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

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

Providence Health & Services Washington (NPI 1194099390)

Key Findings

Field	Value
Entity Type	Organization
Organization	Providence Health & Services Washington
Address	101 W 8th Ave
City	Spokane
State	WA
ZIP	99204
Taxonomy	Pulmonary Disease Physician
NPI Enumerated	March 6, 2012

Payer Source	Total Paid
Medicaid	$78.6M
Medicare	$0

This entity is effectively a single‑payer Medicaid biller: Total Medicare revenue is listed as none (no Medicare billing on file) while total Medicaid revenue is $78.6M, so all reported fee‑for‑service activity in the dataset is concentrated in Medicaid. Analysts should treat comparisons and risk‑adjustment accordingly because there is no Medicare footprint to balance payer risk or volume.

Revenue is highly concentrated in office/outpatient evaluation and management: the top three Medicaid codes 99214, 99213, and 99215 together account for 65.0% of this provider’s total Medicaid revenue. Specifically, 99214 generates $23.2M (33.7%), 99213 $15.6M (22.6%), and 99215 $6M (8.7%), indicating the bulk of dollars come from established‑patient and high‑complexity outpatient visits.

The service mix implied by the dominant codes (99214, 99213, 99215) points to a high‑volume ambulatory practice model focused on ongoing management of established patients and frequent chronic‑care follow‑ups. The prominence of 99215 (high complexity, longer visits) alongside 99213/99214 suggests a mix of routine chronic‑care visits and more complex evaluations that require substantial clinician time or decision making, which is consistent with the provider’s Pulmonary Disease Physician taxonomy.

Competitive standing in‑state for the top E/M codes is dominant: 99214 ranks #5 of 1823 providers in‑state (100th percentile; extreme outlier), 99213 ranks #3 of 1863 providers (100th percentile; extreme outlier), and 99215 ranks #2 of 536 providers (100th percentile; extreme outlier). These rankings indicate the provider is a major statewide outlier in volume and revenue for core outpatient E/M services and would be considered a system‑level competitor for payer contracting or network adequacy.

The provider also reports substantial inpatient/observation follow‑up activity, with 99232 and 99233 contributing $3.7M (5.4%) and $3.4M (5.0%) of Medicaid revenue respectively and ranking in the 99th percentile or higher (99232: #3 of 170, 99233: #3 of 143; both described as extreme outliers). This pattern shows that, in addition to outpatient clinic throughput, the organization bills a material amount for subsequent inpatient/observation care.

Preventive and well‑visit codes are unusually prominent for this taxonomy: 99392 ($2.5M, 3.7%, rank #1 of 299, 100th percentile; extreme outlier), 99391 ($2.2M, 3.2%, rank #2 of 279, 100th percentile; extreme outlier), and 99393 ($1.7M, 2.4%, rank #3 of 315, 99th percentile; extreme outlier). The presence and scale of these preventive codes indicate the provider delivers high volumes of routine preventive visits across age groups, which may reflect integrated ambulatory services or affiliated primary/preventive care sites within the same billing entity.

The procedure and ancillary mix extends beyond E/M to imaging, endoscopy, echocardiography, vaccination, and select injections, demonstrating a broad service footprint. Notable examples include 43239 ($548K, rank #3 of 119, 98th percentile; extreme outlier), 76816 ($917.6K, rank #4 of 96, 97th percentile; notably above typical), 90686 ($360.8K, rank #3 of 584, 100th percentile; extreme outlier), and 93303/93306 echocardiography codes (each several hundred thousand dollars), which together suggest onsite or closely affiliated diagnostic and procedure capacity.

The provider has an established reporting history with NPI enumeration on 2012-03-06 (~14 years ago), indicating a multi‑year presence in the state Medicaid market. Given the tenure plus the statewide outlier volumes across numerous codes, this entity appears to be a long‑standing, high‑capacity Medicaid provider whose activity will materially affect utilization and cost patterns for the local payer network.

Medicaid: Complete Services Breakdown

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

341 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…	331,740	$70	$23.2M
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…	272,950	$60	$15.6M
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…	51,510	$120	$6M
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…	108,570	$30	$3.7M
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…	72,980	$50	$3.4M
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…	26,050	$100	$2.5M
99391	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…	24,010	$90	$2.2M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	17,190	$100	$1.7M
99204	The provider sees a new 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 provider…	12,020	$120	$1.5M
99203	The provider sees a new 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 provider…	19,480	$70	$1.4M

Showing 1–10 of 341

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Providence Health & Services Washington — 18 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

341 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	425	650	4,110	$250	$4.9M
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.	152	230	5,440	$90	$1.8M
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.	163	230	6,220	$100	$1.8M
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.	143	190	5,130	$100	$1.8M
G9149	National committee for quality assurance - level 2 medical home	34	90	1,680	$200	$1.5M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	3	10	4,100	$160	$753.2K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	93	100	3,660	$100	$635.7K
93304	The provider performs a limited or follow–up transthoracic echocardiography to obtain images of the heart through the chest wall in patients born with heart defects. It is a limited examination of a…	3	10	2,190	$210	$533.3K
J0585	Injection, onabotulinumtoxina, 1 unit	22	40	1,040	$390	$518.8K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	9	30	90	$1,070	$496.9K

Showing 1–10 of 341

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services - Wa	WA	General Acute Care Hospital	$0	$78.7M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Sutter Valley Medical Foundation	CA	Multi-Specialty Clinic/Center	$0	$41.2M
Providence Health & Services Washington	WA	General Acute Care Hospital	$0	$39.9M
Children's Hospital And Health System, Inc.	WI	Urgent Care Clinic/Center	$0	$17.7M
Thomas Schlesinger	CA	Retina Specialist (Ophthalmology) Physician	$4.3M	$7.9M
Providence Health & Services Washington	WA	Clinical Medical Laboratory	$1.6M	$9.3M
Stephen Meffert	CA	Retina Specialist (Ophthalmology) Physician	$3.2M	$5.5M
Louis Chang	CA	Ophthalmology Physician	$2.2M	$5.9M
Matthew Powers	CA	Retina Specialist (Ophthalmology) Physician	$3.7M	$4.3M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Multicare Health System	WA	General Acute Care Hospital	$0	$55.1M
New Horizon Care Center, Inc.	WA	Substance Abuse Rehabilitation Facility	$0	$20.2M
Spokane Addiction Recovery Centers	WA	Substance Abuse Rehabilitation Facility	$0	$19M
Spokane Emergency Care Physicians PLLC	WA	Emergency Medicine Physician	$0	$13.9M
Spokane Emergency Physicians, Ps	WA	Emergency Medicine Physician	$0	$13.1M
Spokane Eye Clinic Ps	WA	Multi-Specialty Clinic/Center	$0	$8M
Laboratory Corporation Of America	WA	Clinical Medical Laboratory	$1.6M	$6.1M
Integra Imaging, Ps	WA	Diagnostic Radiology Physician	$0	$7.5M
Shriners Hospitals For Children	WA	Children's Hospital	$0	$6.1M
Spokane Behavioral Health LLC	WA	Psychiatric Hospital	$0	$5.6M

Providence Health & Services Washington — 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