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 1265683650)

Providence Health & Services-washington is a pediatrics physician provider located in Monroe, Washington. This profile covers 0 Medicare and 57 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Providence Health & Services-washington
Address	19200 N Kelsey St
City	Monroe
State	WA
ZIP	98272
Taxonomy	Pediatrics Physician
NPI Enumerated	October 4, 2008

Payer Source	Total Paid
Medicaid	$3.2M
Medicare	$0

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

57 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…	13,300	$70	$971.2K
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…	4,790	$100	$478.6K
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…	4,370	$110	$463.3K
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…	3,970	$90	$373.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,680	$100	$364.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	2,000	$110	$215.5K
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,…	1,150	$50	$55.2K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	3,470	$20	$52K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	2,590	$20	$38.8K
90680	This code represents a live pentavalent rotavirus vaccine given by mouth in a three–dose schedule to protect against rotavirus infection.	1,730	$20	$26K

Showing 1–10 of 57

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 — 0 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

57 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	334	1,820	480	$60	$379.6K
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…	197	1,860	610	$40	$295.5K
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…	48	280	540	$70	$166.5K
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…	38	300	400	$80	$164.4K
D0120	Periodic oral evaluation - established patient	876	920	690	$20	$131.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	36	320	290	$70	$104.8K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	51	60	730	$60	$102.1K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	706	730	730	$20	$98.5K
D9999	N/A	281	290	690	$30	$75.9K
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,…	137	700	180	$50	$59.3K

Showing 1–10 of 57

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services-wa	WA	General Acute Care Hospital	$0	$62.4M
Georgetown Memorial Hospital	SC	General Acute Care Hospital	$0	$27.6M
Providence Health & Services- Washington	WA	General Practice Physician	$0	$7.6M
Providence Health & Services - Washington	WA	Family Medicine Physician	$0	$7.6M
Providence Health & Services - Washington	WA	Pediatrics Physician	$0	$6.8M
Providence Health & Services - Washington	WA	General Practice Physician	$0	$6M
Providence Health & Services - Washington	WA	Family Medicine Physician	$0	$2.9M
Express Care Or PC	OR	General Practice Physician	$0	$2.4M
John Fitzharris	OR	Medical Oncology Physician	$672.6K	$0
Amir Mehrvarz Sarshekeh	WA	Hematology & Oncology Physician	$651.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Public Hospital District 1 Of Snohomish County	WA	General Acute Care Hospital	$0	$11.2M
Sea Mar Community Health Centers	WA	Federally Qualified Health Center (FQHC)	$0	$5.2M
Pspd - Monroe, PLLC	WA	Pediatric Dentistry	$0	$3.5M
Sea Mar Community Health Centers	WA	Federally Qualified Health Center (FQHC)	$0	$3.2M
Snohomish Regional Fire And Rescue	WA	Land Ambulance	$476.2K	$1.2M
Harpreet Kaur	WA	Occupational Therapist	$112.8K	$0
Kenneth Lin	WA	Orthopaedic Surgery Physician	$75.9K	$0
Lindsay Petty	WA	Family Nurse Practitioner	$56.9K	$0
Susanne Hopkins	WA	Obstetrics & Gynecology Physician	$2.9K	$0

Providence Health & Services-washington — Billing Profile & Reimbursement Data

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Providence Health & Services-washington — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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