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.

Wagner Indian Health Service Health Center (NPI 1326066796)

Field	Value
Entity Type	Organization
Organization	Wagner Indian Health Service Health Center
Address	111 Washington Ave
City	Wagner
State	SD
ZIP	57380
Taxonomy	Clinic/Center
NPI Enumerated	July 17, 2006

Payer Source	Total Paid
Medicaid	$8.8M
Medicare	$0

Key Findings

This provider is effectively single-payer on file: there is no Medicare billing reported while Medicaid revenue totals $8.8M, indicating the organization's reimbursed activity in our data is concentrated in Medicaid-covered services. The NPI was enumerated on 2006-07-17 (~20 years ago), consistent with a long-standing clinic presence serving the local Medicaid population.

Revenue is highly concentrated in ambulatory evaluation-and-management codes: the precomputed top three Medicaid codes account for 76.8% of the provider's Medicaid revenue, led by 99213 ($3.6M, 7.9K claims, $462 avg paid/claim, 42.2% of Medicaid revenue), followed by 99212 ($1.7M, 3.6K claims, $463 avg paid/claim, 19.2%) and 99214 ($1.3M, 2.6K claims, $509 avg paid/claim, 15.4%). This concentration signals that a small set of office visit codes drives most of the revenue base.

The code mix points to a primary care, ambulatory clinic model with additional on-site services: high volumes of 99213/99212/99214 and 99211 (2K claims, $707.5K) indicate panel-based management of established patients, while non-E/M codes such as 90832 (547 claims, $335.9K) and 90471 (182 claims, $89.7K) show the clinic also provides behavioral-health and vaccination services. Dental procedures (D1206, D0140, D1120) and non-emergency transportation (S0215, 1.1K claims, $127.1K) further suggest an integrated primary care setting offering basic dental and access-support services.

State competitive standing is mixed by code: for 99213 the provider ranks #52 of 344 in-state (85th percentile), which is above median but not dominant; for 99212 it ranks #11 of 155 (94th percentile) and is described as notably above typical state volume, indicating a relatively strong position for lower-complexity established-patient visits; for 99214 it ranks #61 of 260 (77th percentile), a typical statewide volume. In short, the clinic is a meaningful Medicaid participant for several E/M services and particularly prominent for 99212.

There are striking volume outliers in low-revenue lab testing and COVID testing: 87635 shows 5K claims at $3 avg paid/claim and is ranked #1 of 37 in-state (100th percentile; extreme outlier), meaning the provider performs far more of these amplified nucleic acid COVID tests than peers despite the low per-claim payment and modest share of total Medicaid revenue (0.2%). High urinalysis activity (81003, 2.4K claims, $101.1K, rank #5 of 39, 89th percentile) also points to substantial on-site point-of-care lab throughput relative to peers.

Operational and revenue-risk implications follow from the concentrated E/M mix: because 76.8% of Medicaid revenue comes from three office-visit codes, changes in visit volume, coding rules, or reimbursement for those specific E/M codes could have outsized impact on the provider's revenue. Complementary services (behavioral health, immunizations, dental, transportation) create some diversification but together represent a much smaller share of the $8.8M Medicaid revenue.

Medicaid: Complete Services Breakdown

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

67 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…	7,890	$460	$3.6M
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,…	3,590	$460	$1.7M
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…	2,620	$510	$1.3M
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.	2,040	$350	$707.5K
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…	550	$610	$335.9K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	620	$210	$129.4K
S0215	Non-emergency transportation; mileage, per mile	1,090	$120	$127.1K
D0140	Limited oral evaluation – problem focused	480	$230	$109.2K
81003	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will…	2,410	$40	$101.1K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	180	$490	$89.7K

Showing 1–10 of 67

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

Wagner Indian Health Service Health Center — 1 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

67 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…	52	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…	61	260	860	$80	$222.6K
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…	25	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.	6	60	120	$210	$171.2K
S0215	Non-emergency transportation; mileage, per mile	8	20	900	$100	$169.9K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	37	40	260	$90	$151.5K
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…	43	50	410	$80	$127.2K
D1351	Sealant - per tooth	44	50	400	$30	$117.3K
A0425	Ground mileage, per statute mile	47	60	680	$50	$106.2K
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,…	11	160	210	$120	$97.4K

Showing 1–10 of 67

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wagner Community Memorial Hospital	SD	Critical Access Hospital	$0	$768.3K
Rural Office Of Community Services, Inc	SD	Non-emergency Medical Transport (VAN)	$0	$739.4K
Wagner Community Memorial Hospital	SD	Family Medicine Physician	$0	$499.8K
Gary Bubak	SD	Internal Medicine Physician	$0	$251.5K
Rural Office Of Community Services Inc	SD	Secured Medical Transport (VAN)	$0	$81.2K
First Chiropractic Centers, PC	SD	Chiropractor	$0	$72.7K
Jay Fitzgerald	SD	Sports Physician Chiropractor	$54K	$0
Avera Mckennan	SD	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$42.2K
Berkley Erickson	SD	Family Nurse Practitioner	$20.3K	$0

Wagner Indian Health Service Health Center — Billing Profile & Reimbursement Data

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Wagner Indian Health Service Health Center — 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