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

Why is the Medicaid comparison limited to Oklahoma 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. Oklahoma (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 Anthony Shawnee Hospital Inc (NPI 1134123193)

Field	Value
Entity Type	Organization
Organization	St Anthony Shawnee Hospital Inc
Address	1102 W Macarthur St
City	Shawnee
State	OK
ZIP	74804
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 8, 2005

Payer Source	Total Paid
Medicaid	$23M
Medicare	$0

Key Findings

ST ANTHONY SHAWNEE HOSPITAL INC reports no Medicare billing on file and $23M in lifetime Medicaid revenue, making its financial footprint effectively single-payer at this dataset level. The absence of Medicare revenue paired with material Medicaid receipts suggests payer concentration risk and means Medicaid performance will dominate any revenue or utilization analysis for this facility.

Revenue is highly concentrated in emergency-department evaluation-and-management codes: the precomputed top-3 Medicaid codes (99283, 99284, 99282) account for 63.9% of the provider's total Medicaid revenue. Individually, 99283 generated $6.8M (30.9%), 99284 generated $4.9M (22.3%), and 99282 generated $2.4M (10.7%), indicating that a majority of Medicaid dollars flow through ED visits at lower-to-moderate acuity levels.

Operationally, the code mix points to an ED-centric acute care model: very high claim volumes for ED E/M codes (99283: 43.4K claims; 99284: 21.9K claims; 99282: 25.3K claims) plus substantial use of IV administration codes (96374: 14.5K claims; 96375: 8.5K claims) and rapid infusions (96361: 4.2K claims). This pattern is consistent with a high-throughput emergency department treating many unscheduled or acute presentations and administering on-site IV therapies.

Competitive standing within Oklahoma is strong for multiple high-volume codes. 99282 ranks #4 of 159 providers in-state (98th percentile) and is labeled an "extreme outlier, far above typical state volume," while 99283 ranks #10 of 254 (96th percentile) and 99284 ranks #22 of 230 (91th percentile); additionally G0463 ranks #1 of 50 (100th percentile) and is an "extreme outlier, far above typical state volume," underscoring dominant outpatient clinic/ED visit volumes relative to peers.

The provider also reports notable volume in SARS–CoV–2 testing and other lab services that support high outpatient throughput: U0003 produced $728.2K (3.3%) with 9.8K claims and ranks #3 of 52 in-state (96th percentile), while 87635 generated $239.5K (1.1%) and ranks #6 of 210 (98th percentile). These lab volumes align with frequent acute respiratory evaluation and reinforce the ED/front-door role suggested by the E/M coding mix.

Although ED codes dominate revenue, the facility performs a range of ancillary and procedure services that contribute meaningfully to Medicaid revenue. Tympanostomy 69436 accounted for $637.7K (2.9%) with 998 claims (rank #12 of 69, 84th percentile) and tonsil/adenoid 42820 generated $511.8K (2.3%) with 153 claims (rank #21 of 53, 62th percentile), indicating an active operative service line for pediatric ENT procedures alongside ED care.

Several codes are flagged as "notably above typical" statewide volumes across infusion and diagnostic categories, which supports the idea of a high-volume treatment facility rather than a low-throughput community hospital. Examples include 96374 (rank #5 of 95, 96th percentile), 96372 (rank #12 of 361, 97th percentile), 87070 (rank #4 of 53, 94th percentile), and 96361 (rank #4 of 71, 96th percentile), showing consistent above-typical usage across medication administration and microbiology testing.

The provider has an established operational history with NPI enumerated on 2005-06-08 (~21 years ago), indicating a long tenure in the market. Combined with the Medicaid concentration and the facility's strong state-level rankings on ED and outpatient clinic codes, this tenure suggests an entrenched regional ED/acute outpatient service role that will be the primary driver of payer negotiations and network value for Medicaid relationships.

Medicaid: Complete Services Breakdown

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

131 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.	43,380	$160	$6.8M
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.	21,910	$220	$4.9M
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.	25,290	$90	$2.4M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	14,460	$130	$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.	3,370	$320	$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…	9,840	$70	$728.2K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	1,000	$640	$637.7K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	150	$3,350	$511.8K
J3490	Unclassified drugs	11,240	$40	$427K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	8,490	$40	$365K

Showing 1–10 of 131

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oklahoma Distribution

St Anthony Shawnee Hospital Inc — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oklahoma

Full comparison — all codes billed, vs. Oklahoma median

131 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.	22	230	1,440	$170	$1.2M
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.	10	250	1,820	$130	$1.1M
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.	51	180	1,030	$200	$1M
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	21	50	70	$1,800	$496.5K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	5	100	990	$130	$405.9K
00170	The provider performs anesthesia services for a patient undergoing an intraoral procedure, including biopsy.	57	70	290	$290	$376.1K
01967	The provider performs neuraxial anesthesia services for a patient undergoing a planned vaginal delivery.	13	20	220	$450	$286.7K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	12	70	150	$450	$279K
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…	3	50	330	$80	$238.7K
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…	41	50	550	$60	$235.1K

Showing 1–10 of 131

Related Providers

Other providers that share a Tax Identification Number (TIN) with St Anthony Shawnee Hospital Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ssm Health Care Of Oklahoma, Inc.	OK	General Acute Care Hospital	$0	$46.8M
Midwest Regional Medical Center, LLC	OK	General Acute Care Hospital	$0	$5.3M
Ssm Health Care Of Oklahoma, Inc	OK	General Acute Care Hospital	$0	$4.9M
Ssm Health Care Of Oklahoma, Inc	OK	Psychiatry Physician	$0	$1.8M
Midwest Regional Medical Center, LLC	OK	Ambulance	$0	$1.8M
Ssm Health Care Of Oklahoma, Inc	OK	Ambulance	$0	$1.6M
Don Wynn	TX	Pulmonary Disease Physician	$1.4M	$0
Clifford Henderson	OK	Dermatology Physician	$1.2M	$0
Tiffani Lowell	OK	Family Nurse Practitioner	$1.1M	$0
Jessica Graves	OK	Medical Physician Assistant	$859.2K	$0

Nearby Providers

Other providers in the same ZIP code as St Anthony Shawnee Hospital Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saints Medical Group, LLC	OK	Internal Medicine Physician	$0	$14.5M
Citizen Potawatomi Nation	OK	Federally Qualified Health Center (FQHC)	$0	$8.6M
React Emergency Medical Service	OK	Land Ambulance	$1.3M	$6.4M
Advance Physicians Group	OK	Urgent Care Clinic/Center	$0	$7M
Hope Revealed Behavioral Health Center	OK	Community/Behavioral Health Agency	$0	$4.6M
Saint Medical Group, LLC	OK	Family Medicine Physician	$0	$4.5M
Ocean Dental, PC	OK	General Practice Dentistry	$0	$4M
Summer Dental Shawnee PLLC	OK	Dentist	$0	$2.6M
Foundations Therapy, PLLC	OK	Pediatric Occupational Therapist	$0	$2M
Eric Reding	OK	Dermatology Physician	$261.7K	$0

St Anthony Shawnee Hospital Inc — 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