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

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

St Francis Community Hospital (NPI 1093713091)

Key Findings

Field	Value
Entity Type	Organization
Organization	St Francis Community Hospital
Address	34515 9th Ave S
City	Federal Way
State	WA
ZIP	98003
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 13, 2005

Payer Source	Total Paid
Medicaid	$44.7M
Medicare	$0

ST FRANCIS COMMUNITY HOSPITAL shows no Medicare billing on file and reports $44.7M in total Medicaid revenue, making it effectively single‑payer (Medicaid) in the available data. The absence of Medicare claims suggests limited revenue diversification across federal programs and concentrates financial exposure in Medicaid reimbursement streams.

Revenue concentration is substantial within a few services: the precomputed top 3 Medicaid codes account for 36.7% of the provider's total Medicaid revenue, driven specifically by 99283 ($5M, 13.2%), 96361 ($4.6M, 12.1%), and 43239 ($4.3M, 11.3%). This degree of concentration indicates that a relatively small set of procedures underpins a large share of the hospital’s Medicaid income.

The code mix indicates a dual focus on emergency department evaluation-and-management and infusion services. High claim volumes for ED E/M codes (99283 with 45.7K claims and $5M revenue; 99284 with 45.7K claims and $4M revenue; 99285 with 24.8K claims and $2.1M revenue) combined with large infusion code volumes (96361 with 15.7K claims and $4.6M revenue; 96365 and 96366 also present) imply substantial ED throughput and ongoing infusion/IV therapy activity in the outpatient setting.

Gastroenterology and endoscopy are clear service-line strengths: 43239 (12.4K claims, $4.3M) ranks #1 of 119 providers in-state (100th percentile; extreme outlier), and colonoscopy/therapeutic colonoscopy codes 45380 (8.3K claims, $2.9M), 45385 (7.2K claims, $2.6M), and 45378 (3.4K claims, $1.6M) also rank #1 in their peer sets (100th percentile; extreme outlier). These rankings indicate the hospital is a dominant statewide provider for upper‑ and lower‑GI endoscopy volume under Medicaid.

Competitive standing is mixed by service line: for multiple GI and endoscopy codes the hospital is a statewide outlier and ranks #1, demonstrating market dominance in those procedures, while emergency department codes show high absolute volume but more typical statewide positions (for example, 99283 ranks #26 of 234, 89th percentile; 99284 ranks #31 of 225, 87th percentile; 99285 ranks #44 of 192, 77th percentile). In short, the hospital is a top GI/endoscopy player in Washington but a busy—rather than dominant—ED provider by state ranking.

Imaging and ancillary outpatient services supply meaningful additional Medicaid revenue but do not show the same extreme concentration: 74177 (CT abdomen/pelvis) generated $1.6M (4.3%) and ranks #27 of 139 (81st percentile), 70450 (CT head without contrast) generated $1.2M (3.2%) and ranks #27 of 129 (80th percentile), and multiple ultrasound codes (76705, 76830, 76856) appear in the top 25, indicating a broad outpatient diagnostic footprint supporting the ED and procedural services.

Operational tenure is long-standing: the NPI was enumerated on 2005-07-13 (~21 years ago), consistent with an established hospital that has had time to develop high-volume GI and ED service lines reflected in the Medicaid claims mix. This longevity aligns with the patterns of dominant specialty volumes observed in the data.

The combination of concentrated Medicaid revenue (36.7% from the top three codes) and no Medicare billing on file presents both strengths and risks: the provider’s clear statewide dominance in several GI/endoscopy codes suggests a specialized referral footprint and negotiating leverage with Medicaid plans in those areas, while the lack of Medicare diversification means changes in Medicaid policy, rates, or enrollment could disproportionately affect total revenue.

Medicaid: Complete Services Breakdown

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

325 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	45,710	$110	$5M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	15,740	$290	$4.6M
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.	12,420	$340	$4.3M
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.	45,740	$90	$4M
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	8,320	$350	$2.9M
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	7,180	$360	$2.6M
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.	24,820	$80	$2.1M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	9,970	$160	$1.6M
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	3,420	$460	$1.6M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	9,460	$130	$1.2M

Showing 1–10 of 325

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

St Francis Community Hospital — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

325 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	36	100	2,830	$80	$3.8M
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	25	110	5,950	$270	$2.6M
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.	31	230	5,440	$90	$1.8M
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.	26	230	6,220	$100	$1.8M
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.	44	190	5,130	$100	$1.8M
77412	The provider delivers radiation therapy at level 3 complexity. This includes photon therapy delivered to multiple isocenters, photon therapy with active motion management, total skin electron…	10	10	1,470	$400	$1.2M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	27	140	2,830	$150	$1.1M
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	57	100	1,940	$70	$1M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	35	170	2,120	$40	$779.1K
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.	27	100	3,660	$100	$635.7K

Showing 1–10 of 325

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Clare Hospital	WA	General Acute Care Hospital	$0	$30M
Franciscan Health System	WA	General Acute Care Hospital	$0	$14.3M
Nagavedu Raghunath	WA	Psychiatry Physician	$116.7K	$0
James Howard	WA	Psychiatry Physician	$75.6K	$0
Fletcher Taylor	WA	Psychiatry Physician	$50.6K	$0
Joy Jones	WA	Psychiatry Physician	$19.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ashley House	WA	Nursing Care Agency	$0	$46.5M
Wei Guo, Dmd,md,pllc	WA	Oral and Maxillofacial Surgery (Dentist)	$0	$8.3M
Multicare Health System	WA	Pediatrics Physician	$0	$6.9M
Sea Mar Community Health Centers	WA	Federally Qualified Health Center (FQHC)	$0	$6.8M
Healthpoint	WA	Federally Qualified Health Center (FQHC)	$0	$6.8M
Bridging Care, LLC	WA	Community/Behavioral Health Agency	$0	$6.5M
Ellen Polsky Dds And Bobby Virk Dmd, Ps	WA	Pediatric Dentistry	$0	$5.8M
Eid, Jaber, Jassar, PLLC	WA	Dental Clinic/Center	$0	$4.2M
Pediatric Specialty Practices, PLLC	WA	Pediatrics Physician	$0	$3.7M
Total Renal Care Inc	WA	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3.5M

St Francis Community Hospital — 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