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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Midwest Ear, Nose & Throat Associates P C (NPI 1003871419)

Field	Value
Entity Type	Organization
Organization	Midwest Ear, Nose & Throat Associates P C
Address	2315 W 57th St
City	Sioux Falls
State	SD
ZIP	57108
Taxonomy	Otolaryngology Physician
NPI Enumerated	April 19, 2006

Payer Source	Total Paid
Medicaid	$851.6K
Medicare	$0

Medicaid: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99213	The 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…	4,930	$30	$167.5K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	1,550	$80	$130.4K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	590	$220	$128.3K
99203	The provider sees a new 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 provider…	1,800	$50	$89.9K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	220	$270	$58.5K
92557	The provider assesses a patient’s hearing with a series of tones at varying intensities to identify the softest level at which the patient can hear. He also measures the patient’s ability to…	1,720	$30	$49.9K
92567	In this procedure, the provider measures the functioning of the middle ear by varying the pressure of air presented to the ear to identify the reason for hearing loss.	3,650	$10	$47.5K
99214	The 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…	810	$60	$44.3K
V5266	Battery for use in hearing device	700	$40	$28.5K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	310	$90	$28.4K

Showing 1–10 of 19

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Midwest Ear, Nose & Throat Associates P C — 5 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

19 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99213	The 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…	75	340	1,010	$100	$511K
99214	The 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…	134	260	860	$80	$222.6K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	4	10	30	$260	$99.6K
99212	The 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,…	130	160	210	$120	$97.4K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	3	10	420	$120	$93.5K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	2	10	120	$510	$66.4K
99203	The provider sees a new 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 provider…	17	100	160	$60	$64.4K
99204	The provider sees a new 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 provider…	35	80	120	$80	$61.5K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	1	10	210	$90	$42.9K
95165	In this procedure, the provider mixes and prepares the antigens for allergen immunotherapy. Use this code when the provider prepares one or more antigens.	3	10	330	$150	$38.7K

Showing 1–10 of 19

Related Providers

Other providers that share a Tax Identification Number (TIN) with Midwest Ear, Nose & Throat Associates P C, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Peter Kasznica	SD	Otolaryngology Physician	$68.1K	$0
Thomas Tamura	SD	Otolaryngology Physician	$47.8K	$0
Kenneth Scott	SD	Otolaryngology Physician	$47.8K	$0
Gregory Danielson	SD	Otolaryngology Physician	$47.7K	$0
Donald Bennett	SD	Otolaryngology Physician	$41.7K	$0
Micah Likness	SD	Otolaryngology Physician	$39.5K	$0
Daniel Todd	SD	Otolaryngology Physician	$37.6K	$0
Ashley Pommer	SD	Physician Assistant	$13.3K	$0
Melissa Baker	SD	Audiologist	$9.7K	$0
Robert Froke	SD	Audiologist	$5.7K	$0

Nearby Providers

Other providers in the same ZIP code as Midwest Ear, Nose & Throat Associates P C, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Avera Mckennan	SD	Psychiatry Physician	$0	$9.1M
Vance Thompson Vision Surgery Center Prof LLC	SD	Ambulatory Surgical Clinic/Center	$4.5M	$22.7K
Siouxland Oral Surgery	SD	Oral and Maxillofacial Surgery (Dentist)	$0	$3.9M
Avera Home Medical Equipment, LLC	SD	Durable Medical Equipment & Medical Supplies	$0	$3.4M
Ryan Geraets	SD	Ophthalmology Physician	$3M	$0
Anderson-smith Speech Therapy, LLC	SD	Speech-Language Pathologist	$0	$1.9M
Ophthalmology Ltd Eye Surgery Center L L C	SD	Ambulatory Surgical Clinic/Center	$1.8M	$16.2K
Elizabeth Atchison	SD	Ophthalmology Physician	$1.7M	$0
Dakota Vision Center, LLC	SD	Optometrist	$0	$1.2M
Usc Ambulatory Surgical Center Prof LLC	SD	Ambulatory Surgical Clinic/Center	$1.1M	$44.2K

Midwest Ear, Nose & Throat Associates P C — Billing Profile & Reimbursement Data

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Midwest Ear, Nose & Throat Associates P C — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References