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

Why is the Medicaid comparison limited to Oregon 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. Oregon (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.

Confederated Tribes Of The Grand Ronde Community Of Oregon (NPI 1174666358)

Field	Value
Entity Type	Organization
Organization	Confederated Tribes Of The Grand Ronde Community Of Oregon
Address	9605 Grand Ronde Rd
City	Grand Ronde
State	OR
ZIP	97347
Taxonomy	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
NPI Enumerated	February 15, 2007

Payer Source	Total Paid
Medicaid	$18.6M
Medicare	$0

Key Findings

CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON is effectively a Medicaid-centric provider: there is no Medicare billing on file while total Medicaid revenue is $18.6M, indicating the organization operates predominantly within the Medicaid payer stream rather than as a dual-payer practice. This payer concentration frames how analysts should view utilization and competitive positioning — comparisons should be made against in-state Medicaid peers.

Revenue concentration is high: the precomputed top-3 Medicaid codes account for 64.7% of this provider's total Medicaid revenue, with H0020 alone contributing $7.5M (40.5% of Medicaid revenue), followed by 99214 at $2.5M (13.4%) and 99213 at $2M (10.7%). This level of concentration around a small set of codes implies that changes in coverage, reimbursement, or demand for those services would have outsized impact on this provider's topline.

The code mix shows a service-line focus on substance use treatment and behavioral health combined with substantial primary care outpatient work: H0020 (methadone administration) is the single largest revenue driver (150.9K claims, $50 avg paid/claim, $7.5M revenue), and H0004 (behavioral health counseling, 11.5K claims, $156 avg paid/claim, $1.8M revenue) also ranks in the top earners. Together with H0005 and H0038 appearing in the list, the data indicate a robust addiction/behavioral-health program integrated with the provider’s ambulatory services.

Primary care evaluation-and-management activity is a major secondary revenue stream: 99214 (9.5K claims, $264 avg paid/claim, $2.5M revenue) and 99213 (6.9K claims, $290 avg paid/claim, $2M revenue) are the second- and third-largest Medicaid revenue sources. Both codes rank highly statewide (99214 ranks #163 of 1503 providers in-state, 89th percentile; 99213 ranks #220 of 1591, 86th percentile), positioning the clinic as a relatively strong provider of routine and moderately complex outpatient visits within Oregon’s Medicaid network.

Competitive standing is mixed by service line: for its dominant behavioral-health/substance-use code H0020 the provider ranks #14 of 32 in-state (58th percentile), which is a modest position among a small set of specialized programs; by contrast, its E/M volumes (99214 and 99213) place it in the upper deciles statewide (89th and 86th percentiles), indicating it is a significant player for office/outpatient visits. Other service lines such as psychotherapy (90837, ranks 75th percentile) and dental prophylaxis (D1110, 80th percentile) show consistent, above-typical volumes but not outright dominance.

The presence of dental (D0140, D1110, D1120), ophthalmology (92014, 92004) and laboratory/testing codes (87635) alongside medication codes like J0575 (buprenorphine/naloxone, 4.2K claims, $19 avg paid/claim, $79.5K revenue) suggests the provider operates as a multi-disciplinary tribal health center offering primary care, behavioral health/substance-use disorder treatment, dental, vision, and some dispensing/medication services. J0575 ranks #2 of 3 providers in-state (50th percentile), which indicates the clinic is one of a very small number billing that medication but not necessarily an outlier in volume.

Operational longevity provides context for these patterns: the provider’s NPI was enumerated on 2007-02-15 (~19 years ago), indicating a long-standing presence in the community that is consistent with established service lines and sustained Medicaid relationships. That tenure supports the interpretation that the observed code mix is the result of mature program offerings rather than a new or transient service profile.

From a risk and strategic perspective, the heavy reliance on a few Medicaid codes — with the top three codes accounting for 64.7% of Medicaid revenue — creates revenue vulnerability to policy or demand shifts affecting methadone and outpatient E/M services. For analysts, this suggests priority monitoring areas: Medicaid coverage and reimbursement changes for H0020 and E/M codes, as well as competitive moves by other in-state providers offering addiction treatment and primary care, will materially affect the provider’s financial profile.

Medicaid: Complete Services Breakdown

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

37 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	150,890	$50	$7.5M
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…	9,460	$260	$2.5M
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…	6,880	$290	$2M
H0004	Behavioral health counseling and therapy, per 15 minutes	11,460	$160	$1.8M
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…	1,710	$490	$842.5K
D0140	Limited oral evaluation – problem focused	1,350	$490	$659.7K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1,190	$500	$592.9K
D1120	Prophylaxis–child	1,200	$480	$575K
H0005	Alcohol and/or drug services; group counseling by a clinician	6,880	$70	$488.3K
D0120	Periodic oral evaluation - established patient	550	$560	$310.2K

Showing 1–10 of 37

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Confederated Tribes Of The Grand Ronde Community Of Oregon — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

37 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	14	30	86,800	$10	$2.4M
H0005	Alcohol and/or drug services; group counseling by a clinician	67	180	3,250	$40	$783.8K
H0004	Behavioral health counseling and therapy, per 15 minutes	43	270	1,660	$90	$681K
H0038	Self‑help/peer services, per 15 minutes	56	150	1,030	$80	$417.2K
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…	344	1,380	540	$140	$363.3K
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…	163	1,500	650	$70	$312.4K
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…	220	1,590	590	$50	$236.5K
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…	267	400	230	$90	$153.8K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	111	140	5,430	$10	$147.7K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	125	250	460	$80	$121.3K

Showing 1–10 of 37

Related Providers

Other providers that share a Tax Identification Number (TIN) with Confederated Tribes Of The Grand Ronde Community Of Oregon, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lance Loberg	OR	Family Medicine Physician	$51.3K	$0
Karrie Martin	OR	Family Nurse Practitioner	$38.7K	$0

Confederated Tribes Of The Grand Ronde Community Of Oregon — 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

Frequently Asked Questions

References