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

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

Providence Health & Services - Oregon (NPI 1003991845)

Field	Value
Entity Type	Organization
Organization	Providence Health & Services - Oregon
Address	4805 Ne Glisan St
City	Portland
State	OR
ZIP	97213
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 26, 2006

Payer Source	Total Paid
Medicaid	$49M
Medicare	$0

Key Findings

PROVIDENCE HEALTH & SERVICES - OREGON shows no Medicare billing on file and is effectively single‑payer in this data set, with $49M in lifetime Medicaid revenue reported and no Medicare revenue to compare against. This payer mix means Medicaid activity entirely drives the billing profile available for analysis and any revenue or utilization shifts among Medicaid populations will disproportionately affect this provider's reported volumes.

Revenue is highly concentrated in three emergency department E/M codes: the top three Medicaid codes (99285, 99284, 99283) account for 73.9% of the provider's total Medicaid revenue. That concentration indicates the facility’s Medicaid revenue depends largely on ED visits rather than a diversified mix of outpatient or inpatient procedural revenue streams.

The code mix and top revenue drivers identify the provider as a high-volume emergency care site: 99285 generates $15.8M (33.0% of Medicaid revenue) and 99284 generates $12.4M (25.9%). High average paid/claim values and large claim counts for these E/M levels point to frequent, moderate-to-high acuity ED encounters as the operational core of billed services.

99285 is a statewide standout: the provider ranks #5 of 129 in-state and sits at the 97th percentile for that code, described as "notably above typical state volume." This positions the provider as a major regional provider for high-acuity ED visits among Medicaid payers, suggesting competitive strength in emergency services versus in-state peers.

Beyond emergency care, the provider reports notable public health testing and lab throughput — U0003 (SARS‑CoV‑2 NAAT) produced $2.9M (6.0% of Medicaid revenue) with rank #2 of 60 and 98th percentile, and high-volume lab panels 85025 and 80053 show large claim counts and top-state percentiles (98th and 96th, respectively). These patterns indicate significant testing and routine laboratory volumes, consistent with a large hospital-based outpatient and ED lab operation.

Behavioral health and outpatient psychiatry appear as meaningful ancillary lines: S9480 (intensive outpatient psychiatric services) produced $2.3M (4.8% of Medicaid revenue) and ranks #2 of 18 (94th percentile), while group psychotherapy 90853 is notable at $458.6K and ranks #5 of 140 (97th percentile). The presence of these codes at high in-state percentiles suggests embedded mental health programming and meaningful state-level market share in behavioral health services for Medicaid.

Infusion and procedural outpatient treatments are present but smaller contributors: 96374 ($1.4M) and 96413 ($290.6K) appear on the top code list, indicating ongoing infusion/chemotherapy activity in the outpatient setting, but they are far down the revenue stack compared with ED E/M codes. This mix suggests ancillary oncology/infusion capacity that complements a primary ED-driven business model rather than serving as a primary revenue engine.

The provider’s NPI was enumerated on 2006-10-26 (~20 years ago), indicating established tenure in the market; combined with its high state rankings on several codes (notably 99285, U0003, 90853), the data portray a long-standing hospital that is a significant Medicaid ED and testing provider within Oregon. Given the concentrated revenue footprint and strong state-level ranks on key codes, payers and partners should view this entity as a major emergency and testing resource for Medicaid beneficiaries in Portland/OR.

Medicaid: Complete Services Breakdown

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

171 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	48,880	$320	$15.8M
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.	47,600	$260	$12.4M
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.	43,340	$170	$7.2M
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…	60,190	$50	$2.9M
S9480	Intensive outpatient psychiatric services, per diem	11,070	$210	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	30,820	$60	$1.9M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	14,370	$100	$1.4M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	5,010	$90	$461K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	12,400	$40	$458.6K
H0035	Mental health partial hospitalization, treatment, less than 24 hours	1,530	$240	$362.9K

Showing 1–10 of 171

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Providence Health & Services - Oregon — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

171 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	12	150	7,400	$170	$2.8M
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.	5	130	2,610	$200	$2.3M
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.	13	140	10,160	$130	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	10	40	3,200	$60	$1.5M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	3	10	910	$450	$1.1M
S9480	Intensive outpatient psychiatric services, per diem	2	20	650	$330	$1.1M
H0005	Alcohol and/or drug services; group counseling by a clinician	77	180	3,250	$40	$783.8K
H0004	Behavioral health counseling and therapy, per 15 minutes	131	270	1,660	$90	$681K
Q5104	Injection, infliximab-abda, biosimilar, (renflexis), 10 mg	4	10	320	$1,050	$658.8K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	8	60	3,620	$90	$623.7K

Showing 1–10 of 171

Related Providers

Other providers that share a Tax Identification Number (TIN) with Providence Health & Services - Oregon, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services Oregon	OR	General Acute Care Hospital	$0	$20.5M
Providence Health & Services - Oregon	OR	Clinical Pathology Physician	$0	$13.7M
Providence Health & Services Oregon	OR	Clinical Pathology Physician	$0	$5.4M
Julia Obadiah	OR	MOHS-Micrographic Surgery Physician	$444.5K	$0
Anna Bar	OR	MOHS-Micrographic Surgery Physician	$151.3K	$0
Zachary Pena	OR	Dermatology Physician	$132.7K	$0
Pratik Bhattacharya	MI	Neurology Physician	$115.9K	$0
Charles Cannan	AZ	Cardiovascular Disease Physician	$114K	$0
Jennifer Bray	OR	Family Nurse Practitioner	$105.2K	$0
Aly Rahimtoola	OR	Cardiovascular Disease Physician	$102.9K	$0

Nearby Providers

Other providers in the same ZIP code as Providence Health & Services - Oregon, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services Oregon	OR	Durable Medical Equipment & Medical Supplies	$0	$45.5M
Providence Health & Services Oregon	OR	Home Infusion Therapy Pharmacy	$0	$9.8M
Providence Health & Services - Oregon	OR	Child & Adolescent Psychiatry Physician	$0	$8.7M
Radiology Specialists Of The Northwest, PC	OR	Diagnostic Radiology Physician	$0	$5.7M
Laboratory Corporation Of America	OR	Clinical Medical Laboratory	$1.4M	$3.2M
Providence Health & Services - Oregon	OR	Internal Medicine Physician	$0	$3.8M
Uptown Providers Inc	OR	Urgent Care Clinic/Center	$0	$2.8M
Credena Health LLC	OR	Specialty Pharmacy	$0	$2.5M
Oregon Pediatrics Ne Portland PC	OR	Pediatrics Physician	$0	$2.2M
Behavioral Learning Network - Oregon LLC	OR	Behavior Analyst	$0	$1.8M

Providence Health & Services - Oregon — Billing Profile & Reimbursement Data

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Providence Health & Services - Oregon — 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