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

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

Southwest Idaho Ear, Nose And Throat (NPI 1306823125)

Southwest Idaho Ear, Nose And Throat is a otolaryngology physician provider located in Boise, Idaho. This profile covers 0 Medicare and 13 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	Southwest Idaho Ear, Nose And Throat
Address	900 N Liberty St
City	Boise
State	ID
ZIP	83704
Taxonomy	Otolaryngology Physician
NPI Enumerated	December 22, 2005

Payer Source	Total Paid
Medicaid	$515.2K
Medicare	$0

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	2,820	$70	$205.5K
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…	2,530	$50	$134.1K
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…	390	$130	$49.9K
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…	340	$100	$32.9K
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,…	730	$30	$24.1K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	150	$120	$17.7K
92567	In this procedure, the provider measures the functioning of the middle ear by varying the pressure of air presented to the ear to identify the reason for hearing loss.	1,590	$10	$17.5K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	270	$50	$12.3K
69210	The provider uses an instrument such as a curette, vacuum evacuation, or forceps to remove entrapped wax from a patient's external auditory canal.	440	$20	$9.3K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	40	$160	$5.8K

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Southwest Idaho Ear, Nose And Throat — 1 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

13 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…	187	670	740	$40	$193.6K
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…	358	620	560	$60	$191.8K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	17	20	100	$450	$102.5K
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…	13	220	90	$80	$51.4K
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…	34	180	70	$110	$45.6K
31231	In this procedure, the provider inserts an endoscope into the nasal cavity to examine the structures of the nasal cavity on one or both sides.	3	10	200	$130	$35.9K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	19	80	60	$50	$15.1K
92567	In this procedure, the provider measures the functioning of the middle ear by varying the pressure of air presented to the ear to identify the reason for hearing loss.	5	20	200	$10	$12.9K
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,…	31	210	90	$20	$10.4K
30520	Septoplasty is most often performed for a deviated septum which can be either C–shaped, S–shaped, or a cartilaginous deviation.	3	10	10	$580	$9.2K

Showing 1–10 of 13

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tyson Nielsen	ID	Otolaryngology Physician	$93.8K	$0
Thomas Douthit	ID	Physician Assistant	$89.3K	$0
Alexander Rock	OH	Otolaryngology Physician	$53.5K	$0
Jonathan Miller	ID	Medical Physician Assistant	$50.8K	$0
Ryan Van De Graaff	ID	Otolaryngology Physician	$50.6K	$0
John Symms	ID	Otolaryngology Physician	$33.7K	$0
Tiffany Kearny	ID	Physician Assistant	$28.6K	$0
Lindsay Walles	WA	Audiologist	$13.1K	$0
Shalise Adams	ID	Audiologist	$9.3K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Full Circle Health, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$53.3M
Community Connections, Inc	ID	Case Management Agency	$0	$30M
K A Health Services LLC	ID	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$13.9M
County Of Ada	ID	Land Ambulance	$2M	$11.4M
Developmental Concepts, Inc.	ID	Developmental Disabilities Clinic/Center	$0	$13.2M
Pathways Of Idaho, LLC	ID	Community/Behavioral Health Agency	$0	$12M
Havenwood Caregiver Services Of Idaho, LLC	ID	In Home Supportive Care Agency	$0	$10.7M
Living Independently Forever, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$9.8M
Community Partnerships Of Idaho, Inc.	ID	Developmental Disabilities Clinic/Center	$0	$7.6M
All Horizons Inc	ID	Mental Health Counselor	$0	$6.7M

Southwest Idaho Ear, Nose And Throat — Billing Profile & Reimbursement Data

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Southwest Idaho Ear, Nose And Throat — 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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