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.

Rosebud Indian Health Service (NPI 1194757369)

Field	Value
Entity Type	Organization
Organization	Rosebud Indian Health Service
Address	400 Soldier Creek Road
City	Rosebud
State	SD
ZIP	57570
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 7, 2006

Payer Source	Total Paid
Medicaid	$22.2M
Medicare	$0

Key Findings

ROSEBUD INDIAN HEALTH SERVICE reports no Medicare billing on file and $22.2M in lifetime Medicaid revenue, making Medicaid effectively the sole public payer visible in these data. The absence of Medicare activity means any analysis of this provider’s public-payor performance should be centered on Medicaid volumes and rates rather than dual‑payer comparisons.

Revenue is highly concentrated in office/outpatient evaluation-and-management codes: 99213 ($7.5M, 35.8% of Medicaid revenue), 99214 ($2.9M, 13.9%), and 99212 ($1.5M, 7.3%) — the three codes together account for 57.1% of this provider’s Medicaid revenue. This concentration indicates that routine established-patient visits are the primary revenue driver for the organization.

The code mix implies a predominantly ambulatory/primary-care and outpatient clinic operation: the leading codes 99213/99214/99212 are established-patient E/M visits, and the presence of G0463 ($125.2K) further supports substantial hospital outpatient clinic activity. Preventive services and public-health functions are visible as well, with 90471 (vaccination, $995.6K) and 87635 (SARS–CoV‑2 testing, $403.4K) showing material programmatic throughput.

Compared with in-state peers, ROSEBUD ranks strongly on several high-volume codes: 99213 ranks #24 of 344 (93th percentile) and 99214 ranks #27 of 260 (90th percentile), placing the provider among the higher-volume state participants for routine office visits. Although the vendor notes these volumes as “typical, unremarkable” for some codes, the percentile and rank positions indicate the provider is a meaningful regional source of outpatient E/M care.

Several codes show unusually high relative standing in the state, flagging service specialties or operational emphasis beyond pure primary care: 99211 is labeled an “extreme outlier, far above typical state volume” (5.5K claims, $659.1K), 0054A ranks #1 of 13 (100th percentile, $627.7K) and 0124A ranks #1 of 18 (100th percentile, $493.7K). These high-percentile items suggest concentrated capabilities or programmatic services that differentiate the provider from many peers.

The provider’s service mix also includes dental and behavioral health components at nontrivial scale — D0220 ($463.6K) and D0140 ($440.4K) show routine dental imaging and limited oral evaluations, while psychotherapy codes 90837 ($377.4K) and 90832 ($175.5K) reflect ongoing mental-health service delivery. Ophthalmology visits (92014, $269.5K; 92012, $196.8K) and a high-volume low-acuity ED code 99281 (rank #1 of 16, 100th percentile, $271.9K) demonstrate additional clinical breadth.

ROSEBUD has an established operational tenure, with its NPI enumerated on 2006-07-07 (~20 years ago), indicating long-standing presence in the market and likely sustained relationships with Medicaid payors and local patient populations. This tenure may support institutional knowledge and program continuity reflected in repeatable, high-volume outpatient activity.

From a payer and revenue-risk perspective, the combination of single-payer exposure (no Medicare billing on file) and heavy dependence on a small set of E/M codes (57.1% of Medicaid revenue concentrated in the top three codes) makes the provider sensitive to Medicaid policy, reimbursement changes, or shifts in outpatient visit volumes; conversely, the diverse secondary service lines (vaccination, dental, behavioral health, ophthalmology) provide some operational diversification beneath that Medicaid E/M core.

Medicaid: Complete Services Breakdown

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

75 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…	16,700	$450	$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…	6,420	$450	$2.9M
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	3,260	$470	$1.5M
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	2,650	$380	$995.6K
0001A	N/A	1,930	$380	$732.2K
0002A	N/A	1,810	$380	$693.6K
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.	5,540	$120	$659.1K
0054A	N/A	1,190	$530	$627.7K
0124A	N/A	1,120	$440	$493.7K
D0220	Intraoral - periapical first radiographic image	1,720	$270	$463.6K

Showing 1–10 of 75

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

Rosebud Indian Health Service — 9 of 25 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

75 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…	24	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…	27	260	860	$80	$222.6K
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.	44	60	680	$60	$205.7K
90832	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…	29	70	200	$80	$176.7K
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.	3	60	120	$210	$171.2K
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	70	1,150	$50	$155.9K
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…	82	190	430	$90	$154.1K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	14	40	260	$90	$151.5K
42700	The provider uses an incision to drain an abscess next to one of the tonsils.	1	10	60	$350	$138.1K
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…	42	50	410	$80	$127.2K

Showing 1–10 of 75

Nearby Providers

Other providers in the same ZIP code as Rosebud Indian Health Service, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rosebud Sioux Tribe Ambulance Service	SD	Paramedic	$406K	$6.1M
Guardian Flight LLC	SD	Air Ambulance	$336.5K	$3.3M
Total Renal Care Inc	SD	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2M
Rosebud Sioux Tribe -chr	SD	Private Vehicle	$0	$304.3K
Anne Cowles	SD	Family Nurse Practitioner	$23.7K	$0
Shannelle Rico	SD	Family Medicine Physician	$8K	$0

Rosebud Indian Health Service — Billing Profile & Reimbursement Data

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Rosebud Indian Health Service — 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