Medical Center
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    Montefiore Medical Center — Billing Profile & Reimbursement Data

    NPI 1952476988 · Bronx, NY · General Acute Care Hospital

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    Montefiore Medical Center is a general acute care hospital provider located in Bronx, New York. This profile covers 0 Medicare and 1445 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
    OrganizationMontefiore Medical Center
    Address111 E 210th St
    CityBronx
    StateNY
    ZIP10467
    TaxonomyGeneral Acute Care Hospital
    NPI EnumeratedNovember 22, 2006

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

    Payer SourceTotal Paid
    Medicaid$961.7M
    Medicare$0

    Key Findings

    MONTEFIORE MEDICAL CENTER has no Medicare billing on file and reports $961.7M in lifetime Medicaid revenue, making it effectively a Medicaid-dominant provider in this data set; analysts should treat its public payer exposure as single-payer–heavy rather than split between Medicare and Medicaid. The provider’s NPI was enumerated on 2006-11-22 (~20 years ago), indicating a long-tenured presence in the market.

    Revenue concentration is high within a few outpatient E/M and opioid-treatment related codes: the top three Medicaid codes (99213, 99214, G2067) together account for 37.3% of the provider’s total Medicaid revenue. Those individual contributions are 99213: $91.4M (16.4%), 99214: $69.1M (12.4%), and G2067: $47.4M (8.5%), signaling that a relatively small set of service lines drives over one-third of Medicaid receipts.

    The code mix points to a blended operation with heavy ambulatory primary care and significant substance-use disorder (SUD) treatment capacity. High-volume office/clinic codes such as 99212–99215 (e.g., 99213: 574.9K claims, $159 avg paid/claim) coexist with large SUD-related volumes (G2067: 235.7K claims; H0020: 870.2K claims, $36 avg paid/claim, $31.3M revenue), suggesting embedded opioid treatment program services alongside routine outpatient visits.

    Emergency and urgent care activity is a major business line: multiple ED E/M codes appear among top Medicaid revenue drivers with very large claim counts and top-state rankings. Examples include 99282 (145.2K claims, $29.2M revenue) which ranks #1 in-state, 99281 (124.5K claims, $25.5M revenue) ranking #1 in-state, and 99285 (58.3K claims, $10.7M revenue) in the 100th percentile; these figures indicate a substantial emergency department throughput supporting both clinical volume and Medicaid revenue.

    On behavioral health, psychotherapy and substance-use assessment codes are prominent and report unusually high volumes relative to in-state peers, consistent with an institutional emphasis on mental health and SUD services. Codes 90832 (213.3K claims, $26.9M), 90834 (63.5K claims, $11.2M), 90833 (79.3K claims, $5.6M), and structured assessment/intervention codes G0396 (119.6K claims, $14.7M) and G0397 (58.5K claims, $9.6M) all rank at or near the top statewide and are described as extreme outlier or notably above typical state volume.

    The provider also delivers high-cost infusion and oncology drugs and robust laboratory testing, indicating advanced outpatient specialty capabilities. J9271 (pembrolizumab) accounts for $16.5M (3.0%) and ranks #4 in-state, J1745 (infliximab) accounts for $11.2M (2.0%) and ranks #1 in-state, while comprehensive lab panels (80053: 504.4K claims, $11.1M revenue) rank #3, demonstrating capacity for both specialty therapeutics and high-volume lab services.

    Competitive standing in New York is dominant for many Medicaid services: numerous top codes are labeled “extreme outlier” or in the 100th percentile and several specific codes rank #1 statewide (for example, 99282, 99281, 99202, 99215, 99203/where applicable are among the highest-ranked codes listed). This pattern indicates that MONTEFIORE is a major, often market-leading Medicaid provider for both routine outpatient E/M, emergency care, and SUD/behavioral health services across the state.

    Operational scale is reflected in very large claim volumes for some individual codes that are unusual in-state: examples include H0020 at 870.2K claims and 99213 at 574.9K claims, both called out as extreme outliers. Such volumes point to system-level service delivery (high throughput clinics, opioid treatment programs, and emergency services) rather than a small or community-only outpatient practice model.

    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.

    1445 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    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…574,880$160$91.4M
    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…413,650$170$69.1M
    G2067Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed…235,700$200$47.4M
    H0020Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)870,230$40$31.3M
    99282The 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.145,170$200$29.2M
    90832In 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…213,320$130$26.9M
    99283The 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.135,650$200$26.5M
    99281The provider sees a patient for the lowest level emergency department visit.124,500$210$25.5M
    99212The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…166,900$150$25.4M
    99201Deleted code, effective Jan. 1, 2021301,070$70$21.1M

    Showing 1–10 of 1445

    • More pages

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. New York median

    1445 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    T2022Case management, per month1680360$550$11.6M
    J9271Injection, pembrolizumab, 1 mg420750$8,890$8.1M
    T1999Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"620100$180$7.1M
    G2067Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed…2905,000$210$4.5M
    H0020Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)412061,480$30$4.4M
    J1745Injection, infliximab, excludes biosimilar, 10 mg120730$2,870$3.5M
    J9299Injection, nivolumab, 1 mg410360$6,430$3M
    96150N/A1120220$710$3M
    J9144Injection, daratumumab, 10 mg and hyaluronidase‑fihj210300$4,540$2.5M
    J3380Injection, vedolizumab, intravenous, 1 mg520120$5,050$1.9M

    Showing 1–10 of 1445

    • More pages

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Montefiore Medical CenterNYAnesthesiology Physician$1.4M$398.4M
    Sachin Kumar Amruthlal JainNYCardiovascular Disease Physician$773K$663.1K
    Glenda AgustinCAInternal Medicine Physician$1.3M$6.7K
    David CioconNJMOHS-Micrographic Surgery Physician$843.5K$5.9K
    Sandeep GuptaNYRheumatology Physician$538.2K$8.1K
    William GotsisNYInterventional Cardiology Physician$397.9K$41K
    Seth LessnerNYClinical Cardiac Electrophysiology Physician$398.9K$30.8K
    Arup BhadraNYOrthopaedic Surgery Physician$412.9K$2.7K
    Mayank PatelNYSurgery Physician$350.3K$46.2K
    April NoreigaNYPhysician Assistant$394.1K$0

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Port Morris Home Care Agency, LLCNYHome Health Agency$0$95.8M
    Jsp Life Agency Inc.NYHome Health Agency$0$94M
    Bronx Jewish Community Council -home Attendant Services IncNYHome Health Agency$0$39.2M
    Bronx Community Home Care, Inc.NYIn Home Supportive Care Agency$0$26.5M
    Bronx Sc LLCNYAmbulatory Surgical Clinic/Center$396.7K$2.4M
    Mahmood KazmiNYPsychiatry Physician$540.6K$760.6K
    Menachem GoldNYDiagnostic Radiology Physician$207.7K$852.7K
    Aleksandr MorimNYDiagnostic Radiology Physician$801.3K$62.8K
    Venise CameronNYFamily Medicine Physician$593.3K$0
    Elona DhramiNYOphthalmology Physician$213.2K$332.2K

    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. New York Providers
    7 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. New York Distribution
    Montefiore Medical Center — 24 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — New York