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.

Providence Health & Services Oregon (NPI 1366536963)

Key Findings

Field	Value
Entity Type	Organization
Organization	Providence Health & Services Oregon
Address	10150 Se 32nd Ave
City	Milwaukie
State	OR
ZIP	97222
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 3, 2006

Payer Source	Total Paid
Medicaid	$20.5M
Medicare	$0

PROVIDER has no Medicare billing on file and is effectively single-payer in this dataset, with all reported federal program revenue coming from Medicaid totaling $20.5M. The facility’s NPI was enumerated on 2006-10-03 (~20 years ago), indicating a long-tenured presence but current revenue exposure is concentrated entirely in Medicaid.

Revenue is highly concentrated in three emergency department E/M codes: 99284 accounts for $7.3M (35.5% of Medicaid revenue), 99283 accounts for $5.8M (28.3%), and 99285 accounts for $5.4M (26.4%); the precomputed top-3 share equals 90.3% of this provider's total Medicaid revenue. This degree of concentration identifies ED evaluation-and-management visits as the primary revenue engine under Medicaid.

The code mix and claim volumes reinforce an ED-centric operating profile: 99284 has 28K claims, 99283 has 36.2K claims, and 99285 has 17.3K claims, which together drive the bulk of billed activity. The presence of infusion and IV administration codes (96374: 10.9K claims; 96361: 6.5K claims; 96375: 4.7K claims) further suggests frequent in-ED medication/IV treatment rather than outpatient infusion clinic activity as the dominant service line.

Competitive standing for the top ED codes is middle-to-upper statewide rather than dominant: 99284 ranks #27 of 145 in-state (82th percentile; typical, unremarkable volume for this code), 99283 ranks #25 of 137 (82th percentile; typical, unremarkable), and 99285 ranks #29 of 129 (78th percentile; typical, unremarkable). These ranks indicate the provider is a solid participant in Oregon ED volume but not a clear market leader on these specific Medicaid-coded services.

There are a few targeted statistical outliers among ancillary codes that may reflect testing capacity or episodic demand. The multiplex SARS–CoV–2/influenza test 87636 shows 3.9K claims and $284.5K (1.4% of Medicaid revenue) and ranks #3 of 22 in-state (90th percentile; notably above typical state volume), and select IV-fluid/infusion add-on code 96361 (6.5K claims, $183.2K) ranks #7 of 51 (88th percentile), indicating above-typical use of these specific services relative to peers.

Operational/billing note: the hematology code 85025 appears with 32.4K claims but $0 paid/claim and $0 revenue (0.0% of Medicaid revenue). This pattern suggests those CBC services may be paid under bundled rates, included in facility-level payments, or not captured as paid line items in this Medicaid dataset and should be checked when reconciling service volumes against revenue.

Other service lines such as imaging and advanced diagnostic procedures are present but represent a small share of Medicaid revenue. Examples include chest radiography 71046 at $54.7K (0.3%) and CT abdomen/pelvis codes (74177 $7.6K, 74176 $5.2K) which are low-percentage contributors, implying that imaging and inpatient-procedure billing are not primary Medicaid revenue drivers for this provider.

Strategic implications: because Medicaid accounts for the entirety of reported federal program revenue ($20.5M) and ED E/M codes produce 90.3% of that revenue, payer negotiations, capacity planning, and quality metrics tied to emergency care and ED throughput will materially affect this provider’s fiscal performance under Medicaid. The absence of Medicare billing also means the provider’s exposure to Medicare rate changes is minimal in this dataset, concentrating reimbursement risk and opportunity within the Medicaid program.

Medicaid: Complete Services Breakdown

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

58 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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.	27,960	$260	$7.3M
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.	36,180	$160	$5.8M
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.	17,270	$310	$5.4M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	10,860	$100	$1.1M
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	3,900	$70	$284.5K
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	6,540	$30	$183.2K
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…	4,660	$30	$149.2K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	1,280	$100	$122.9K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	1,820	$30	$54.7K
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.	330	$90	$30.6K

Showing 1–10 of 58

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

Providence Health & Services Oregon — 0 of 24 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

58 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.	27	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.	29	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.	25	140	10,160	$130	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	30	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.	18	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…	41	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…	39	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.	57	80	1,130	$90	$327.2K
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.	66	80	1,210	$40	$294.3K
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	75	100	250	$80	$268K

Showing 1–10 of 58

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services - Oregon	OR	General Acute Care Hospital	$0	$49M
Providence Health & Services Oregon	OR	Clinical Pathology Physician	$0	$5.4M
Charles Cannan	AZ	Cardiovascular Disease Physician	$114K	$0
Aly Rahimtoola	OR	Cardiovascular Disease Physician	$102.9K	$0
Kirsten Kinsman	OR	Gastroenterology Physician	$91.7K	$0
Kursteen Price	OR	Allergy & Immunology Physician	$90.3K	$0
Kevin Woolf	OR	Cardiovascular Disease Physician	$86.9K	$0
Alexander Morss	OR	Cardiovascular Disease Physician	$86.6K	$0
Geoffrey Wilson	OR	Cardiovascular Disease Physician	$80.5K	$0
Veselina Korcheva	OR	Dermatopathology (Pathology) Physician	$75.6K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eye Health Northwest, PC	OR	Ophthalmology Physician	$0	$15.7M
Sunnybrook Chiropractic Corp	OR	Chiropractor	$0	$2.1M
Scsm, Inc	OR	Chiropractor	$0	$1.6M
Precision Fit Dental Prosthetics LLC	OR	Denturist	$0	$1.2M
Clackamas Education Service District Ei Ecse	OR	Local Education Agency (LEA)	$0	$1.1M
Terry Isom	OR	Endodontics	$0	$1.1M
Clackamas County Fire District 1	OR	Land Ambulance	$155.6K	$601.7K
Joseph Simonett	OR	Ophthalmology Physician	$532.6K	$0
Jennifer Bray	OR	Family Nurse Practitioner	$105.2K	$0
Peter Taylor	OR	Psychiatry Physician	$101.9K	$0

Providence Health & Services Oregon — Billing Profile & Reimbursement Data

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Providence Health & Services Oregon — 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