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.

Oglala Sioux Tribe (NPI 1164503421)

Key Findings

Field	Value
Entity Type	Organization
Organization	Oglala Sioux Tribe
Address	3200 Canyon Lake Dr
City	Rapid City
State	SD
ZIP	57702
Taxonomy	Obstetrics & Gynecology Physician
NPI Enumerated	October 17, 2006

Payer Source	Total Paid
Medicaid	$5.2M
Medicare	$0

This provider reports no Medicare billing on file and $5.2M in lifetime Medicaid revenue, making its observable business effectively single-payer (Medicaid) in the dataset. Analysts should treat Medicare-related comparisons as inapplicable for this NPI and focus competitively on the Medicaid landscape in South Dakota.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes by revenue account for 89.6% of this provider's total Medicaid revenue, with 99213 alone generating $4M (78.1% of Medicaid revenue). That concentration indicates the practice’s financial performance is primarily driven by routine established‑patient E/M visits rather than a broad mix of procedures.

The code mix is consistent with a clinic‑based Obstetrics & Gynecology practice focused on ambulatory care. High volumes of E/M codes — notably 99213 (9.6K claims) as the dominant revenue driver, supplemented by 99211 (486 claims) and 99214 (480 claims) — point to regular office‑visit throughput rather than a procedure- or surgery‑heavy operation; delivery care (59409) appears minimal at 29 claims ($9.5K, 0.2%).

Behavioral/psychosocial screening appears embedded in the workflow: 96127 accounts for $354.6K (6.9% of Medicaid revenue) with 694 claims and ranks #4 of 18 in-state (82th percentile), a pattern the dataset labels as typical, unremarkable volume. This suggests routine use of brief standardized behavioral assessments alongside gynecologic/primary care visits.

On laboratory and point‑of‑care testing, the practice reports notable activity: 81025 (pregnancy test) has 333 claims and $151.8K revenue (2.9%), 87210 (wet mount) has 76 claims and $43.5K (0.8%), and 88142 (thin‑prep cytology) shows 98 claims and $49.4K (1.0%) where the provider ranks #1 of 2 in-state (100th percentile). These codes indicate on-site or closely integrated lab/cytology services supporting outpatient women's health.

Competitive standing is mixed by code: for the dominant code 99213 the provider ranks #46 of 344 in-state (87th percentile), reflecting relatively strong in-state activity for routine established‑patient visits even though the dataset labels the volume as typical, unremarkable. For other E/M codes the provider sits in more moderate percentiles (e.g., 99211 at 70th percentile, 99214 at 41th percentile), indicating it is an active but not uniformly dominant statewide player across all visit levels.

Tenure is long-standing: the NPI was enumerated on 2006-10-17 (~20 years ago), which supports interpretation of these billing patterns as established practice behavior rather than a short‑term or new entrant effect. Historical presence may also explain steady ambulatory throughput and embedded screening/lab workflows.

From an operational and payer strategy perspective, the heavy reliance on a small set of E/M and screening codes (top 3 = 89.6% of Medicaid revenue) means changes to Medicaid reimbursement, coding rules for office visits, or patient mix could materially affect revenue. The data suggest limited diversification into procedure-heavy services or inpatient deliveries, so any value‑capture or growth strategies would likely need to expand services beyond routine office visits or increase non‑visit revenue lines to change the current payer revenue profile.

Medicaid: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	9,590	$420	$4M
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	690	$510	$354.6K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	490	$490	$238.1K
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…	480	$420	$203K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	330	$460	$151.8K
81002	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dip stick, and shakes off the excess urine. Alternatively, the analyst may place drops of the urine specimen…	110	$500	$55.7K
88142	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	100	$500	$49.4K
87210	The lab analyst or microbiologist performs a wet mount preparation of a specimen, usually from material collected on a swab or placed directly on a microscope slide.	80	$570	$43.5K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	60	$340	$21.3K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	30	$330	$9.5K

Showing 1–10 of 12

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

Oglala Sioux Tribe — 1 of 12 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

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	46	340	1,010	$100	$511K
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…	154	260	860	$80	$222.6K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	18	60	120	$210	$171.2K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	48	70	130	$100	$99K
99395	The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39.	8	10	80	$70	$47.9K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	8	10	40	$500	$28.6K
88142	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	1	10	70	$380	$25K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	4	20	70	$50	$23.8K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	11	30	210	$20	$14.6K
81002	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dip stick, and shakes off the excess urine. Alternatively, the analyst may place drops of the urine specimen…	4	10	110	$40	$8.7K

Showing 1–10 of 12

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Black Hills Works Inc	SD	Developmentally Disabled Services Day Training Agency	$0	$149.7M
Great Plains Tribal Chairmen's Health Board	SD	Pharmacy	$0	$36.4M
Black Hills Pediatric Dentistry	SD	Pediatric Dentistry	$0	$24.7M
Dakota Dental 4 Kids	SD	Dental Clinic/Center	$0	$7.1M
Rushmore Ambulatory Surgery Center	SD	Ambulatory Surgical Clinic/Center	$0	$4.6M
Stay Graceful Inc	SD	In Home Supportive Care Agency	$0	$3.4M
Children's Care Hospital And School	SD	Rehabilitation Clinic/Center	$0	$2.1M
Rushmore Dental Products, Inc.	SD	Durable Medical Equipment & Medical Supplies	$0	$1.7M
Black Hills Orthopedic & Spine Center, Inc.	SD	Multi-Specialty Clinic/Center	$0	$1.7M
Black Hills Caregiving, LLC	SD	Home Health Agency	$0	$1.1M

Oglala Sioux Tribe — 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