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

Why is the Medicaid comparison limited to South 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. South 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.

Sanford Medical Center (NPI 1093090342)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sanford Medical Center
Address	1420 W 22ndst Ste 104
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Family Medicine Physician
NPI Enumerated	October 19, 2011

Payer Source	Total Paid
Medicaid	$68.8M
Medicare	$0

SANFORD MEDICAL CENTER in Sioux Falls reports $68.8M in lifetime Medicaid revenue and has no Medicare billing on file, making its publicly visible payer footprint effectively single-payer (Medicaid) in this dataset. The provider’s NPI was enumerated 2011-10-19 (~15 years ago), indicating an established presence in the market.

Revenue concentration is high within a small set of service lines: the precomputed top 3 Medicaid codes by revenue account for 43.2% of this provider's total Medicaid revenue. The single largest code is 99213 ($10.5M, 21.7% of Medicaid revenue; 275.5K claims), followed by 99214 ($7.1M, 14.8%; 137K claims) and 59400 ($3.2M, 6.7%; 2.4K claims), showing that a mix of ambulatory E/M and global obstetric delivery services drive nearly half of Medicaid revenue.

The code mix indicates a broad primary care and pediatric preventive platform: very high volumes of routine office E/M (99213, 275.5K claims; 99214, 137K claims) are complemented by substantial preventive visits (99391, $1.4M; 21.7K claims and 99392, $1.3M; 18.9K claims) and vaccinations (90460, $1.2M; 32.4K claims). These volumes are consistent with a large outpatient primary-care operation that also manages well-child and adolescent care at scale.

Sanford shows significant inpatient and emergency care activity alongside outpatient services: emergency codes 99285 ($2.6M, 5.4%; 23K claims, rank #2 of 41, 98th percentile) and 99284 ($1.9M, 3.9%; 23.2K claims, rank #3 of 60, 97th percentile) and inpatient follow-up codes such as 99232 ($1.9M, 3.9%; 47.9K claims, rank #2 of 69, 99th percentile) point to integrated ED and hospital workstreams in addition to office visits. This mix suggests the organization provides both ambulatory and acute-care services within the same billing footprint.

Maternal, neonatal and critical newborn services comprise a distinct revenue stream: 59400 (global vaginal delivery) generates $3.2M (6.7%, rank #1 of 8, 100th percentile), 99469 (neonatal subsequent care) $1.6M (3.3%, rank #1 of 4), and 99480 (care for recovering low birth weight infants) $1.5M (3.2%, rank #1 of 4). The presence of 59510 ($627.3K) and follow-up infant codes such as 99472 ($726K) further supports that obstetrics and neonatal care are material components of the service mix.

Competitive standing in-state is dominant for many high-volume codes: multiple codes are ranked #1 at the 100th percentile (for example, 99213 rank #1 of 344, 99214 rank #1 of 260, and 59400 rank #1 of 8), and numerous other codes are in very high percentiles (e.g., 99215 rank #1 of 71, 99203 rank #1 of 102). These rankings characterize Sanford as a major statewide provider and, in several ambulatory and perinatal lines, an extreme outlier far above typical state volume.

Not all high-revenue code categories are outliers versus peers: a few critical care and newborn follow-up codes show typical or unremarkable peer-volume labels (for example, 99469 and 99480 are labeled "typical, unremarkable volume" within small peer groups, and 99291 is described as "typical, unremarkable" at the 71st percentile). This suggests that while Sanford dominates many ambulatory and perinatal measures, some specialized critical-care services align with expected peer volumes.

Operational scale is large across both visit and procedure counts: examples include 275.5K claims for 99213, 67.9K claims for W0037 ($950K, 2.0% of Medicaid revenue, rank #1 of 164), and tens of thousands of claims across ED and inpatient E/M codes. Combined with the ~15 years since NPI enumeration, these volumes indicate sustained high throughput across outpatient, inpatient, emergency, obstetric, neonatal, and pediatric service lines.

Medicaid: Complete Services Breakdown

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

429 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…	275,530	$40	$10.5M
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…	136,970	$50	$7.1M
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	2,400	$1,350	$3.2M
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.	23,050	$110	$2.6M
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…	24,840	$80	$1.9M
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.	23,180	$80	$1.9M
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…	47,890	$40	$1.9M
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…	20,350	$80	$1.6M
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…	29,940	$60	$1.6M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3,980	$400	$1.6M

Showing 1–10 of 429

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Sanford Medical Center — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

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

429 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	21	20	6,090	$420	$3M
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	1	10	2,010	$410	$839.2K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	1	10	3,630	$180	$789.6K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	1	10	1,710	$380	$640.5K
59510	In this global service, the provider provides all of the antepartum care, admission to the hospital for delivery, delivery of the fetus and placenta via an abdominal incision, and inpatient and…	1	10	420	$1,490	$627.1K
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	1	10	30	$1,280	$579.7K
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…	1	340	1,010	$100	$511K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	3	10	240	$140	$472K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	1	10	430	$840	$356.2K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	10	2,410	$130	$344.9K

Showing 1–10 of 429

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center Fargo	ND	Family Medicine Physician	$0	$75.9M
Sanford Medical Center Fargo	ND	General Acute Care Hospital	$0	$50.2M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Sanford Health Of Northern Minnesota	MN	Rural Acute Care Hospital	$0	$47.6M
Sanford Bismarck	ND	Multi-Specialty Clinic/Center	$0	$43.9M
Sanford Health Of Northern Minnesota	MN	Internal Medicine Physician	$0	$27.2M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Sanford Medical Center	SD	Clinical Medical Laboratory	$1.8M	$18M
Rural Health Care, Inc	MN	Federally Qualified Health Center (FQHC)	$0	$15.9M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Dakota Achieve	SD	Developmental Disabilities Clinic/Center	$0	$166.9M
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Southeastern Behavioral Healthcare	SD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$59.1M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M

Sanford Medical Center — 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