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.

Kaiser Foundation Health Plan Of The Northwest (NPI 1184786527)

Key Findings

Field	Value
Entity Type	Organization
Organization	Kaiser Foundation Health Plan Of The Northwest
Address	500 Ne Multnomah St
City	Portland
State	OR
ZIP	97232
Taxonomy	General Practice Physician
NPI Enumerated	December 14, 2006

Payer Source	Total Paid
Medicaid	$116.3M
Medicare	$0

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST reports no Medicare billing on file and is effectively a single-payer Medicaid revenue generator in the dataset, with $116.3M in lifetime Medicaid revenue. The absence of Medicare claims indicates this entity’s operational footprint in the claims data is concentrated on Medicaid beneficiaries rather than fee-for-service Medicare populations.

Revenue concentration is heavily skewed toward a very small set of services: the top 3 Medicaid codes by revenue account for 64.7% of the provider’s total Medicaid revenue. This suggests that a few high-volume, routine ambulatory visit types and emergency/diagnostic services dominate the financial profile rather than a broad mix of low-revenue procedure codes.

Primary ambulatory E/M codes are the largest drivers of Medicaid revenue: 99213 ($25.7M, 29.5% of Medicaid revenue) and 99214 ($22.6M, 25.9% of Medicaid revenue) together account for a majority of dollars. These codes indicate heavy throughput of established outpatient visits and imply the organization operates a large primary care or outpatient clinic network handling routine and moderately complex visits at scale.

Emergency department E/M services also contribute meaningfully through 99284 ($8M, 9.2% of Medicaid revenue) and 99283 ($4M, 4.6% of Medicaid revenue), signaling that the provider’s operations include urgent care or ED-level services in addition to scheduled outpatient care. The presence of both high-volume office visits and ED-level visits points to an integrated ambulatory and urgent/emergency care footprint.

On competitive standing within the state, the provider is an extreme volume outlier for several codes: it ranks in the 100th percentile for 99213 and 99214 (top 5–6 of ~1500 providers), and similarly extreme for high-volume preventive, vaccine, and testing codes such as 90471 (rank #2 of 403), 90472 (rank #2 of 74), 93010 (rank #4 of 141), and 91320 (rank #1 of 40). These percentile and rank positions indicate the organization is a dominant statewide provider for routine outpatient visits, immunizations, and basic diagnostics.

Several ancillary service lines appear substantial but less concentrated: imaging and diagnostics such as 77067 ($3.8M, 4.3%), 71046 ($2M, 2.3%), 74177 ($1.8M, 2.0%), and advanced imaging like 78815 ($767.3K, 0.9%) are present at notable volumes and above-typical statewide ranking. This mix supports a service model that combines primary care with on-site or affiliated radiology and lab services to serve comprehensive outpatient needs.

The provider’s tenure is long-standing in the NPI registry, enumerated ~20 years ago (2006-12-14), which aligns with the scale and breadth of its Medicaid volumes and the establishment of integrated service lines over time. Extended enrollment duration increases plausibility of the sustained high-volume outpatient and vaccination programs reflected in the claims.

Several codes are flagged as extreme or notable outliers for volume relative to peers (e.g., 99213, 99214, 90471, 90472, 93010, 91320, 71046), indicating this provider operates at a much larger scale than typical in-state peers for core ambulatory and preventive services. For payers and network planners, this profile signals a large-capacity outpatient system that could be a key partner for Medicaid population health initiatives and immunization campaigns.

Medicaid: Complete Services Breakdown

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

419 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…	162,410	$160	$25.7M
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…	105,010	$220	$22.6M
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.	36,410	$220	$8M
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.	30,010	$130	$4M
77067	The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software…	12,770	$300	$3.8M
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	84,370	$20	$2M
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	41,950	$50	$2M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	4,170	$420	$1.8M
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…	9,390	$150	$1.4M
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	5,000	$250	$1.2M

Showing 1–10 of 419

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

Kaiser Foundation Health Plan Of The Northwest — 9 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

419 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	150	7,400	$170	$2.8M
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.	31	140	10,160	$130	$2.3M
U0004	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by…	6	10	1,790	$60	$1.8M
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	2	10	1,200	$690	$770.6K
41899	Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available.	8	20	190	$1,070	$556K
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	9	10	110	$910	$468.7K
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	9	10	100	$1,160	$435.3K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	10	60	420	$60	$405.1K
J0585	Injection, onabotulinumtoxina, 1 unit	11	20	470	$460	$398.7K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	59	80	1,420	$60	$368.8K

Showing 1–10 of 419

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cascadia Health	OR	Multi-Specialty Clinic/Center	$0	$76.8M
Legacy Emanuel Hospital & Health Center	OR	General Acute Care Hospital	$0	$50.8M
Legacy Laboratory Services, LLC	OR	Clinical Medical Laboratory	$2.8M	$24.8M
The Oregon Clinic PC	OR	Specialist	$0	$7.4M
Kaiser Foundation Health Plan Of The Northwest	OR	General Practice Dentistry	$0	$6.9M
Laboratory Corporation Of America	OR	Clinical Medical Laboratory	$348.3K	$2.7M
Restore Therapy LLC	OR	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$2.9M
Cascade Pathology Services, Corp	OR	Anatomic Pathology & Clinical Pathology Physician	$0	$2.5M
Pacific Northwest Renal Services, L.L.C.	OR	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2M
Cascade Cytology Reference	OR	Anatomic Pathology & Clinical Pathology Physician	$0	$1.1M

Kaiser Foundation Health Plan Of The Northwest — Billing Profile & Reimbursement Data

Sign up for Kaiser Foundation Health Plan Of The Northwest — Billing Profile & Reimbursement Data policy alerts

Kaiser Foundation Health Plan Of The Northwest — Billing Profile & Reimbursement Data

Sign up for Kaiser Foundation Health Plan Of The Northwest — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References