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

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

Winnebago Tribe Of Nebraska (NPI 1033608328)

Key Findings

Field	Value
Entity Type	Organization
Organization	Winnebago Tribe Of Nebraska
Address	225 South Bluff Street
City	Winnebago
State	NE
ZIP	68071
Taxonomy	Clinic/Center
NPI Enumerated	May 2, 2018

Payer Source	Total Paid
Medicaid	$10.2M
Medicare	$0

WINNEBAGO TRIBE OF NEBRASKA reports $10.2M in lifetime Medicaid revenue and no Medicare billing on file, making it effectively a Medicaid-focused provider in the dataset. This single-payer orientation means analyses of its financial and service patterns should concentrate on Medicaid claims and reimbursement dynamics rather than dual‑payer comparisons.

Revenue is extremely concentrated: the precomputed top 3 Medicaid codes by revenue account for 99.4% of this provider's total Medicaid revenue, and a single code, T1015, represents $10M of the $10.2M total (98.1%). That concentration indicates the provider’s Medicaid income is highly dependent on one all‑inclusive clinic encounter code rather than a diversified mix of procedure or specialty codes.

The code mix signals a clinic-centered ambulatory model. T1015 (Clinic visit/encounter, all‑inclusive) dominating revenue, together with large claim volumes for 99213 (5.7K claims, $13 avg paid/claim, $73.5K revenue) and 99214 (3.1K claims, $19 avg paid/claim, $58.6K revenue), suggests high visit volume and routine primary/outpatient care delivered under an all‑inclusive encounter billing structure rather than relying on higher‑reimbursing procedural codes.

Despite T1015 accounting for nearly all Medicaid revenue, the provider’s state competitive standing on that code is modest: T1015 ranks #7 of 44 providers in Nebraska (86th percentile) and is described as a typical, unremarkable volume for this code. Similarly, 99213 and 99214 rank in the 80s percentiles among large pools of in‑state peers (99213: #118 of 696, 83rd percentile; 99214: #119 of 596, 80th percentile), indicating steady participation but not dominance statewide for these E/M services.

Several ancillary service lines appear in the claims mix but contribute negligible Medicaid revenue. Examples include vaccination and routine lab panels with high claim counts but $0 avg paid/claim (e.g., 90471 with 972 claims, 90472 with 477 claims, 80053 with 480 claims), which suggests these items are either bundled, reimbursed outside the reported Medicaid amounts, or recorded in a way that yields little direct Medicaid payment in this dataset.

The NPI was enumerated on 2018-05-02 (~8 years ago), which provides a relatively recent but multi‑year tenure for evaluating utilization trends and operational stability. Given the consistent high-volume encounter billing and the size of reported Medicaid revenue, the provider appears established in delivering ambulatory clinic services to the Medicaid population over multiple years.

For payers and analysts, the concentration in T1015 presents both a risk and an opportunity: small changes in reimbursement policy, billing practice, or audit focus for all‑inclusive clinic encounters could materially affect this provider's Medicaid revenue. Review of coding consistency around T1015 and reconciliation of ancillary codes with $0 paid could clarify service capture, payment flows, and opportunities for care‑delivery or contract adjustments.

Medicaid: Complete Services Breakdown

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

71 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	25,610	$390	$10M
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…	5,660	$10	$73.5K
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…	3,080	$20	$58.6K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	1,120	$20	$23.6K
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.	1,430	$10	$12.9K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,360	$10	$9.5K
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.	1,280	$10	$7.7K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	820	$1	$2.4K
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,…	120	$10	$1K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	30	$40	$1K

Showing 1–10 of 71

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Winnebago Tribe Of Nebraska — 0 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

71 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	7	40	1,930	$230	$2.3M
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.	98	110	770	$110	$774.3K
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.	60	140	1,100	$110	$607.4K
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…	118	700	660	$70	$305.1K
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…	119	600	610	$70	$251.4K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	34	40	1,710	$20	$231.5K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	25	40	220	$120	$191.5K
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.	30	90	600	$90	$156.8K
87633	The lab analyst performs a test to identify a respiratory virus using amplified nucleic acid probe technique. He may also use a multiplex reverse transcription technique. The provider does this for…	8	20	130	$270	$149.9K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	20	30	730	$30	$89.8K

Showing 1–10 of 71

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Winnebago Tribe Of Nebraska	NE	Clinic/Center	$0	$2.9M
Ashar Luqman	IA	Nephrology Physician	$1.4M	$0
Winnebago Tribe Of Nebraska	NE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$872.4K
Inderjit Chabra	AZ	Dermatology Physician	$525.4K	$0
Paul Rodriguez	NE	Diagnostic Radiology Physician	$259.9K	$0
Kevin Marcum	FL	Diagnostic Radiology Physician	$243.6K	$0
Daniel Herold	NE	Diagnostic Radiology Physician	$200.4K	$0
Jeffrey Klug	NE	Diagnostic Radiology Physician	$192.7K	$0
Earl Larson	NE	Diagnostic Radiology Physician	$165.3K	$0
Brad Rahaman	NJ	Emergency Medicine Physician	$145.6K	$14.8K

Winnebago Tribe Of Nebraska — 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

Frequently Asked Questions

References