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

Why is the Medicaid comparison limited to North 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. North 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.

Altru Health System (NPI 1043309552)

Key Findings

Field	Value
Entity Type	Organization
Organization	Altru Health System
Address	1300 S Columbia Rd
City	Grand Forks
State	ND
ZIP	58201
Taxonomy	Clinic/Center
NPI Enumerated	October 12, 2006

Payer Source	Total Paid
Medicaid	$29.7M
Medicare	$0

This provider has no Medicare billing on file and reports $29.7M in lifetime Medicaid revenue, making its financial footprint effectively single‑payer (Medicaid) in the available data. Analysts should treat Medicaid as the dominant payer when evaluating payer mix, contracting leverage, or risk exposure for this entity.

Revenue is highly concentrated in three codes: 99213 ($7.2M), 99214 ($6M), and 99285 ($3.4M) — these three codes together account for 61.8% of the provider's total Medicaid revenue. This concentration indicates that routine office E/M and higher‑acuity ED E/M are the primary revenue drivers for the organization.

The top outpatient codes (99213: 122.3K claims, $59 avg paid/claim; 99214: 71K claims, $84 avg paid/claim) point to a high‑volume ambulatory practice model focused on established patient visits and primary care longitudinal management. The absolute claim volumes and per‑claim payments suggest throughput‑driven ambulatory operations rather than a low‑volume specialty clinic.

High‑acuity emergency services are a material part of activity: 99285 produced $3.4M from 21.7K claims and 99284 generated $1.8M from 16.5K claims, with 99285 ranking #4 of 19 providers in‑state (83th percentile; labeled typical, unremarkable volume). The mix of ED E/M with substantial inpatient E/M codes (e.g., 99232: 23K claims, $1.1M; 99233: $701.3K) suggests the provider bills across ambulatory, emergency, and inpatient settings rather than exclusively outpatient care.

Preventive and immunization services are also prominent: 90471 (vaccine administration) appears with 26.3K claims and $394.6K revenue and ranks #2 of 96 in‑state (99th percentile; extreme outlier). In combination with preventive visit codes 99391/99392, this pattern supports a significant pediatric/primary care and vaccination throughput within the clinic footprint.

Behavioral health add‑on and psychotherapy services are unusually concentrated here: 90833 generated $362.3K (5.3K claims) and ranks #1 of 15 in‑state (100th percentile; extreme outlier), while 90834 also appears on the top list. Those standings indicate integrated mental‑health service delivery at volumes far above typical state peers for those codes.

Competitive standing is strongest in routine outpatient E/M where the provider ranks #3 of 206 for 99213 and #3 of 171 for 99214 (both 99th percentile and described as extreme outliers), marking it as a dominant statewide provider for established office visits. For several hospital/ED codes the provider ranks in the upper percentiles but is characterized as typical or unremarkable, so its dominance appears concentrated in ambulatory E/M and certain high‑volume ancillary services.

The NPI was enumerated on 2006-10-12 (~20 years ago), indicating long tenure in the market; combined with $29.7M lifetime Medicaid revenue and very large claim counts on leading codes (e.g., 122.3K claims for 99213), this profile is consistent with a well‑established, high‑throughput clinical center focused on Medicaid populations.

Medicaid: Complete Services Breakdown

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

238 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…	122,260	$60	$7.2M
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…	70,970	$80	$6M
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.	21,730	$160	$3.4M
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.	16,490	$110	$1.8M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	23,000	$50	$1.1M
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.	13,950	$60	$850.6K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	9,740	$70	$701.3K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	3,770	$150	$576.8K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	6,760	$80	$527.2K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	4,800	$90	$436.8K

Showing 1–10 of 238

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Altru Health System — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

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

238 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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.	4	20	1,120	$220	$2M
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.	6	30	1,280	$180	$1.4M
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.	5	50	670	$150	$829.9K
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…	3	210	360	$100	$498.2K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	4	30	460	$50	$423.5K
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	170	300	$100	$415.8K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	3	20	310	$70	$364K
Q3014	Telehealth originating site facility fee	4	30	130	$180	$355.8K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	3	10	310	$150	$323.5K
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,…	4	60	130	$190	$242.5K

Showing 1–10 of 238

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Altru Health System	ND	General Acute Care Hospital	$0	$18.7M
Mercy Hospital Of Devils Lake	ND	Critical Access Hospital	$0	$11.1M
Max Johnson	ND	Retina Specialist (Ophthalmology) Physician	$2.8M	$0
Altru Health System	ND	Rural Health Clinic/Center	$0	$1.5M
Dwight Fitch	FL	Radiation Oncology Physician	$1.5M	$0
Altru Health System	ND	Ambulance	$527.6K	$490.7K
Darrin Johnson	MN	Diagnostic Radiology Physician	$908.4K	$0
Shree Subedi	WA	Diagnostic Radiology Physician	$774.2K	$0
Altru Specialty Services, Inc	ND	Durable Medical Equipment & Medical Supplies	$0	$766.7K
Matthew Manganaro	NY	Diagnostic Radiology Physician	$688K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Development Homes Inc	ND	Community/Behavioral Health Agency	$0	$53.9M
L.i.s.t.e.n. Inc	ND	Community/Behavioral Health Agency	$0	$9.4M
Peterson Medical Clinics, LLC	ND	Multi-Specialty Clinic/Center	$0	$8.8M
Edgewood Sartell LLC	ND	Assisted Living Facility	$0	$7.1M
Northeast Behavioral Health Clinic	ND	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.7M
Spectra Health	ND	Federally Qualified Health Center (FQHC)	$0	$5.5M
Little Miracles, Inc.	ND	Multi-Specialty Clinic/Center	$0	$5.5M
Anil Potti	ND	Hematology & Oncology Physician	$4.9M	$0
Valley Oral & Facial Surgery PC	ND	Oral and Maxillofacial Surgery Clinic/Center	$0	$4.5M
Rehabauthority, LLC	ND	Multi-Specialty Clinic/Center	$0	$3.5M

Altru Health System — 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