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

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

Providence Health & Services - Oregon (NPI 1114015971)

Field	Value
Entity Type	Organization
Organization	Providence Health & Services - Oregon
Address	9205 Sw Barnes Rd
City	Portland
State	OR
ZIP	97225
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 10, 2006

Payer Source	Total Paid
Medicaid	$36.9M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports total Medicaid revenue of $36.9M, making it effectively a single‑payer (Medicaid) operation in the available claims data; that concentration means payer mix risk is concentrated on Medicaid reimbursement policies and network contracts. The NPI was enumerated 2006-10-10 (~20 years ago), indicating an established presence in the market but continued reliance on Medicaid revenue.

Revenue is highly concentrated in emergency department evaluation-and-management codes: the top three Medicaid codes (99284, 99285, 99283) together account for 86.2% of the provider's total Medicaid revenue. Those three codes individually account for $12.9M (35.0%) for 99284, $12M (32.5%) for 99285, and $6.8M (18.6%) for 99283, which shows a narrow set of services driving the bulk of spend.

The code mix points to a hospital operating with heavy ED and acute-care throughput: 99284/99285/99283 are the dominant revenue drivers, supported by ED-adjacent services such as IV medication administration (96374, 96361, 96375), hospital observation (G0378), imaging (74177, 71045/71046), and rapid multiplex respiratory testing (87636). Together these codes paint a profile of an acute care hospital with substantial emergency department volume and on-site capabilities for imaging, labs, and IV therapy.

Statewide competitive standing for the high-revenue ED codes is strong in percentile terms: 99284 ranks #10 of 145 providers in-state (94th percentile), 99285 ranks #12 of 129 (91st percentile), and 99283 ranks #16 of 137 (89th percentile), indicating this provider is a high-volume Medicaid ED participant in Oregon. That said, each of those codes is described in the source as “typical, unremarkable volume for this code,” so while the provider sits in high percentiles it is not presented as an extreme outlier for ED utilization patterns.

Behavioral health and psychiatric services are a visible secondary line: S9480 (intensive outpatient psychiatric services) generated $1.8M (4.9% of Medicaid revenue) and 90853 (group psychotherapy) generated $423.3K (1.1%). The psychiatric evaluation code 90791 produced $279.7K (0.8%) and is explicitly flagged as “notably above typical state volume,” suggesting the provider runs a meaningful outpatient/partial-hospitalization behavioral health program relative to peers.

Operationally, the presence of high-volume infusion and supportive care codes (96374 at $1.3M, 96361 at $113.7K, 96375 at $102.3K), observation hours (G0378 at $44.2K), and respiratory multiplex testing (87636 at $213.9K) supports the interpretation of significant ED throughput with on-site acute care services rather than a clinic-only footprint. These ancillary services amplify revenue tied to ED encounters and could be leverage points in payer negotiations or utilization reviews.

A small set of low‑claim, high‑unit‑price procedures appear intermittently in the mix (for example 54300: 13 claims, $2795 avg paid/claim, $36.3K revenue; 54640: 27 claims, $1263 avg paid/claim, $34.1K revenue; D7140: 18 claims, $1863 avg paid/claim, $33.5K revenue). Individually these codes do not drive material Medicaid revenue but represent episodic surgical, urologic, or dental procedures that are outliers by average paid per claim and may reflect specialty cases or limited procedural capacity.

For payers and analysts, the combination of a ~20‑year tenure and a Medicaid-only billing footprint means contract and network discussions should center on emergency care capacity, behavioral health services, and the implications of a highly concentrated revenue base (86.2% from three ED codes). Monitoring utilization trends for 99284/99285/99283 and the flagged psychiatric evaluation code 90791 will be most informative for forecasting future Medicaid spend and assessing network adequacy in the region.

Medicaid: Complete Services Breakdown

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

97 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	50,590	$260	$12.9M
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.	36,520	$330	$12M
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.	40,970	$170	$6.8M
S9480	Intensive outpatient psychiatric services, per diem	7,230	$250	$1.8M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	12,070	$110	$1.3M
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	7,170	$60	$423.3K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	2,330	$120	$279.7K
H0005	Alcohol and/or drug services; group counseling by a clinician	3,270	$70	$219.2K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	2,520	$90	$213.9K
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…	1,310	$90	$122K

Showing 1–10 of 97

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Providence Health & Services - Oregon — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

97 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	10	150	7,400	$170	$2.8M
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.	12	130	2,610	$200	$2.3M
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.	16	140	10,160	$130	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	43	40	3,200	$60	$1.5M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	4	10	910	$450	$1.1M
S9480	Intensive outpatient psychiatric services, per diem	3	20	650	$330	$1.1M
H0005	Alcohol and/or drug services; group counseling by a clinician	92	180	3,250	$40	$783.8K
H0004	Behavioral health counseling and therapy, per 15 minutes	145	270	1,660	$90	$681K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	13	60	3,620	$90	$623.7K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	12	20	190	$1,070	$556K

Showing 1–10 of 97

Related Providers

Other providers that share a Tax Identification Number (TIN) with Providence Health & Services - Oregon, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services - Oregon	OR	Clinical Pathology Physician	$0	$11.4M
Salem Pediatric Clinic	OR	Pediatrics Physician	$0	$9M
Providence Health & Services - Oregon	OR	Child & Adolescent Psychiatry Physician	$0	$8.7M
Providence Health & Services - Oregon	OR	Internal Medicine Physician	$0	$4.6M
Providence Health & Services - Oregon	OR	Internal Medicine Physician	$0	$3.8M
Providence Health & Services - Oregon	OR	Clinic/Center	$0	$3.6M
Providence Health & Services Oregon	OR	Internal Medicine Physician	$0	$3M
Providence Health & Services - Oregon	OR	Family Medicine Physician	$0	$2.7M
Providence Health & Services - Oregon	OR	Family Medicine Physician	$0	$2.7M
Express Care Or PC	OR	General Practice Physician	$0	$2.4M

Nearby Providers

Other providers in the same ZIP code as Providence Health & Services - Oregon, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Columbia Medical Alarm, Inc.	OR	Home Health Agency	$0	$6.1M
Childrens Clinic PC	OR	Pediatrics Physician	$0	$4.7M
West Hills Gastroenterology Equipment Corp	OR	Endoscopy Clinic/Center	$861.3K	$3.2M
Chiropractic Art & Science LLC	OR	Health Service Clinic/Center	$0	$2.7M
Hd Industries, LLC	OR	In Home Supportive Care Agency	$0	$2.7M
Trg, LLC	OR	Diagnostic Radiology Physician	$0	$2.4M
Westside Pediatric Clinic PC	OR	Pediatrics Physician	$0	$2.3M
Carlos Ugalde	OR	Oral and Maxillofacial Surgery (Dentist)	$0	$2.3M
Philipp Kupfer	OR	Oral and Maxillofacial Surgery (Dentist)	$0	$1.6M
Providence Health & Services - Oregon	OR	Neurology Physician	$0	$1.5M

Providence Health & Services - Oregon — Billing Profile & Reimbursement Data

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Providence Health & Services - Oregon — 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