SAFETY NET/FINANCIALLY DISTRESSED HOSPITAL OUTPATIENT RATE ADD-ONS

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EFFECTIVE 4/1/2023 - 3/31/2024 Clinic

Safety Net/Financially Distressed Hospital Rate Add-ons (4/1/2023 - 3/31/2024) 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 $218.00 $1,374.00 $210.00
7000001 00476022 1417027558 Bronxcare Hospital Center $218.00 $1,374.00 $210.00
7000001 01754636 1548310758 Bronxcare Hospital Center $218.00 $1,374.00 $210.00
7000001 01793948 1578613782 Bronxcare Hospital Center $218.00 $1,374.00 $210.00
7001002 03109900 1124166657 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 00243572 1295868073 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 00243669 1316112600 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 02998667 1346380870 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 02998745 1356307656 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 03139104 1407989288 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 00734336 1487724712 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 03427507 1558630426 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 03005649 1588868889 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 02998763 1689849952 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001002 02998772 1841465218 Brookdale Hospital Medical Center $168.00 $1,396.00 $201.00
7001003 00243614 1326046467 Brooklyn Hospital Center $189.00 $1,504.00 $265.00
7001003 02998718 1609800432 Brooklyn Hospital Center $189.00 $1,504.00 $265.00
7001003 02998727 1790719524 Brooklyn Hospital Center $189.00 $1,504.00 $265.00
3301008 00279396 1033107743 Crouse Hospital $218.00 $1,638.00 $273.00
7003001 00243843 1033257738 Flushing Hospital Medical Center $218.00 $1,436.00 $273.00
7003001 03184145 1063545283 Flushing Hospital Medical Center $218.00 $1,436.00 $273.00
7003001 02998823 1154461622 Flushing Hospital Medical Center $218.00 $1,436.00 $273.00
7003001 01780354 1548217763 Flushing Hospital Medical Center $218.00 $1,436.00 $273.00
7003001 N/A 1568693174 Flushing Hospital Medical Center $218.00 $1,436.00 $273.00
7003001 03184154 1730213877 Flushing Hospital Medical Center $218.00 $1,436.00 $273.00
7003003 00243852 1225176175 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7003003 02998832 1245370717 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7003003 N/A 1245432483 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7003003 01616320 1477505220 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7003003 N/A 1548579196 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7003003 03456815 1669505301 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7003003 N/A 1750516795 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7003003 03009001 1780624049 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7003003 03456824 1982737136 Jamaica Hospital Medical Center $164.00 $1,416.00 $218.00
7001020 00243641 1083623144 Maimonides Medical Center $167.00 $1,287.00 $216.00
7001020 02998736 1093777492 Maimonides Medical Center $167.00 $1,287.00 $216.00
7000006 N/A 1073708392 Montefiore Medical Center $156.00 $1,171.00 $185.00
7000006 03157802 1275710519 Montefiore Medical Center $156.00 $1,171.00 $185.00
7000006 N/A 1588859870 Montefiore Medical Center $156.00 $1,171.00 $185.00
7000006 N/A 1891154886 Montefiore Medical Center $156.00 $1,171.00 $185.00
7000006 02998167 1952476988 Montefiore Medical Center $156.00 $1,171.00 $185.00
7000006 N/A 1962693739 Montefiore Medical Center $156.00 $1,171.00 $185.00
5903001 00274117 1992131320 Montefiore Mount Vernon Hospital $218.00 $1,638.00 $273.00
3102000 00354467 1285717298 Niagara Falls Medical Center $218.00 $1,638.00 $273.00
7004010 N/A 1174835268 Richmond University Medical Center $218.00 $1,638.00 $273.00
7004010 N/A 1184873135 Richmond University Medical Center $218.00 $1,638.00 $273.00
7004010 00248820 1740389154 Richmond University Medical Center $218.00 $1,638.00 $273.00
7000014 05174790 1326148669 SBH Health System $188.00 $1,413.00 $227.00
7000014 00243361 1548367873 SBH Health System $188.00 $1,413.00 $227.00
7001024 N/A 1245475144 St Johns Episcopal Hospital So Shore $218.00 $1,638.00 $273.00
7001024 00729382 1346274537 St Johns Episcopal Hospital So Shore $218.00 $1,638.00 $273.00
7001024 03005603 1528221959 St Johns Episcopal Hospital So Shore $218.00 $1,638.00 $273.00
7001024 03005612 1700049145 St Johns Episcopal Hospital So Shore $218.00 $1,638.00 $273.00
5907001 03303142 1235171018 St Johns Riverside Hospital $207.00 $1,638.00 $273.00
5907001 00245501 1578526695 St Johns Riverside Hospital $207.00 $1,638.00 $273.00
5907001 03326038 1790728053 St Johns Riverside Hospital $207.00 $1,638.00 $273.00
5907002 02998447 1154482164 St Josephs Medical Center $218.00 $1,638.00 $273.00
5907002 03282217 1194035709 St Josephs Medical Center $218.00 $1,638.00 $273.00
5907002 04238886 1326434515 St Josephs Medical Center $218.00 $1,638.00 $273.00
5907002 00258920 1336236629 St Josephs Medical Center $218.00 $1,638.00 $273.00
5907002 02999957 1477640258 St Josephs Medical Center $218.00 $1,638.00 $273.00
5907002 02999966 1619032273 St Josephs Medical Center $218.00 $1,638.00 $273.00
5907002 N/A 1669516332 St Josephs Medical Center $218.00 $1,638.00 $273.00
5907002 03282226 1679883037 St Josephs Medical Center $218.00 $1,638.00 $273.00
5907002 03283176 1932419306 St Josephs Medical Center $218.00 $1,638.00 $273.00
0602001 03130985 1033227111 UPMC Chautauqua at WCA $218.00 $1,638.00 $273.00
0602001 00354623 1063498889 UPMC Chautauqua at WCA $218.00 $1,638.00 $273.00
0602001 05691929 1568023687 UPMC Chautauqua at WCA $218.00 $1,638.00 $273.00
0602001 03001750 1770573222 UPMC Chautauqua at WCA $218.00 $1,638.00 $273.00
7001035 02996972 1700886322 Wyckoff Heights Medical Center $177.00 $1,467.00 $217.00