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.

Santee Sioux Tribe Of Nebraska (NPI 1053465096)

Field	Value
Entity Type	Organization
Organization	Santee Sioux Tribe Of Nebraska
Address	110 S Visiting Eagle St
City	Niobrara
State	NE
ZIP	68760
Taxonomy	Clinic/Center
NPI Enumerated	January 23, 2007

Payer Source	Total Paid
Medicaid	$10.6M
Medicare	$0

Key Findings

This provider is effectively single‑payer in scope: there is no Medicare billing on file while reported Medicaid lifetime revenue is $10.6M, so Medicaid represents the entirety of documented fee‑for‑service activity. The NPI was enumerated 2007-01-23 (~19 years ago), indicating an established presence in the market but with concentrated exposure to one public payer.

Revenue is extremely concentrated in a single encounter code: T1015 accounts for $10.3M in revenue (97.2% of this provider's total Medicaid revenue) and the precomputed top‑3 Medicaid codes together account for 99.4% of Medicaid revenue. That concentration implies most dollars flow through bundled clinic/encounter billing rather than diverse fee‑for‑service lines.

The operation appears to function as a comprehensive clinic/center that bills predominantly via an all‑inclusive encounter code: T1015 is described as Clinic visit/encounter, all‑inclusive, with 19.2K claims at $539 avg paid/claim, which aligns with a model that aggregates multiple services into a single encounter payment. This pattern is reinforced by many ancillary procedure codes showing claims but little or no separate paid revenue, suggesting those services may be included in the T1015 bundle or paid through alternative funding streams.

State competitive standing is mixed: for its revenue driver T1015 the provider ranks #8 of 44 providers in‑state (84th percentile; typical, unremarkable volume for this code), so it is an upper‑quartile but not dominant clinic for that encounter code. By contrast, the provider is an extreme outlier on 99212 (4.6K claims, $23 avg paid/claim, $106.9K revenue; ranks #5 of 254 providers in‑state, 98th percentile; extreme outlier), indicating unusually high volume of low‑complexity established‑patient E/M visits relative to peers despite that code representing only 1.0% of its Medicaid revenue.

Other E/M activity is present but small: 99213 produced 7.7K claims and $123.9K revenue (1.2% of Medicaid revenue) and ranks #79 of 696 providers in‑state (89th percentile; typical, unremarkable volume for this code), consistent with a high‑volume clinic seeing many low‑to‑moderate complexity outpatient visits. The combination of heavy T1015 billing plus elevated 99212 and 99213 volumes points to frequent brief or routine encounters rather than specialty or procedural care as the primary business line.

There is evidence of onsite testing and limited diagnostic service billing: 87635 (SARS–COV–2 amplified NAAT) shows 826 claims, $44 avg paid/claim, $36.3K revenue and ranks #19 of 104 providers in‑state (83th percentile; typical, unremarkable volume for this code), and 87430 (strep antigen) contributes $15.5K revenue. These counts suggest the clinic performs point‑of‑care or on‑site lab testing as part of its encounter operations rather than as a major independent revenue stream.

A notable pattern across many ancillary service codes (dental D1206 802 claims, D1120 363 claims; vaccines 90686 39 claims; vision 92340 131 claims; several immunization and vaccine product codes) is $0 avg paid/claim and $0 reported Medicaid revenue despite recorded claim activity. This likely reflects Medicaid payment routing or bundling—services are either captured within the T1015 encounter payment, paid by another funding mechanism, or adjudicated to $0 in the fee‑for‑service data set rather than representing no clinical activity.

Telehealth and originating‑site billing appear minimal or non‑reimbursed separately: Q3014 (51 claims) and T1014 (51 claims) show claim activity but $0 avg paid/claim, indicating the provider submitted some telehealth originating site or transmission codes but did not record separate Medicaid payments for those lines. Combined with the dominant T1015 billing, this suggests telehealth activity is either limited, included in bundled encounter payments, or reimbursed outside the claims captured here.

Medicaid: Complete Services Breakdown

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

30 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	19,180	$540	$10.3M
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…	7,740	$20	$123.9K
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,…	4,650	$20	$106.9K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	830	$40	$36.3K
87430	The lab analyst performs an assay to evaluate the patient’s sample for antigens to Streptococcus, group A, using an immunoassay method, such as EIA.	140	$120	$15.5K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	130	$50	$6.3K
V2020	Frames, purchases	160	$20	$3.6K
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…	60	$1	$180
0011A	N/A	10	$0	$0
0012A	N/A	20	$0	$0

Showing 1–10 of 30

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

Santee Sioux Tribe Of Nebraska — 1 of 8 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

30 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	8	40	1,930	$230	$2.3M
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…	79	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…	489	600	610	$70	$251.4K
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…	373	510	450	$100	$168.1K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	100	140	390	$50	$70.3K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	123	320	460	$20	$62.2K
D1120	Prophylaxis–child	137	290	320	$30	$61K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	83	140	220	$50	$45K
D0120	Periodic oral evaluation - established patient	287	400	430	$20	$44.3K
V2020	Frames, purchases	129	180	520	$30	$39.5K

Showing 1–10 of 30

Related Providers

Other providers that share a Tax Identification Number (TIN) with Santee Sioux Tribe Of Nebraska, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Byron Nielsen	SD	Nephrology Physician	$378.6K	$0
Scott Hiltunen	SD	Internal Medicine Physician	$81.4K	$0
Melissa Thoene	SD	Physician Assistant	$53.6K	$0
Christy Wiarda	SD	Podiatrist	$34.7K	$0
Ashleigh Eilts	SD	Family Nurse Practitioner	$8K	$0

Santee Sioux Tribe Of Nebraska — Billing Profile & Reimbursement Data

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Santee Sioux 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