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

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

Tuality Healthcare (NPI 1275591984)

Key Findings

Field	Value
Entity Type	Organization
Organization	Tuality Healthcare
Address	335 Se 8th Ave
City	Hillsboro
State	OR
ZIP	97123
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 2, 2006

Payer Source	Total Paid
Medicaid	$27.8M
Medicare	$0

This provider is effectively a single-payer Medicaid hospital: there is no Medicare billing on file and total Medicaid revenue is $27.8M, so Medicaid constitutes the visible entirety of reported programmatic revenue. The absence of Medicare claims on file suggests the dataset captures primarily Medicaid-facing activity for this entity rather than a balanced Medicare/Medicaid mix.

Revenue is highly concentrated in three codes: 99285 ($6.6M, 24.2%), 99283 ($6.2M, 22.6%), and G0463 ($5.4M, 19.9%); the precomputed top-3 share is 66.7% of total Medicaid revenue. This concentration means two emergency department E/M levels plus hospital outpatient clinic visits together drive roughly two-thirds of reported Medicaid dollars.

The code mix indicates an operation centered on emergency department throughput and hospital outpatient clinic services: 99285 shows 17.4K claims, 99283 shows 34.6K claims, and G0463 shows 72.4K claims, with 99284 adding another 21.1K claims and $5.3M in revenue. Combined claim volumes and dollar-weighting across these E/M and clinic visit codes point to a high-volume acute-care ED with substantial outpatient clinic throughput rather than a specialty procedural focus.

Competitive standing varies by service line. For outpatient clinic visits (G0463) the provider ranks #3 of 44 in-state and is in the 95th percentile while the line is still described as "typical, unremarkable volume for this code," indicating a relatively prominent statewide position in clinic-based assessment and management despite the provided qualitative label.

For emergency visit codes the provider is a solid but not dominant statewide participant: 99285 ranks #28 of 129 (79th percentile), 99283 ranks #26 of 137 (82th percentile), and 99284 ranks #49 of 145 (67th percentile), with each code characterization listed as "typical, unremarkable volume for this code." These percentiles and ranks suggest consistent, mid-to-high peer activity in ED E/M services rather than outlier market dominance.

Beyond visit codes, ancillary services reveal substantial operational throughput but low per-claim revenue: 36415 shows 52.9K claims ($52.9K revenue) and ranks #16 of 415 (96th percentile), and 80053 shows 36.7K claims ($73.3K revenue) and ranks #22 of 135 (84th percentile). The pattern—very high claim counts for blood draws and panels with low average paid/claim—supports a high-volume, facility-based testing and specimen-collection workflow accompanying ED and outpatient visits.

Infusion/IV administration is a visible ancillary revenue stream: 96374 accounts for $1.3M (4.9% of Medicaid revenue) with 11.9K claims and a rank of #15 of 62 (77th percentile), consistent with frequent administration of IV medications in the ED or observation setting. This supports the interpretation of substantial in-place acute care and short-term therapeutic interventions rather than elective ambulatory infusion services.

The provider has a long tenure in national registry, with NPI enumeration on 2006-05-02 (~20 years ago), indicating an established presence in the market and continuity of operations over multiple Medicare/Medicaid payment cycles. Given the heavy concentration of Medicaid dollars in a few visit codes (top 3 = 66.7%), revenue exposure is closely tied to ED and hospital outpatient visit volumes and reimbursement for those services.

Medicaid: Complete Services Breakdown

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

160 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	17,430	$380	$6.6M
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.	34,590	$180	$6.2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	72,430	$80	$5.4M
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.	21,100	$250	$5.3M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	11,920	$110	$1.3M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	7,110	$100	$717.9K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	7,340	$50	$374.5K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	7,970	$40	$286.8K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	3,300	$40	$125.3K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	200	$610	$124.4K

Showing 1–10 of 160

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Tuality Healthcare — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

160 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	49	150	7,400	$170	$2.8M
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.	28	130	2,610	$200	$2.3M
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.	26	140	10,160	$130	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	3	40	3,200	$60	$1.5M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	15	60	3,620	$90	$623.7K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	30	60	420	$60	$405.1K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	11	60	460	$40	$327.4K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	17	80	1,130	$90	$327.2K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	27	40	310	$420	$325.7K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	47	80	1,210	$40	$294.3K

Showing 1–10 of 160

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shawn Macalester	OR	Rheumatology Physician	$887.2K	$6.2K
Paul Motika	OR	Neurology Physician	$16.9K	$0
Lisa Silbert	OR	Neurology Physician	$15.8K	$0
Barry Oken	OR	Neurology Physician	$14K	$0
Benjamin Huckett	WA	Psychiatric/Mental Health Nurse Practitioner	$3.9K	$0
Brandy Carpenter	OR	Family Nurse Practitioner	$3.7K	$0
Amie Leaverton	OR	Obstetrics & Gynecology Physician	$2.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tuality Medical Group LLC	OR	Internal Medicine Physician	$0	$11.5M
Hillsboro Pediatric Clinic LLC	OR	Pediatrics Physician	$0	$5.4M
Tuality Medical Equipment And Supply	OR	Parenteral & Enteral Nutrition Supplies (DME)	$0	$5.2M
Bridgetown Physical Medicine	OR	Chiropractor	$0	$2.6M
Hillsboro Eye Clinic, PC	OR	Ophthalmology Physician	$0	$2.5M
Washington County Juvenile Shelter	OR	Case Management Agency	$0	$2.4M
Corazon Chiropractic Clinic, LLC	OR	Chiropractor	$0	$2.3M
Virginia Garcia Memorial Health Center	OR	Federally Qualified Health Center (FQHC)	$0	$1.9M
Acorn Dentistry For Kids - Hillsboro, LLC	OR	Dental Clinic/Center	$0	$1.3M
Nw Preventive And Primary Care	OR	Naturopath	$0	$1.1M

Tuality Healthcare — 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