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

Why is the Medicaid comparison limited to South 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. South 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.

Avera Mckennan (NPI 1164492906)

Field	Value
Entity Type	Organization
Organization	Avera Mckennan
Address	4101 W Memory Cir Ste 110
City	Sioux Falls
State	SD
ZIP	57107
Taxonomy	Home Infusion Agency
NPI Enumerated	January 24, 2006

Payer Source	Total Paid
Medicaid	$6.7M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $6.7M in lifetime Medicaid revenue, making its revenue footprint effectively single-payer Medicaid rather than a mixed Medicare/Medicaid practice. Analysts should treat Medicaid as the sole available claims universe when evaluating utilization patterns and financial exposure.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 98.0% of the provider's total Medicaid revenue, with a single code, 90378, representing $6.2M or 92.3% of that total. This concentration indicates the business is overwhelmingly driven by one clinical product/service line rather than a broad mix of procedures.

The provider’s taxonomy is Home Infusion Agency and the code mix reinforces a combined infusion/immunoglobulin and DME/supplies orientation — 90378 (RSV–IgIM) dominates revenue while A9274 (external ambulatory insulin delivery system) and A4239 (CGM supply allowance) contribute smaller, supplementary revenue streams. This suggests operations span drug administration and durable medical equipment/supply distribution for diabetes management.

Competitive standing on the top revenue code is state-leading: 90378 ranks #1 of 2 providers in-state and is at the 100th percentile, though the descriptor notes this is a "typical, unremarkable volume for this code." In other words, AVERA MCKENNAN is the top filer in South Dakota for 90378 but its reported volume should not be interpreted as an extreme statistical outlier.

Several supply and device codes show sole-reporter patterns in-state: A9274, A9276, A9277 and A4221 each rank #1 of 1 providers in-state and are annotated with "0th percentile; no state peer volume comparison available," indicating either sole participation in Medicaid billing for these items or insufficient peer data for a meaningful comparative percentile. This implies limited measured in-state competition for specific DME/supply lines.

A4239 ranks #1 of 3 providers in-state and is at the 100th percentile, reporting $132.4K in revenue (2.0% of Medicaid revenue) across 693 claims at $191 avg paid/claim. While materially smaller than the immunoglobulin dollars, this positions the provider as a statewide supplier for CGM supplies and a visible participant in diabetes-related services.

The provider’s NPI was enumerated on 2006-01-24 (~20 years ago), indicating a long-tenured presence in the market. That tenure supports the likelihood of established operational processes and payer relationships within the Medicaid program.

From a risk/opportunity perspective, the extreme revenue dependence on 90378 creates sensitivity to changes in utilization, clinical guidelines, or Medicaid coverage for RSV–IgIM; conversely, leadership positions (including sole-reporter status for several DME codes) may afford negotiating leverage with payers and a platform to grow the smaller A9274/A4239 supply lines to diversify revenue.

Medicaid: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	2,990	$2,060	$6.2M
A9274	External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories	370	$670	$250.3K
A4239	Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service	690	$190	$132.4K
A9276	Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply	160	$650	$105.8K
A9277	Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system	170	$160	$26.9K
A4221	Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)	30	$20	$600

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Avera Mckennan — 2 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

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

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90378	Immunoglobulin is a very complex protein that is produced by certain cells in the body to protect it from various types of infections and produce passive immunity. RSV–IgIM (respiratory syncytial…	1	10	1,740	$2,060	$3.6M
A9274	External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories	1	10	370	$670	$250.4K
A9276	Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply	1	10	160	$650	$105.8K
A4239	Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service	1	10	540	$120	$54.3K
A9277	Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system	1	10	170	$160	$26.9K
A4221	Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)	1	10	30	$20	$590

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center Fargo	ND	Family Medicine Physician	$0	$75.9M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Avera Mckennan	SD	Psychiatry Physician	$0	$9.1M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M
Avera Mckennan	SD	Emergency Medicine Physician	$0	$4.1M
Avera Mckennan	SD	General Acute Care Hospital	$0	$3.7M
Avera Mckennan	SD	Diagnostic Radiology Physician	$0	$3.3M
Avera Mckennan	SD	Hospitalist Physician	$0	$2.6M

Nearby Providers

Other providers in the same ZIP code as Avera Mckennan, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eli Home Care LLC	SD	Home Health Agency	$0	$1.5M
Avera Mckennan	SD	Long Term Care Pharmacy	$880.7K	$53.7K
City Of Sioux Falls	SD	Federally Qualified Health Center (FQHC)	$0	$210.4K
Walmart Inc.	SD	Community/Retail Pharmacy	$58.1K	$0
Keri Orstad	SD	Family Medicine Physician	$50.6K	$0

Avera Mckennan — Billing Profile & Reimbursement Data

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Avera Mckennan — 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