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

Why is the Medicaid comparison limited to North 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. North 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.

Spirit Lake Tribe (NPI 1114472891)

Field	Value
Entity Type	Organization
Organization	Spirit Lake Tribe
Address	3883 74th Ave Ne
City	Fort Totten
State	ND
ZIP	58335
Taxonomy	Health Service Clinic/Center
NPI Enumerated	August 23, 2016

Payer Source	Total Paid
Medicaid	$16.6M
Medicare	$0

Key Findings

This provider is effectively single‑payer: it reports no Medicare billing on file and $16.6M in lifetime Medicaid revenue, so all observed professional activity and revenue in the dataset flow through Medicaid. The absence of Medicare suggests the clinic primarily serves Medicaid populations or operates in segments (e.g., tribal clinic services) where Medicaid is the dominant payer.

Revenue is highly concentrated in a very small set of codes: the precomputed top‑3 Medicaid codes account for 97.2% of the provider’s total Medicaid revenue, with 99213 alone responsible for $15.2M (91.9% of Medicaid revenue). That degree of concentration indicates the clinic’s financial performance is driven almost entirely by routine established‑patient office/E&M visits.

The top revenue codes define core service lines: heavy volume on 99213 plus presence of 99211 and 99214/99215 shows primary care and ambulatory E/M visits are the operational backbone, while 90837 (psychotherapy) at $721.8K (4.4%) signals a meaningful behavioral‑health service line embedded in clinic operations. Ancillary preventive and dental codes (for example D1206 and D0140) and vaccine/telehealth codes (90471, Q3014) indicate on‑site preventive, dental, and remote access capabilities beyond basic medical visits.

Competitive standing on the dominant code is strong within the state: 99213 ranks #6 of 206 providers in‑state (98th percentile), marking SPIRIT LAKE TRIBE as a major statewide provider of established‑patient office visits. By contrast, 90837 ranks #24 of 138 (83th percentile) and 99211 ranks #5 of 24 (83th percentile), which position the clinic as an above‑typical but not dominant provider for psychotherapy and low‑acuity visits statewide.

Several lower‑revenue codes show atypical state positioning or limited peer comparison: 0012A ranks #2 of 18 (94th percentile) and is explicitly labeled as "notably above typical state volume for this code," which suggests an unusually high relative footprint for that specific procedure code. Conversely, 4270 is reported with only this provider in‑state (ranks #1 of 1; no state peer volume comparison available), indicating either a unique service offering or a code with little state peer reporting.

Operational implications: relying on 99213 for the overwhelming share of revenue implies sensitivity to changes in visit volume, coding policy, or Medicaid reimbursement for standard E/M visits. The clinic’s service mix—primary care E/M, embedded psychotherapy (90837), preventive immunizations and lab work—aligns with a community/tribal health center model that provides broad primary care and behavioral health access rather than high‑acuity specialty services.

Tenure and footprint: the provider’s NPI was enumerated on 2016-08-23 (~10 years ago), consistent with roughly a decade of formal operation under this NPI. That tenure combined with concentrated Medicaid revenue suggests an established Medicaid-facing clinic with a stable role in the local payer network over the last several years.

Payer and revenue risk considerations: because the dataset shows no Medicare activity and $16.6M entirely from Medicaid, the provider’s financial and access profile would be highly sensitive to state Medicaid policy changes, network participation decisions, or shifts in Medicaid enrollment. Diversification into other payers or expansion of higher‑value services would materially change the observed risk profile given current concentration in a few Medicaid codes.

Medicaid: Complete Services Breakdown

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

42 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…	34,710	$440	$15.2M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	1,480	$490	$721.8K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	360	$440	$159K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	220	$690	$153.2K
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…	1,380	$90	$129.7K
D0140	Limited oral evaluation – problem focused	150	$650	$95K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	20	$570	$10.2K
D1120	Prophylaxis–child	20	$570	$9.6K
4270	N/A	250	$40	$9.3K
Q3014	Telehealth originating site facility fee	250	$30	$7.6K

Showing 1–10 of 42

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Spirit Lake Tribe — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

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

42 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0016	Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)	6	10	9,500	$90	$1.4M
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…	6	210	360	$100	$498.2K
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…	45	170	300	$100	$415.8K
A0080	Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest	4	10	170	$30	$356.3K
Q3014	Telehealth originating site facility fee	10	30	130	$180	$355.8K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	24	140	390	$110	$129.2K
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…	38	40	190	$110	$99K
42700	The provider uses an incision to drain an abscess next to one of the tonsils.	3	10	100	$210	$96.9K
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…	24	30	90	$60	$69.3K
D1120	Prophylaxis–child	68	80	360	$40	$48.3K

Showing 1–10 of 42

Related Providers

Other providers that share a Tax Identification Number (TIN) with Spirit Lake Tribe, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spirit Lake Tribe	ND	Land Ambulance	$133.7K	$2.7M
Spirit Lake Tribe	ND	Addiction (Substance Use Disorder) Counselor	$0	$221.1K
Jeffrey Vaagen	ND	Family Medicine Physician	$44.1K	$0
John Miller	CO	Foot & Ankle Surgery Podiatrist	$17.9K	$0
Cheryl Hefta	ND	Women's Health Nurse Practitioner	$16.6K	$0
Stella Onyeakazi	ND	Family Nurse Practitioner	$12.4K	$0

Nearby Providers

Other providers in the same ZIP code as Spirit Lake Tribe, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spirit Lake Tribe	ND	Case Management Agency	$0	$765K

Spirit Lake Tribe — Billing Profile & Reimbursement Data

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Spirit Lake Tribe — 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