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.

Benewah Medical Center (NPI 1366637068)

Field	Value
Entity Type	Organization
Organization	Benewah Medical Center
Address	427 12th St
City	Plummer
State	ID
ZIP	83851
Taxonomy	Health Service Clinic/Center
NPI Enumerated	September 6, 2007

Payer Source	Total Paid
Medicaid	$25.5M
Medicare	$0

Key Findings

BENEWAH MEDICAL CENTER is effectively a single-payer Medicaid provider: there is no Medicare billing on file and all reported lifetime revenue comes from Medicaid totaling $25.5M. The absence of Medicare activity indicates the clinic’s payer exposure and revenue risk are concentrated entirely in the Medicaid program rather than split between Medicare and Medicaid.

Revenue is highly concentrated in a very small set of codes: the precomputed top-3 Medicaid codes account for 98.4% of the provider’s total Medicaid revenue. This concentration implies the center’s business model and cash flow depend heavily on a few service lines rather than a broad, diversified mix of billed services.

T1015 is the dominant revenue driver, producing $19.1M (75.0% of Medicaid revenue) across 37.9K claims with an average paid/claim of $504. This profile — a very large volume of clinic visit/encounter codes paid at a relatively high per-claim rate — is consistent with an organization operating as a high-volume ambulatory clinic or community health center delivering bundled clinic encounters.

D0999 contributes $5.9M (23.0% of Medicaid revenue) over 11.1K claims at $528 average paid/claim and ranks #6 of 32 in-state (84th percentile). Together with T1015, these two nonspecific or encounter-focused codes account for nearly all revenue, reinforcing that the facility’s services are concentrated in bundled clinic encounters or related miscellaneous/dental/service codes rather than discrete high-fee procedures.

Other individual CPT and HCPCS codes each contribute only fractional shares of total Medicaid revenue (examples: 99213 $113.6K, G0467 $105.4K, 99214 $101.3K), indicating that traditional per-visit E/M codes and diagnostic labs are secondary revenue sources. Rank and percentile positions for these codes are generally in the typical-to-high range (many in the 80s–90s percentile), suggesting steady operational volume relative to in-state peers but not dominance outside the top two codes.

There are a few services where the provider is a statistical outlier in-state: 87400 ranks #1 of 10 (100th percentile) and 98940 ranks #1 of 21 (100th percentile), indicating notably above-typical state volume for influenza antigen testing and certain spinal manipulation services respectively. These standout ranks point to niche service strengths or local demand for those specific services even though they represent negligible portions of total revenue.

The provider has long tenure in the NPI system, enumerated approximately 19 years ago on 2007-09-06. This duration suggests an established presence in the PLUMMER, ID market and likely stable patient relationships that support high-volume Medicaid clinic encounters.

From a competitive-stance perspective within Idaho, the facility is a significant Medicaid clinic-level participant: T1015 ranks #12 of 143 providers (92th percentile), showing the provider operates at a high volume relative to many peers for clinic encounter billing. However, because revenue is dominated by encounter/bundled codes rather than diverse high-revenue procedures, the center is a major in ambulatory clinic services but not a broad-spectrum, high-margin specialty or hospital provider.

Medicaid: Complete Services Breakdown

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

80 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	37,930	$500	$19.1M
D0999	N/A	11,100	$530	$5.9M
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…	12,620	$10	$113.6K
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which…	4,580	$20	$105.4K
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…	12,660	$10	$101.3K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	5,270	$10	$26.3K
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,…	1,730	$10	$24.2K
98941	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in three to four spinal regions.	1,580	$10	$18.9K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	3,180	$1	$12.7K
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…	1,710	$10	$12K

Showing 1–10 of 80

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

Benewah Medical Center — 3 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

80 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	12	140	5,470	$180	$2.6M
D0999	N/A	6	30	3,960	$250	$1.5M
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…	45	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…	30	620	560	$60	$191.8K
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…	65	80	450	$80	$171.3K
D1120	Prophylaxis–child	148	250	180	$60	$143K
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.	16	30	1,370	$50	$121.7K
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…	25	160	320	$90	$92.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	69	80	130	$80	$91.4K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	63	320	310	$80	$80.8K

Showing 1–10 of 80

Related Providers

Other providers that share a Tax Identification Number (TIN) with Benewah Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Benewah Medical Center	ID	Federally Qualified Health Center (FQHC)	$0	$5.3M
Katelyn Hammrich	ID	Physician Assistant	$71.7K	$0
Dane Jackson	ID	Diagnostic Radiology Physician	$39.9K	$0
Ryan Kain	ID	Chiropractor	$25.5K	$0
Ruth Berner	WA	Emergency Medicine Physician	$15.9K	$1.6K
Jason Chapman	ID	General Practice Physician	$13.5K	$0
Kate Aguirre	ID	Family Medicine Physician	$13.3K	$0
Tucker Larsen	ID	Physician Assistant	$9.9K	$0
Marilou Gonzalez	ID	Family Medicine Physician	$8.5K	$0
Nichole Vetter	NC	Family Nurse Practitioner	$7.5K	$0

Nearby Providers

Other providers in the same ZIP code as Benewah Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Darren Heer	ID	Physical Therapist	$58.9K	$0

Benewah Medical Center — Billing Profile & Reimbursement Data

Sign up for Benewah Medical Center — Billing Profile & Reimbursement Data policy alerts

Benewah Medical Center — Billing Profile & Reimbursement Data

Sign up for Benewah Medical Center — Billing Profile & Reimbursement Data policy alerts

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