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

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

Saint Alphonsus Specialty Services Inc (NPI 1093040479)

Saint Alphonsus Specialty Services Inc is a trauma surgery physician provider located in Boise, Idaho. This profile covers 0 Medicare and 33 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Saint Alphonsus Specialty Services Inc
Address	6140 W Curtisian Ave
City	Boise
State	ID
ZIP	83704
Taxonomy	Trauma Surgery Physician
NPI Enumerated	October 2, 2009

Payer Source	Total Paid
Medicaid	$608.2K
Medicare	$0

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

33 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	3,140	$50	$141.5K
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…	2,500	$40	$87.3K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	1,120	$70	$74.9K
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…	440	$130	$57.7K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	1,620	$30	$47K
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…	550	$80	$43.5K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	230	$100	$22.2K
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,…	700	$30	$20.2K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	110	$160	$18.1K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	200	$80	$14.6K

Showing 1–10 of 33

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Saint Alphonsus Specialty Services Inc — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

33 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	18	20	110	$840	$224.4K
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…	188	670	740	$40	$193.6K
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…	118	620	560	$60	$191.8K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	10	20	100	$450	$102.5K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	8	30	330	$50	$75K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	32	40	180	$170	$75K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	8	30	290	$60	$52.3K
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…	47	220	90	$80	$51.4K
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…	33	180	70	$110	$45.6K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	4	10	200	$130	$35.9K

Showing 1–10 of 33

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nicholas Kalayeh	NV	Interventional Cardiology Physician	$573.7K	$88.4K
Lindsay Sales	ID	Therapeutic Radiology Physician	$175.1K	$0
Kevin Kavanaugh	WA	Interventional Cardiology Physician	$134.4K	$0
David Oakes	WY	Clinical Cardiac Electrophysiology Physician	$125.4K	$0
Jesse Doty	TN	Orthopaedic Surgery Physician	$99.2K	$0
Dawn King	ID	Urology Physician	$94.5K	$0
Keith Holley	ID	Adult Reconstructive Orthopaedic Surgery Physician	$74.1K	$0
Andrew Stith	CO	Orthopaedic Foot and Ankle Surgery Physician	$71.1K	$0
Matthew Griffin	CA	Orthopaedic Surgery Physician	$61.2K	$0
James Meserow	ND	Maternal & Fetal Medicine Physician	$0	$60K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Full Circle Health, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$53.3M
Community Connections, Inc	ID	Case Management Agency	$0	$30M
K A Health Services LLC	ID	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$13.9M
County Of Ada	ID	Land Ambulance	$2M	$11.4M
Developmental Concepts, Inc.	ID	Developmental Disabilities Clinic/Center	$0	$13.2M
Pathways Of Idaho, LLC	ID	Community/Behavioral Health Agency	$0	$12M
Havenwood Caregiver Services Of Idaho, LLC	ID	In Home Supportive Care Agency	$0	$10.7M
Living Independently Forever, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$9.8M
Community Partnerships Of Idaho, Inc.	ID	Developmental Disabilities Clinic/Center	$0	$7.6M
All Horizons Inc	ID	Mental Health Counselor	$0	$6.7M

Saint Alphonsus Specialty Services Inc — Billing Profile & Reimbursement Data

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Saint Alphonsus Specialty Services Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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