SAFETY NET/FINANCIALLY DISTRESSED HOSPITAL OUTPATIENT RATE ADD-ONS
EFFECTIVE 4/1/2024 - 3/31/2025
- Table also available in Portable Document Format (PDF)
| Safety Net/Financially Distressed Hospital Rate Add-ons (4/1/2024 - 3/31/2025) | Clinic (Article 28) |
Ambulatory Surgery |
Emergency Department |
|||
|---|---|---|---|---|---|---|
| Operating Certificate |
Medicaid ID | NPI | Hospital Name | Add-on Payment Per Visit |
Add-on Payment Per Visit |
Add-on Payment Per Visit |
| 7000001 | 01744072 | 1245390855 | Bronxcare Hospital Center | $112.00 | $844.00 | $141.00 |
| 7000001 | 00476022 | 1417027558 | Bronxcare Hospital Center | $112.00 | $844.00 | $141.00 |
| 7000001 | 01754636 | 1548310758 | Bronxcare Hospital Center | $112.00 | $844.00 | $141.00 |
| 7000001 | 01793948 | 1578613782 | Bronxcare Hospital Center | $112.00 | $844.00 | $141.00 |
| 7001002 | 03109900 | 1124166657 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 00243572 | 1295868073 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 00243669 | 1316112600 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 02998667 | 1346380870 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 02998745 | 1356307656 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 03139104 | 1407989288 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 00734336 | 1487724712 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 03427507 | 1558630426 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 03005649 | 1588868889 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 02998763 | 1689849952 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001002 | 02998772 | 1841465218 | Brookdale Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001003 | 00243614 | 1326046467 | Brooklyn Hospital Center | $225.00 | $1,687.00 | $281.00 |
| 7001003 | 02998718 | 1609800432 | Brooklyn Hospital Center | $225.00 | $1,687.00 | $281.00 |
| 7001003 | 02998727 | 1790719524 | Brooklyn Hospital Center | $225.00 | $1,687.00 | $281.00 |
| 3301008 | 00279396 | 1033107743 | Crouse Hospital | $112.00 | $844.00 | $141.00 |
| 7003001 | 00243843 | 1033257738 | Flushing Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7003001 | 03184145 | 1063545283 | Flushing Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7003001 | 02998823 | 1154461622 | Flushing Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7003001 | 01780354 | 1548217763 | Flushing Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7003001 | N/A | 1568693174 | Flushing Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7003001 | 03184154 | 1730213877 | Flushing Hospital Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7003003 | 00243852 | 1225176175 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7003003 | 02998832 | 1245370717 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7003003 | N/A | 1245432483 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7003003 | 01616320 | 1477505220 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7003003 | N/A | 1548579196 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7003003 | 03456815 | 1669505301 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7003003 | N/A | 1750516795 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7003003 | 03009001 | 1780624049 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7003003 | 03456824 | 1982737136 | Jamaica Hospital Medical Center | $225.00 | $1,687.00 | $281.00 |
| 1401002 | 00360614 | 1245365196 | John R Oishei Childrens Hosp | $112.00 | $844.00 | $141.00 |
| 1401002 | 03002366 | 1689708885 | John R Oishei Childrens Hosp | $112.00 | $844.00 | $141.00 |
| 7001020 | 00243641 | 1083623144 | Maimonides Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7001020 | 02998736 | 1093777492 | Maimonides Medical Center | $337.00 | $1,687.00 | $422.00 |
| 7000006 | N/A | 1073708392 | Montefiore Medical Center | $112.00 | $844.00 | $141.00 |
| 7000006 | 03157802 | 1275710519 | Montefiore Medical Center | $112.00 | $844.00 | $141.00 |
| 7000006 | N/A | 1588859870 | Montefiore Medical Center | $112.00 | $844.00 | $141.00 |
| 7000006 | N/A | 1891154886 | Montefiore Medical Center | $112.00 | $844.00 | $141.00 |
| 7000006 | 02998167 | 1952476988 | Montefiore Medical Center | $112.00 | $844.00 | $141.00 |
| 7000006 | N/A | 1962693739 | Montefiore Medical Center | $112.00 | $844.00 | $141.00 |
| 5903001 | 00274117 | 1992131320 | Montefiore Mount Vernon Hospital | $225.00 | $1,687.00 | $281.00 |
| 3121001 | 01746616 | 1043394745 | Mount St Mary's Hospital | $225.00 | $1,687.00 | $281.00 |
| 3102000 | 00354467 | 1285717298 | Niagara Falls Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7004010 | N/A | 1174835268 | Richmond University Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7004010 | N/A | 1184873135 | Richmond University Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7004010 | 00248820 | 1740389154 | Richmond University Medical Center | $225.00 | $1,687.00 | $281.00 |
| 7000014 | 05174790 | 1326148669 | SBH Health System | $337.00 | $1,687.00 | $422.00 |
| 7000014 | 00243361 | 1548367873 | SBH Health System | $337.00 | $1,687.00 | $422.00 |
| 7001024 | N/A | 1245475144 | St Johns Episcopal Hospital So Shore | $337.00 | $1,687.00 | $422.00 |
| 7001024 | 00729382 | 1346274537 | St Johns Episcopal Hospital So Shore | $337.00 | $1,687.00 | $422.00 |
| 7001024 | 03005603 | 1528221959 | St Johns Episcopal Hospital So Shore | $337.00 | $1,687.00 | $422.00 |
| 7001024 | 03005612 | 1700049145 | St Johns Episcopal Hospital So Shore | $337.00 | $1,687.00 | $422.00 |
| 5907001 | 03303142 | 1235171018 | St Johns Riverside Hospital | $225.00 | $1,687.00 | $281.00 |
| 5907001 | 00245501 | 1578526695 | St Johns Riverside Hospital | $225.00 | $1,687.00 | $281.00 |
| 5907001 | 03326038 | 1790728053 | St Johns Riverside Hospital | $225.00 | $1,687.00 | $281.00 |
| 5907002 | 02998447 | 1154482164 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 5907002 | 03282217 | 1194035709 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 5907002 | 04238886 | 1326434515 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 5907002 | 00258920 | 1336236629 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 5907002 | 02999957 | 1477640258 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 5907002 | 02999966 | 1619032273 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 5907002 | N/A | 1669516332 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 5907002 | 03282226 | 1679883037 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 5907002 | 03283176 | 1932419306 | St Josephs Medical Center | $225.00 | $1,687.00 | $281.00 |
| 0602001 | 03130985 | 1033227111 | UPMC Chautauqua at WCA | $225.00 | $1,687.00 | $281.00 |
| 0602001 | 00354623 | 1063498889 | UPMC Chautauqua at WCA | $225.00 | $1,687.00 | $281.00 |
| 0602001 | 05691929 | 1568023687 | UPMC Chautauqua at WCA | $225.00 | $1,687.00 | $281.00 |
| 0602001 | 03001750 | 1770573222 | UPMC Chautauqua at WCA | $225.00 | $1,687.00 | $281.00 |
| 7001035 | 02996972 | 1700886322 | Wyckoff Heights Medical Center | $225.00 | $1,687.00 | $281.00 |
