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.

Kaiser Foundation Hospitals (NPI 1124182902)

Key Findings

Field	Value
Entity Type	Organization
Organization	Kaiser Foundation Hospitals
Address	10180 Se Sunnyside Rd
City	Clackamas
State	OR
ZIP	97015
Taxonomy	General Acute Care Hospital
NPI Enumerated	December 19, 2006

Payer Source	Total Paid
Medicaid	$18M
Medicare	$0

This entity is effectively single‑payer in the dataset: there is no Medicare billing on file while total Medicaid revenue is $18M, so Medicaid accounts for the entirety of reported lifetime government payer revenue and will drive any payer-mix and reimbursement analyses. Analysts should treat Medicaid payment patterns as the primary revenue signal for this provider.

Revenue is highly concentrated in a small set of evaluation-and‑management codes: the precomputed top‑3 Medicaid codes account for 73.1% of the provider’s total Medicaid revenue, with 99283 alone generating $8.1M (51.5% of Medicaid revenue). This concentration means changes to ED or outpatient E/M reimbursement or utilization will disproportionately affect the provider’s topline.

The top individual revenue drivers show an operational mix weighted toward emergency and ambulatory E/M care: 99283 (27.2K claims, $298 avg paid/claim, $8.1M), 99214 (9.2K claims, $234 avg paid/claim, $2.2M), and 99213 (7.7K claims, $159 avg paid/claim, $1.2M). The presence of multiple ED codes (99283, 99284, 99282) alongside high outpatient visit codes suggests the hospital operates both a busy ED and substantial outpatient/clinic services that together produce the majority of Medicaid revenue.

The provider maintains broad on‑site laboratory and preventive services as secondary revenue contributors: high-volume lab and screening codes appear throughout the top-25 (for example, 80053 with 15K claims, 83036 with 6.6K claims, 87491 and 87591 each with 3.8K claims, and 90471 with 4.5K claims). Several of these lab/preventive codes sit at elevated statewide percentiles (90471 at the 96th percentile, 87880 at the 93rd percentile, 83036 at the 90th percentile), indicating meaningful lab and vaccination throughput even though the dataset labels these volumes as "typical, unremarkable volume" for the code.

State-level competitive standing for the top E/M codes is mid-to-high but not market-dominant: 99283 ranks #35 of 137 providers in-state (75th percentile), 99214 ranks #170 of 1503 (89th percentile), and 99213 ranks #204 of 1591 (87th percentile), each described in the source as "typical, unremarkable volume." These ranks signal that KAISER FOUNDATION HOSPITALS is a significant participant in its market for these services but generally within peer norms rather than an outlier leader.

Given the facility’s NPI enumeration date of 2006-12-19 (~20 years ago), this is an established provider with multi-year billing history in the public dataset; tenure supports interpreting current patterns as sustained operational behavior rather than a short-term fluctuation. Analysts should consider historical stability when assessing network value or contracting leverage.

From a utilization-management and contracting perspective, the heavy dependence on a few E/M codes (top 3 = 73.1% of Medicaid revenue) and the large absolute contribution from 99283 ($8.1M) represent concentration risk and opportunity: negotiations or utilization-review policies focused on ED throughput, triage, and outpatient follow-up could materially change revenue. Review of ED admission rates, ambulatory access, and lab reimbursement trends will be high‑impact areas for payers and provider finance teams.

Medicaid: Complete Services Breakdown

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

228 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.	27,200	$300	$8.1M
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…	9,240	$230	$2.2M
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…	7,740	$160	$1.2M
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.	1,200	$350	$422.8K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	3,800	$110	$407K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	3,800	$110	$406.4K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	2,950	$130	$386.3K
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.	2,280	$160	$369.4K
84443	The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the…	5,850	$50	$286.6K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	1,400	$140	$191.4K

Showing 1–10 of 228

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

Kaiser Foundation Hospitals — 1 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

228 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.	89	150	7,400	$170	$2.8M
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.	35	140	10,160	$130	$2.3M
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	5	10	1,790	$60	$1.8M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	41	40	3,200	$60	$1.5M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	37	60	3,620	$90	$623.7K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	25	60	420	$60	$405.1K
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…	1,225	1,380	540	$140	$363.3K
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…	58	60	460	$40	$327.4K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	29	80	1,130	$90	$327.2K
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…	170	1,500	650	$70	$312.4K

Showing 1–10 of 228

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northwest Medical, LLC.	OR	Oxygen Equipment & Supplies (DME)	$0	$9.8M
First Transit, Inc.	OR	Transportation Broker	$0	$6.7M
Rupa K. Shah, Md, PC	OR	Pediatrics Physician	$0	$5.5M
Sleep Technologies Ltd	OR	Durable Medical Equipment & Medical Supplies	$0	$3.9M
Clackamas County	OR	Federally Qualified Health Center (FQHC)	$0	$3.3M
Active Recovery Tms PLLC	OR	Psychiatry Physician	$0	$2.4M
Kaiser Foundation Hospitals	OR	Ambulatory Surgical Clinic/Center	$6.9K	$1.9M
Crossing Bridges Counseling Center	OR	Mental Health Counselor	$0	$1.9M
Kaiser Foundation Hospitals	OR	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.8M
Elizabeth Verner-cole	OR	Retina Specialist (Ophthalmology) Physician	$1.7M	$0

Kaiser Foundation Hospitals — 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

Nearby Providers

Frequently Asked Questions

References