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

Why is the Medicaid comparison limited to North 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. North 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.

Sanford Medical Center Fargo (NPI 1184917924)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sanford Medical Center Fargo
Address	1220 Sheyenne St
City	West Fargo
State	ND
ZIP	58078
Taxonomy	Family Medicine Physician
NPI Enumerated	May 26, 2011

Payer Source	Total Paid
Medicaid	$75.9M
Medicare	$0

SANFORD MEDICAL CENTER FARGO has no Medicare billing on file and reports $75.9M in lifetime Medicaid revenue, making its public payer footprint effectively single‑payer (Medicaid) in the available claims data. This concentration in one payer should be treated as a primary driver of observed volumes and service mix for analytic comparisons.

Revenue is highly concentrated in a small set of outpatient E/M and emergency codes: the precomputed top three Medicaid codes account for 57.1% of the provider's Medicaid revenue. Those top three are 99214 ($14.6M, 23.6%), 99213 ($14.2M, 23.1%), and 99285 ($6.4M, 10.5%), indicating that a majority of Medicaid dollars flow through a few high-volume E/M services.

The code mix is strongly consistent with a high-volume primary care and ambulatory practice within a larger system: 99214 and 99213 together generate $28.8M in revenue and each rank #1 in-state (100th percentile; described as extreme outlier for both codes), while new-patient and preventive codes such as 99203 ($1.1M) and 99392 ($804.3K) also appear among top billings. These patterns reflect extensive established‑patient office visits plus meaningful preventive care activity under the Family Medicine taxonomy.

In parallel, the presence of high-revenue emergency and inpatient E/M codes signals substantial hospital-based acute care capacity: 99285 ($6.4M) and 99284 ($5M) both rank #1 in-state with labels indicating noticeably above-typical or extreme outlier volumes, and critical/inpatient codes such as 99291 ($1.2M) and 99232 ($4.6M) also rank at or near the top statewide. This combination of ED, critical care, and inpatient E/M claims indicates operations that extend well beyond a narrow outpatient clinic.

A broad diagnostic and procedural footprint is visible across imaging, cardiology, and specialty services: 74177 ($832.9K), 70450 ($509.4K), 77067 ($625K), 93010 ($492.1K, 82K claims), and ophthalmology codes 92014 ($795K) and 92004 ($591.3K) all rank #1 in-state and are described as extreme outliers or notably above typical volume. These high-ranking ancillary code volumes suggest integrated on-site imaging, cardiac testing, and specialty clinics that support both ambulatory and hospital care.

Competitive standing within North Dakota is dominant across many service lines: dozens of the top Medicaid codes are ranked #1 of statewide providers and appear as 100th‑percentile extreme outliers, which characterizes SANFORD MEDICAL CENTER FARGO as a major market leader for both outpatient E/M and several hospital-based services in-state. This dominance should be a key consideration when benchmarking peer performance or network negotiations in the region.

Not every line is an extreme outlier: some procedures show more typical participation or mid-high percentiles (for example, J0585 $1.2M ranks #2 at the 80th percentile, and 90837 $496.2K ranks #9 at the 94th percentile). These distinctions indicate pockets of normal competitive distribution amid otherwise concentrated service dominance, so analysts should avoid assuming uniform outlier status across all codes.

The provider's NPI was enumerated on 2011-05-26 (~15 years ago), indicating an established presence in the market. Coupled with the combined high outpatient, ED, inpatient, and ancillary volumes, the tenure and code mix suggest a mature, integrated delivery platform that serves a wide range of Medicaid patient needs across primary, acute, and diagnostic care.

Medicaid: Complete Services Breakdown

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

383 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	205,010	$70	$14.6M
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…	267,940	$50	$14.2M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	45,040	$140	$6.4M
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.	50,870	$100	$5M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	109,290	$40	$4.6M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	27,700	$50	$1.5M
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	11,280	$110	$1.2M
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	9,080	$130	$1.2M
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…	15,270	$80	$1.2M
J0585	Injection, onabotulinumtoxina, 1 unit	1,530	$750	$1.2M

Showing 1–10 of 383

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Sanford Medical Center Fargo — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

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

383 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	1	20	1,120	$220	$2M
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.	1	30	1,280	$180	$1.4M
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.	10	50	670	$150	$829.9K
J0585	Injection, onabotulinumtoxina, 1 unit	2	10	140	$380	$576.6K
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…	1	210	360	$100	$498.2K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	1	30	460	$50	$423.5K
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…	1	170	300	$100	$415.8K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2	20	310	$70	$364K
Q3014	Telehealth originating site facility fee	6	30	130	$180	$355.8K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	2	10	4,120	$80	$329.7K

Showing 1–10 of 383

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Sanford Medical Center Fargo	ND	General Acute Care Hospital	$0	$50.2M
Sanford Health Of Northern Minnesota	MN	Rural Acute Care Hospital	$0	$47.6M
Sanford Bismarck	ND	Multi-Specialty Clinic/Center	$0	$43.9M
Sanford Health Of Northern Minnesota	MN	Internal Medicine Physician	$0	$27.2M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Health Of Northern Minnesota	MN	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$15.1M
Sanford Bismarck	ND	General Acute Care Hospital	$0	$12.5M
Sanford Medical Center Fargo	ND	Air Ambulance	$0	$12M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
North Dakota Autism Center, Inc	ND	Community/Behavioral Health Agency	$0	$5.7M
West Fargo Public School District 6	ND	Home Health Registered Nurse	$0	$2.6M
Fm Endoscopy Center LLC	ND	Ambulatory Surgical Clinic/Center	$2.5M	$0
Michael Greenwood	ND	Ophthalmology Physician	$530.7K	$0
Innovis Health, LLC	ND	Multi-Specialty Clinic/Center	$0	$235K
Alex Wohl	ND	Physical Therapist	$222.1K	$0
Optimal Chiropractic PLLC	ND	Chiropractor	$0	$221K
Kci Usa, Inc.	ND	Durable Medical Equipment & Medical Supplies	$0	$185.9K
Innovis Health LLC	ND	Family Medicine Physician	$0	$157.3K
Matthew Friederichs	ND	Sports Medicine (Orthopaedic Surgery) Physician	$126K	$0

Sanford Medical Center Fargo — 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