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

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

Mountain States Health Alliance (NPI 1972606465)

Field	Value
Entity Type	Organization
Organization	Mountain States Health Alliance
Address	400 N State Of Franklin Rd
City	Johnson City
State	TN
ZIP	37604
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 7, 2006

Payer Source	Total Paid
Medicaid	$31.3M
Medicare	$0

Key Findings

This provider effectively operates as a Medicaid-focused hospital: there is no Medicare billing on file and total Medicaid revenue is reported as $31.3M, making Medicaid the sole documented payer-driving revenue in the dataset. That concentrated payer mix indicates the provider’s financial performance will be highly sensitive to Medicaid policy and reimbursement changes rather than Medicare trends.

Revenue is highly concentrated in emergency department evaluation-and-management services: the top three Medicaid codes (99284, 99283, 99285) together account for 70.3% of this provider’s total Medicaid revenue. Those three codes alone are reported as $11M (36.2%) for 99284, $5.4M (17.9%) for 99283, and $4.9M (16.2%) for 99285, underscoring that ED visits are the dominant revenue stream.

The mix of ED codes shows both high volume and a range of acuity: the provider billed 46.3K claims of 99284 at $237 avg paid/claim, 32.8K claims of 99283 at $165 avg paid/claim, and 23K claims of 99285 at $213 avg paid/claim. This combination of large claim counts and representation across low, moderate, and high medical decision-making levels suggests the hospital’s operations are centered on a busy emergency department managing a broad clinical severity mix.

State-level competitive standing for emergency care is strong: for its top ED codes the provider ranks in high percentiles statewide (99284: #25 of 625, 96th percentile; 99283: #39 of 611, 94th percentile; 99285: #27 of 565, 95th percentile). These rankings indicate the hospital is a major in-state participant for ED services rather than a modest or peripheral ED provider.

Laboratory and diagnostic testing are a notable secondary revenue stream, anchored by high-volume proprietary testing: code 0202U generated $3.2M (10.7% of Medicaid revenue) and the provider ranks #1 of 15 in-state (100th percentile, described as notably above typical state volume). Additional lab/COVID testing activity is visible through U0003 (16.3K claims, $800.9K revenue) and multiplex testing codes (e.g., 87631), indicating sizable outpatient testing capacity alongside ED services.

High-volume basic facility services further support a busy throughput model: G0463 clinic visits (20.7K claims, $766.3K), G0378 observation hours ($668.1K), and very large volumes of specimen collection (36415: 52.8K claims, $105.6K and ranked in the 98th percentile, notably above typical state volume) reflect significant outpatient and observation-unit activity that complements the ED-centric revenue base.

The provider also reports infusion and oncology-related activity (96361 IV fluids $488.2K; 96413 chemotherapy $231.4K) which suggests on-site infusion and chemotherapy services in the outpatient/hospital setting. These ancillary service lines, while smaller than ED revenue, indicate diversified clinical operations supporting both acute and ongoing therapy needs.

The organization has long-term operational tenure: its NPI was enumerated on 2006-09-07 (~20 years ago), consistent with an established hospital footprint that has developed high ED and testing volumes over time. Given the combination of long tenure, heavy ED revenue concentration, and minimal Medicare exposure, the hospital’s competitive dynamics and financial sensitivity will be driven primarily by state Medicaid utilization and payment policies.

Medicaid: Complete Services Breakdown

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

168 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.	46,300	$240	$11M
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.	32,760	$170	$5.4M
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.	22,980	$210	$4.9M
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	13,200	$250	$3.2M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	16,340	$50	$800.9K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	20,710	$40	$766.3K
G0378	Hospital observation service, per hour	3,500	$190	$668.1K
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.	2,860	$170	$488.2K
0241U	N/A	4,860	$100	$486.4K
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.	3,120	$130	$390.1K

Showing 1–10 of 168

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Mountain States Health Alliance — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

168 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	8	60	1,340	$50	$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.	25	630	510	$120	$1.1M
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.	39	610	570	$110	$884.4K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	9	30	410	$520	$719.2K
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.	27	570	640	$100	$637.8K
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…	207	230	2,130	$40	$616.8K
0202U	This is a Proprietary Laboratory Analyses (PLA) code, meaning that the code applies to only one unique lab test made by a specific manufacturer or performed by a specific lab. Report 0202U for the…	1	20	1,060	$210	$535.6K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	9	100	400	$60	$524.7K
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	13	40	1,860	$70	$294.9K
G0378	Hospital observation service, per hour	12	100	410	$210	$264K

Showing 1–10 of 168

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Johnston Memorial Hospital, Inc	VA	General Acute Care Hospital	$0	$35.9M
Mountain States Health Alliance	TN	General Acute Care Hospital	$0	$15.5M
Mountain States Health Alliance	VA	General Acute Care Hospital	$0	$11.4M
Mountain States Health Alliance	VA	Critical Access Hospital	$0	$8.3M
Mountain States Health Alliance	TN	General Acute Care Hospital	$0	$8.1M
Mountain States Health Alliance	TN	General Acute Care Hospital	$0	$7.2M
Mountain States Health Alliance	TN	Critical Access Hospital	$0	$3M
Charlotte Townsend	VA	Family Medicine Physician	$227.2K	$33.9K
Dane Lee	VA	Family Medicine Physician	$59.9K	$88.1K
Marta Wayt	TN	Internal Medicine Physician	$118K	$0

Nearby Providers

Other providers in the same ZIP code as Mountain States Health Alliance, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cura Partners, LLC	TN	In Home Supportive Care Agency	$0	$49.3M
Medical Education Assistance Corporation	TN	Internal Medicine Physician	$0	$31.1M
Tri-cities Regional Emergency Physicians, PC	TN	Emergency Medicine Physician	$0	$24.7M
Catalyst Health Solutions,llc	TN	Substance Use Disorder Rehabilitation Clinic/Center	$0	$18.7M
Juhn And Stark LLC	TN	Pediatric Dentistry	$0	$8.1M
First Tennessee Human Resource Agency	TN	Non-emergency Medical Transport (VAN)	$0	$4.7M
Mountain Empire Radiology Inc PC	TN	Diagnostic Radiology Physician	$0	$4.5M
Tri-city Pediactric Cardiology P C	TN	Pediatric Cardiology Physician	$0	$4.5M
Brit E. Bowers, Dds, P. C.	TN	Dental Clinic/Center	$0	$4.4M
Watauga Pathology Associates PC	TN	Anatomic Pathology & Clinical Pathology Physician	$0	$3.3M

Mountain States Health Alliance — 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