Loading...
NPI 1962464016 · Richmond, VA · General Acute Care Hospital
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Bon Secours St. Mary's Hospital Of Richmond LLC is a general acute care hospital provider located in Richmond, Virginia. This profile covers 0 Medicare and 495 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Bon Secours St. Mary's Hospital Of Richmond LLC |
| Address | 5801 Bremo Rd |
| City | Richmond |
| State | VA |
| ZIP | 23226 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | April 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $83.1M |
| Medicare | $0 |
This provider is effectively a Medicaid-focused facility: there is no Medicare billing on file and lifetime Medicaid revenue is $83.1M. That payer concentration means analyses of financial and operational performance should be interpreted in a Medicaid context rather than a dual-payer Medicare/Medicaid balance. The NPI was enumerated 2006-04-04 (~20 years ago), indicating long-standing participation in public programs.
Revenue is highly concentrated in emergency department evaluation-and-management services: the precomputed top 3 Medicaid codes by revenue (99283, 99284, 99285) account for 44.5% of this provider's total Medicaid revenue. Individually, 99283 generates $14.2M (22.1% of Medicaid revenue), 99284 generates $9.5M (14.8%), and 99285 generates $4.9M (7.6%), signaling that ED case mix and acuity are primary revenue drivers.
The code mix and high volumes point to a high-throughput emergency department and acute outpatient observation practice: large claim counts for 99283 (83.8K claims), 99284 (56.5K claims), 99285 (28.3K claims) plus G0378 observation hours (14.1K claims, $2.1M) and G0463 outpatient clinic visits (31.9K claims, $2.7M) indicate routine conversion between ED, observation, and outpatient clinic settings. These patterns are consistent with a general acute care hospital operating a busy ED and associated observation units rather than a narrow specialty center.
Competitive standing in-state is strong for multiple service lines: 99283 ranks #14 of 626 providers in Virginia (98th percentile; extreme outlier) and 99284 ranks #25 of 620 (96th percentile; notably above typical), identifying the hospital as a dominant ED volume contributor relative to peers. Beyond emergency care, diagnostic procedure 43239 ranks #1 of 146 providers (100th percentile; extreme outlier) and sleep study code 95811 also ranks #1 of 35 providers (100th percentile; extreme outlier), showing exceptional statewide leadership in upper endoscopy with biopsy and polysomnography volume.
Several specialty procedure codes are unusually concentrated compared with peers, suggesting specific service-line strengths: 41899 (dental procedures) produced $4.6M and ranks #3 of 27 (92nd percentile; notably above typical), 45380 (colon biopsy) produced $1.5M and ranks #3 of 89 (98th percentile; notably above typical), and 45378 (colon lavage/brushing) produced $1.1M and ranks #2 of 56 (98th percentile; notably above typical). These high ranks across endoscopy and related GI procedures indicate a referral or in-hospital capability that is materially above the state norm.
Imaging, infusion, and respiratory therapies contribute meaningfully but are more typical versus peers: CT abdomen/pelvis 74177 ($2.4M) and CT head 70450 ($2M) are in the 80s–85th percentile ranges (typical, unremarkable volume), while infusion codes 96361/96366 and oxygen therapy 94640 show notable operational capacity (96361 $4.2M, 76th percentile typical; 94640 $634.1K, 96th percentile notably above typical). This mix suggests the hospital supports a broad acute care diagnostic and treatment footprint with some above-average capacity in respiratory therapy.
Operational risk/opportunity signals are visible in service concentration: having nearly half of Medicaid revenue driven by three ED E/M codes (the top 3 account for 44.5%) concentrates reimbursement on visit volume and acuity coding practices, which makes overall revenue sensitive to changes in ED utilization, state Medicaid policy, or coding guidelines. For payers and network planners, this concentration highlights where utilization management or care-pathway redesign could influence total spend.
From a payer-analytics perspective, the provider is a long-tenured, high-volume Medicaid facility with clear specialty strengths. Its NPI tenure (2006-04-04, ~20 years) plus rank outlier positions in ED E/M, endoscopy (43239), and sleep studies (95811) identify it as a major Medicaid-market participant in Virginia whose cost and utilization profile will be driven disproportionately by emergency services and high-volume procedural lines.
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
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
495 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. | 83,750 | $170 | $14.2M |
| 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. | 56,500 | $170 | $9.5M |
| 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. | 28,300 | $170 | $4.9M |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 3,780 | $1,220 | $4.6M |
| 96361 | The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration. | 15,680 | $270 | $4.2M |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 6,900 | $480 | $3.3M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 31,920 | $90 | $2.7M |
| 74177 | The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs. | 10,410 | $230 | $2.4M |
| G0378 | Hospital observation service, per hour | 14,060 | $150 | $2.1M |
| 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. | 11,870 | $170 | $2M |
Showing 1–10 of 495
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
495 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 96361 | The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration. | 22 | 90 | 9,030 | $280 | $3.2M |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 12 | 70 | 3,200 | $110 | $2.8M |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 3 | 30 | 600 | $1,370 | $1.7M |
| 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. | 33 | 340 | 160 | $130 | $1.3M |
| 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. | 14 | 630 | 90 | $140 | $1.1M |
| 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. | 26 | 140 | 3,240 | $160 | $1M |
| G0378 | Hospital observation service, per hour | 7 | 80 | 3,650 | $160 | $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. | 25 | 620 | 70 | $120 | $1M |
| 74177 | The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs. | 28 | 180 | 2,950 | $140 | $783.2K |
| 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. | 30 | 170 | 3,390 | $100 | $658.8K |
Showing 1–10 of 495
Other providers in the same ZIP code as Bon Secours St. Mary's Hospital Of Richmond LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Home Care Delivered, Inc. | VA | Durable Medical Equipment & Medical Supplies | $0 | $309.5M |
| Cep America, LLC | VA | Emergency Medicine Physician | $0 | $9.7M |
| Richmond Emergency Physicians, Inc. | VA | Specialist | $0 | $7.9M |
| At Home Care Staffing-richmond | VA | Home Health Agency | $0 | $5.6M |
| Virginia Eye Institute Inc | VA | Ambulatory Surgical Clinic/Center | $4.8M | $696.2K |
| David Jacobs | VA | Ophthalmology Physician | $4M | $0 |
| Byron Ladd | VA | Ophthalmology Physician | $3.8M | $0 |
| Ryan Deasy | VA | Ophthalmology Physician | $3.3M | $0 |
| Jeffrey Slott | VA | Ophthalmology Physician | $2.6M | $0 |
| St. Mary's Ambulatory Surgery Center, LLC | VA | Ambulatory Surgical Clinic/Center | $1.6M | $0 |
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.