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NPI 1134632599 · Anacortes, WA · Substance Use Disorder Rehabilitation Clinic/Center
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Swinomish Health Services is a substance use disorder rehabilitation clinic/center provider located in Anacortes, Washington. This profile covers 2 Medicare and 50 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Swinomish Health Services |
| Address | 8212 S March Point Rd |
| City | Anacortes |
| State | WA |
| ZIP | 98221 |
| Taxonomy | Substance Use Disorder Rehabilitation Clinic/Center |
| NPI Enumerated | November 8, 2017 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $195.9M |
| Medicare | $184.9K |
This provider’s revenue is overwhelmingly Medicaid‑driven: total Medicaid revenue is $195.9M versus total Medicare revenue of $184.9K, indicating SWINOMISH HEALTH SERVICES is effectively a Medicaid-centric operation with Medicare representing a negligible share of lifetime billing. The payer mix suggests the organization’s scale and reimbursement exposure are concentrated in state Medicaid programs rather than Medicare.
The code mix and descriptions identify SWINOMISH as an opioid treatment/behavioral health clinic that centers on methadone-based medication‑assisted treatment and high-volume clinic encounters. Medicaid’s top code T1015 (clinic visit/encounter, all‑inclusive) generated $186.5M (95.3% of the provider’s Medicaid revenue) and Medicaid also shows methadone administration via H0020 ($4.8M) and behavioral counseling H0004 ($1.6M), while Medicare activity is dominated by G2067 (medication assisted treatment, methadone bundle) and G2078 (take‑home methadone supply).
Revenue concentration is extreme at the payer‑code level: the top 3 Medicaid codes account for 98.6% of Medicaid revenue, driven primarily by T1015 at $186.5M (95.3%), and the top 3 Medicare codes account for 100.0% of Medicare revenue with G2067 contributing $157.6K (85.1%). These figures indicate a highly concentrated billing profile where a single bundled clinic code and a methadone weekly bundle dominate financials for each payer.
Competitively within Washington State, the provider is an outlier on the Medicaid clinic encounter metric: T1015 ranks #4 of 652 in‑state and is labeled an "extreme outlier, far above typical state volume for this code," which positions SWINOMISH as a major statewide provider for all‑inclusive clinic visits. In contrast, its in‑state rankings on methadone administration and behavioral health (H0020 rank #17/60, H0004 rank #27/317) are high but not extreme, consistent with a dominant clinic encounter volume supported by substantial but more typical ancillary services.
From the national Medicare perspective the provider’s footprint is modest: G2067 ranks #395 of 830 (52th percentile) and G2078 ranks #94 of 493 (81th percentile), both described as "typical, unremarkable" volumes relative to national peers. Combined with the very small Medicare revenue total ($184.9K), these ranks imply SWINOMISH is not a major Medicare player and its Medicare activity likely mirrors a smaller, program‑specific subset of its broader Medicaid operations.
Operational throughput is very large on Medicaid: T1015 shows 406.3K claims with an average paid/claim of $459, and H0020 shows 298.3K claims at $16 avg paid/claim, indicating high‑frequency, lower‑unit‑value encounters typical of daily or weekly medication dispensing and clinic visits. These claim volumes support a high‑capacity clinic model (dispensing, counseling, group services, toxicology testing) rather than a low‑volume specialty practice.
Although the bulk of revenue is concentrated in a few codes, billing shows clinical breadth beyond dosing and clinic bundles: behavioral health counseling codes such as H0004 (24K claims, $65 avg paid/claim, $1.6M revenue), psychotherapy codes like 90837 (3.5K claims, $75 avg paid/claim), and assessment/psych testing codes (96153: 16K claims, $33 avg paid/claim) appear across Medicaid claims. These line items indicate integrated behavioral health, group therapy, and assessment services supplement the dominant methadone/clinic encounter business line.
The provider has an NPI enumerated on 2017-11-08 (~9 years ago), giving it an established presence long enough to scale the high Medicaid volumes reported. Tenure combined with the extreme in‑state ranking on T1015 suggests the organization has operationalized a high‑throughput clinic model over multiple years rather than being a recent entrant to large‑scale Medicaid billing.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed… | 670 | $240 | $157.6K |
| G2078 | Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | 710 | $40 | $27.6K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
50 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 406,250 | $460 | $186.5M |
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 298,300 | $20 | $4.8M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 24,050 | $70 | $1.6M |
| 96153 | N/A | 15,960 | $30 | $526.6K |
| 96165 | The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health… | 20,410 | $20 | $448.9K |
| 96164 | The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health… | 20,580 | $20 | $391K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 11,020 | $30 | $319.5K |
| 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… | 3,520 | $80 | $263.9K |
| H0001 | Alcohol and/or drug assessment | 1,760 | $130 | $228.9K |
| 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… | 5,070 | $40 | $192.7K |
Showing 1–10 of 50
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington median
50 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 4 | 650 | 4,110 | $250 | $4.9M |
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 17 | 60 | 18,030 | $10 | $4.1M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 27 | 320 | 2,080 | $60 | $495.5K |
| 96165 | The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health… | 26 | 220 | 2,880 | $50 | $431K |
| 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… | 496 | 1,820 | 480 | $60 | $379.6K |
| 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… | 366 | 1,860 | 610 | $40 | $295.5K |
| 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… | 176 | 930 | 680 | $60 | $259.2K |
| H0038 | Self‑help/peer services, per 15 minutes | 103 | 130 | 990 | $30 | $192.6K |
| D2392 | Post 2 surface resin‑based composite | 528 | 540 | 990 | $60 | $188.6K |
| 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… | 334 | 390 | 420 | $50 | $152.3K |
Showing 1–10 of 50
Other providers in the same ZIP code as Swinomish Health Services, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Public Hospital District No 2 Skagit County Washington | WA | General Acute Care Hospital | $0 | $8.4M |
| Public Hospital District No 2 Skagit County Washington | WA | Rural Health Clinic/Center | $0 | $5.8M |
| Public Hospital District No 2 Skagit County Washington | WA | Rural Health Clinic/Center | $0 | $4.8M |
| Hill And Stout, PLLC | WA | Pediatric Dentistry | $0 | $3.6M |
| City Of Anacortes | WA | Land Ambulance | $338.2K | $2.6M |
| Linda Brown | WA | Ophthalmology Physician | $1M | $0 |
| Kenneth Ellis | WA | Ophthalmology Physician | $957.3K | $0 |
| Wirt Hines | WA | MOHS-Micrographic Surgery Physician | $417K | $0 |
| Walgreen Co | WA | Pharmacy | $328.2K | $0 |
| Nicolas Elizondo | WA | Physician Assistant | $230.4K | $0 |
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