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.

St Lukes Clinic-treasure Valley LLC (NPI 1326336058)

Key Findings

Field	Value
Entity Type	Organization
Organization	St Lukes Clinic-treasure Valley LLC
Address	190 E Bannock St
City	Boise
State	ID
ZIP	83712
Taxonomy	Family Medicine Physician
NPI Enumerated	July 15, 2011

Payer Source	Total Paid
Medicaid	$59.2M
Medicare	$0

This entity reports no Medicare billing on file and $59.2M in lifetime Medicaid revenue, making its commercial payer footprint effectively absent in the available data and its financial scale in this dataset Medicaid-driven. The NPI was enumerated on 2011-07-15 (~15 years ago), indicating the organization has had an established billing presence for over a decade while operating predominantly in the Medicaid market.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 56.9% of total Medicaid revenue. Those top drivers are 99213 ($11.1M, 20.4%), 99214 ($10.7M, 19.6%), and 99285 ($9.2M, 16.9%), which together dominate the provider’s Medicaid receipts and create sensitivity to volume or policy shifts affecting these E/M codes.

The code mix points to a dual front-line care model: very large volumes of outpatient established-patient office visits (99213: 206.4K claims; 99214: 147.2K claims) alongside high-volume emergency department E/M visits (99285: 81.7K claims; 99284: 94.6K claims; 99283: 48.8K claims). This pattern suggests the organization operates substantial primary care/ambulatory services together with significant emergent or urgent care throughput rather than a narrow, single-service-line practice.

Competitive standing within Idaho is dominant for many billed services: the provider ranks #1 in-state and is labeled an "extreme outlier" for core codes such as 99213 (rank #1 of 669, 100th percentile), 99214 (rank #1 of 618, 100th percentile), and 99285 (rank #1 of 57, 100th percentile). These percentile/rank indicators identify the provider as a major statewide volume player for both office E/M and ED-level services, well above typical state peer volumes.

Preventive care and immunization throughput are material components of activity: 90471 shows 40.5K claims and $687.9K revenue (rank #2 of 182, 99th percentile, extreme outlier), and preventive codes 99392 and 99391 together contribute meaningful revenue ($860.4K and $766.4K respectively) and sit well above typical state volumes. High vaccine and well-care volumes imply an operational emphasis on routine preventive services in addition to problem-focused visits.

The provider’s billing includes notable procedural and specialty-oriented codes beyond core family medicine E/M, including J0585 ($1M, rank #2 of 10, 89th percentile), ophthalmology codes 92014 ($983.9K, rank #3 of 157, 99th percentile) and 92004 ($415.3K, rank #3 of 129, 98th percentile), ENT procedures such as 42820 ($503.2K, rank #1 of 21, 100th percentile), and cardiac imaging 93306 ($409.2K, rank #1 of 31, 100th percentile). The presence and scale of these codes indicate the organization bills across multiple service lines or integrates specialty procedural services alongside high-volume primary/ED care.

Operationally, the payer mix and claims-level detail show a volume-driven model with many high-claim, low-unit-payment services (for example 93010: 126.4K claims at $5 avg paid/claim) coexisting with higher-paid E/M encounters. This mix suggests revenue growth is driven more by throughput and patient volume than by a concentration of a few high-dollar procedures, which has implications for staffing, site capacity, and sensitivity to claim volume fluctuations.

Concentration risk and mid-term stability: with 56.9% of Medicaid revenue tied to three codes and no Medicare revenue reported, the provider’s financial exposure is concentrated in a narrow set of E/M services within the Medicaid program. Its ~15-year billing tenure combined with repeated extreme outlier rankings imply an entrenched Medicaid-facing operation, but also a business profile that would be materially affected by changes to reimbursement, coding policy, or shifts in Medicaid patient volume for those top codes.

Medicaid: Complete Services Breakdown

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

218 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…	206,440	$50	$11.1M
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…	147,230	$70	$10.7M
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.	81,750	$110	$9.2M
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.	94,610	$80	$7.9M
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.	48,780	$50	$2.4M
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…	14,500	$110	$1.6M
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…	12,170	$120	$1.5M
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…	12,870	$80	$1M
J0585	Injection, onabotulinumtoxina, 1 unit	1,970	$520	$1M
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	10,810	$90	$983.9K

Showing 1–10 of 218

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

St Lukes Clinic-treasure Valley LLC — 20 of 25 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

218 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
96152	N/A	73	70	2,270	$80	$608.8K
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.	1	60	1,080	$110	$595.5K
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.	1	80	1,020	$90	$502.7K
J0585	Injection, onabotulinumtoxina, 1 unit	2	10	300	$510	$359.7K
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.	1	80	880	$70	$265.5K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	1	20	110	$840	$224.4K
42830	The provider performs an initial adenoidectomy in a patient who is less than 12 years old.	2	10	180	$1,130	$205.7K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	10	2,080	$100	$194.4K
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…	1	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…	1	620	560	$60	$191.8K

Showing 1–10 of 218

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Home Society Of Idaho	ID	Mental Health Counselor	$0	$2.1M
Boise Pathology Group P.A.	ID	Dermatopathology (Pathology) Physician	$0	$1.1M
Casey Mcroy	ID	Diagnostic Radiology Physician	$648.3K	$0
Frederick Emge	ID	Pediatric Cardiology Physician	$0	$422.8K
Dentistry For Children	ID	Pediatric Dentistry	$0	$343.1K
Sarah Bolender	ID	Radiation Oncology Physician	$245.1K	$0
Marcos Daccarett	ID	Clinical Cardiac Electrophysiology Physician	$202.3K	$0
Tonya Kuhn	ID	Radiation Oncology Physician	$187.9K	$0
Kenneth Little	ID	Neurological Surgery Physician	$179.9K	$0
Stephen Smith	ID	Radiation Oncology Physician	$161.1K	$0

St Lukes Clinic-treasure Valley LLC — Billing Profile & Reimbursement Data

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St Lukes Clinic-treasure Valley LLC — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Luke's Clinic LLC	ID	Family Medicine Physician	$0	$39.5M
St Lukes Regional Medical Center	ID	General Acute Care Hospital	$0	$25.1M
Southern Idaho Health Partners LLC	ID	General Practice Physician	$0	$9.2M
St Lukes Clinic-treasure Valley LLC	ID	Family Medicine Physician	$0	$6.9M
St Lukes Clinic-treasure Valley LLC	OR	Rural Health Clinic/Center	$0	$2.1M
St Luke's Regional Medical Center	ID	Home Health Agency	$0	$1.6M
Nathan Welch	ID	Ophthalmology Physician	$1.1M	$0
Pejman Rohani	MD	Vascular Surgery Physician	$1M	$0
Peter Castellanos	ID	Neurology with Special Qualifications in Child Neurology Physician	$0	$599.5K
St Luke's Magic Valley Regional Medical Center Ltd	ID	Critical Access Hospital	$0	$573.7K