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.

Providence Health & Services- Washington (NPI 1124270715)

Providence Health & Services- Washington is a general practice physician provider located in Everett, Washington. This profile covers 0 Medicare and 124 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Providence Health & Services- Washington
Address	900 Pacific Ave
City	Everett
State	WA
ZIP	98201
Taxonomy	General Practice Physician
NPI Enumerated	October 15, 2008

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

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

124 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	28,540	$60	$1.6M
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…	42,470	$30	$1.3M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	19,040	$50	$894.7K
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…	15,340	$40	$659.8K
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…	3,830	$100	$363.9K
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…	3,850	$90	$326.9K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	3,620	$90	$322.4K
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…	3,280	$60	$193.6K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	1,580	$110	$174K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	1,520	$110	$161.2K

Showing 1–10 of 124

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

Providence Health & Services- Washington — 3 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

124 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	76	1,820	480	$60	$379.6K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	53	130	890	$100	$337.8K
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…	173	1,860	610	$40	$295.5K
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…	12	170	580	$30	$270.4K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	10	140	490	$40	$268.5K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	239	280	1,920	$40	$262.1K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	23	120	640	$100	$259.3K
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…	170	930	680	$60	$259.2K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	267	590	1,280	$50	$244.5K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	167	480	1,160	$30	$180.9K

Showing 1–10 of 124

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services Washington	WA	Pulmonary Disease Physician	$0	$78.6M
Providence Health & Services-wa	WA	General Acute Care Hospital	$0	$62.4M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Providence Health & Services Washington	WA	General Acute Care Hospital	$0	$39.9M
Georgetown Memorial Hospital	SC	General Acute Care Hospital	$0	$27.6M
Swedish Health Services	WA	Internal Medicine Physician	$0	$21.1M
Swedish Health Services	WA	General Acute Care Hospital	$0	$13.3M
Swedish Health Services	WA	Family Medicine Physician	$0	$11.1M
Providence Health & Services Washington	WA	Clinical Medical Laboratory	$1.6M	$9.3M
Providence Health & Services - Washington	WA	Family Medicine Physician	$0	$7.6M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Health Center Of Snohomish County	WA	Dentist	$0	$112.1M
Sunrise Services, Inc.	WA	Community/Behavioral Health Agency	$0	$21.4M
Optum Care Washington PLLC	WA	Multi-Specialty Clinic/Center	$0	$19.5M
North Sound Emergency Medicine PC	WA	Emergency Medicine Physician	$0	$8.7M
Catholic Community Services Western Washington	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$7.9M
Assured Independence, LLC	WA	Emergency Response System Companies	$0	$7M
Pioneer Human Services	WA	Substance Abuse Rehabilitation Facility	$0	$6.2M
Evergreen Recovery Centers	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$5.9M
Sight Partners	WA	Ambulatory Surgical Clinic/Center	$4.9M	$342.1K
Evergreen Recovery Centers	WA	Substance Abuse Rehabilitation Facility	$0	$4.3M

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

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

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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