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

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

The Duluth Clinic, Ltd (NPI 1245278209)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Duluth Clinic, Ltd
Address	400 E 3rd St
City	Duluth
State	MN
ZIP	55805
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	June 3, 2006

Payer Source	Total Paid
Medicaid	$51.7M
Medicare	$0

No Medicare billing is on file for THE DULUTH CLINIC, LTD, while Medicaid revenue totals $51.7M, which makes this provider effectively single-payer in the dataset and heavily dependent on Medicaid for billed volume and revenue. This payer concentration has implications for reimbursement risk and network negotiations because there is no Medicare revenue stream reported here to diversify payer mix.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes (G9002, 99214, 99233) together account for 54.0% of the provider's Medicaid revenue. G9002 alone represents $13.7M (30.5% of Medicaid revenue) and 74.2K claims, while 99214 contributes $6.4M (14.2%) and 120.6K claims, highlighting that a small set of codes drives the majority of Medicaid receipts.

The code mix indicates a broad multi-specialty operation with a strong emphasis on ambulatory evaluation-and-management and care coordination plus inpatient-level services. High-volume office visits (99214, 99213) and coordinated care billing (G9002) combined with frequent subsequent inpatient E/M codes (99233, 99232, 99231) and critical care (99291) point to a provider that delivers both primary/ambulatory care and significant hospital-related care and care-coordination services.

Competitive standing within the state is strong for several top codes: G9002 ranks #2 of 20 in-state (95th percentile) and is described as notably above typical state volume, 99214 ranks #7 of 1177 (99th percentile) and is labeled an extreme outlier far above typical state volume, and 99233 ranks #5 of 122 (97th percentile) and is notably above typical state volume. These ranks indicate the provider is a major in-state participant for coordinated-care and high-complexity E/M services.

Ambulatory throughput is very high based on claim counts for office visit codes: 99214 has 120.6K claims and 99213 has 109.9K claims, with 99213 labeled an extreme outlier (100th percentile) and 99214 also extreme. This volume profile suggests a substantial established-patient panel and heavy outpatient visit cadence under Medicaid.

The provider also bills across a wide acuity spectrum: high-volume inpatient and observation codes (99233, 99232, 99223, 99239), critical care 99291 (8.6K claims, $949.5K revenue), and nursing facility codes 99309/99310 appear in the top 25. Together these codes indicate services that range from routine ambulatory visits through high-acuity hospital and post-acute care.

Ancillary and diagnostic services contribute meaningfully to revenue: 88305 surgical pathology accounts for $1.5M and ranks #3 of 115 in-state (98th percentile), while imaging and cardiac testing codes such as 74177, 70450, and 93306 appear in the top 25 with notable state-level ranks. This mix supports the conclusion that the provider operates integrated clinical, diagnostic, and pathology capabilities alongside E/M services.

The NPI enumerated on 2006-06-03 (~20 years ago), indicating long tenure in the market. Coupled with the concentrated Medicaid exposure and multiple high-percentile ranks across E/M and coordination codes, this tenure and scale are consistent with an established regional multi-specialty clinic that is a significant Medicaid participant in Minnesota.

Medicaid: Complete Services Breakdown

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

261 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G9002	Coordinated care fee, maintenance rate	74,210	$190	$13.7M
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…	120,630	$50	$6.4M
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…	75,930	$60	$4.2M
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…	109,900	$30	$3.6M
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…	69,840	$40	$2.7M
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…	22,910	$80	$1.8M
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…	16,890	$100	$1.7M
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…	39,270	$40	$1.5M
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…	8,550	$110	$949.5K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	15,390	$60	$923.2K

Showing 1–10 of 261

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Minnesota Distribution

The Duluth Clinic, Ltd — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Minnesota

Full comparison — all codes billed, vs. Minnesota median

261 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G9002	Coordinated care fee, maintenance rate	2	20	6,640	$150	$2.4M
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…	5	120	400	$60	$685.8K
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	50	310	$130	$678K
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…	7	1,180	1,150	$80	$605.7K
90870	The provider applies an electric current to the patient's brain for the purpose of producing a seizure or series of seizures to alleviate symptoms of various mental disorders.	16	20	650	$190	$566.5K
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…	7	1,200	1,030	$70	$549.7K
99337	N/A	13	10	120	$70	$544.6K
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…	738	1,140	1,010	$100	$543K
90839	In this service, the provider performs psychotherapy for a crisis situation when the patient is in a life–threatening state and needs immediate attention. The treatment session typically lasts…	4	10	410	$120	$539.7K
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	18	20	60	$960	$469.8K

Showing 1–10 of 261

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Smdc Medical Center	MN	General Acute Care Hospital	$0	$35.3M
Innovis Health, LLC	ND	General Acute Care Hospital	$0	$25.5M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
St Marys Medical Center	MN	General Acute Care Hospital	$0	$21M
St. Marys Regional Health Center	MN	Rural Acute Care Hospital	$0	$18.7M
St. Mary's Hospital Of Superior	WI	Critical Access Hospital	$0	$13.4M
Essentia Health Virginia, LLC	MN	General Acute Care Hospital	$0	$12.9M
St. Mary's Duluth Clinic Health System	MN	Clinical Medical Laboratory	$260.2K	$5M
Innovis Health LLC	ND	Family Medicine Physician	$0	$5.1M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rem Arrowhead, Inc.	MN	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$107.9M
Brightwater Health Dba Human Development Center	MN	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$50.4M
St. Luke's Hospital Of Duluth	MN	General Acute Care Hospital	$0	$26.6M
Lakewalk Surgery Center, Inc.	MN	Ambulatory Surgical Clinic/Center	$1.7M	$8.6M
Webmed Mental Health	MN	Mental Health Counselor	$0	$7.1M
St. Ann's Home	MN	Assisted Living Facility	$0	$5.1M
Hilary Reich	MN	Dermatology Physician	$294K	$0
Michael Wolz	MN	Dermatology Physician	$180.6K	$0
Center For Alcohol And Drug Treatment, Inc.	MN	Substance Use Disorder Rehabilitation Clinic/Center	$147.3K	$1.3K
Traci Rogers	MN	Family Nurse Practitioner	$130.1K	$0

The Duluth Clinic, Ltd — Billing Profile & Reimbursement Data

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The Duluth Clinic, Ltd — 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