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.

Avera Mckennan (NPI 1376575514)

Field	Value
Entity Type	Organization
Organization	Avera Mckennan
Address	1200 S 7th Ave
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Family Medicine Physician
NPI Enumerated	July 7, 2006

Payer Source	Total Paid
Medicaid	$10.6M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid billing entity: Total Medicaid revenue is $10.6M and there is no Medicare billing on file. The absence of Medicare revenue indicates the provider’s patient and payor mix is heavily—if not exclusively—Medicaid-focused rather than split between traditional Medicare and Medicaid sources.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management and preventive codes: the top three Medicaid codes (99213, 99214, 99391) together account for 60.4% of total Medicaid revenue. 99213 alone generated $3.1M (31.8% of Medicaid revenue) and 99214 generated $2M (20.7%), signaling reliance on frequent established-patient office visits for the majority of revenue.

The code mix strongly supports a primary care/family-medicine and pediatric preventive service model: high volumes and revenue for 99213 and 99214 (established patient E/M) alongside preventive medicine codes 99391, 99392, 99393, 99394 and 99395 indicate routine longitudinal care and periodic well visits across age groups. This pattern, together with substantial vaccine administration coding, is consistent with a clinic that provides comprehensive family and pediatric primary care rather than a specialty or procedure-centric operation.

Immunization and public-health services are a distinct revenue and volume driver. Vaccine administration codes appear at very high volumes—90472 (16.5K claims, $345.6K revenue) ranks #1 of 70 providers in-state (100th percentile; extreme outlier), 90471 has 23.2K claims ($231.9K), and 90473 ranks #1 of 13 providers (100th percentile; extreme outlier)—indicating the provider runs a high-throughput immunization program that materially contributes to Medicaid revenue.

The provider is a dominant in-state performer for several high-volume primary care codes. 99213 and 99214 both rank #2 statewide (99213: #2 of 344 providers, 100th percentile; extreme outlier; 99214: #2 of 260 providers, 100th percentile; extreme outlier), and multiple preventive and vaccine codes rank in the 97th–100th percentiles. These high ranks and labels such as "extreme outlier" and "notably above typical" describe a provider that is a major, above-typical Medicaid participant in South Dakota for core primary care and immunization services.

The provider also bills for newborn and perinatal care as well as minor procedures, indicating a broader family practice scope that includes newborn/hospital services and minor surgery. Codes 99460 (newborn evaluation, $186.9K, ranks #3 of 18), 99462 ($51K, ranks #3 of 11), and 54150 (circumcision, $139.7K, ranks #3 of 7) show meaningful Medicaid revenue from perinatal and neonatal care in addition to outpatient well visits.

There is evidence of inpatient and facility-based activity in the billing mix, though at more typical state volumes. Hospital inpatient and observation E/M codes such as 99222 ($97K, ranks #7 of 53), 99238 ($150.8K, ranks #5 of 45), and 99232 ($57.9K, ranks #23 of 69) appear on the list and suggest the provider performs admission, subsequent, and discharge management services in hospital settings alongside outpatient practice.

The NPI tenure is long-standing: the NPI was enumerated on 2006-07-07 (~20 years ago). This sustained enrollment combined with a Medicaid-dominant revenue base implies an established presence in the state Medicaid market and the potential for stable, repeat primary-care volume rather than a recent entrant or transient billing pattern.

Medicaid: Complete Services Breakdown

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

142 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…	79,340	$40	$3.1M
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…	37,230	$50	$2M
99391	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…	11,900	$70	$773.6K
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…	9,400	$70	$620.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,990	$70	$395.2K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	16,460	$20	$345.6K
0241U	N/A	2,760	$110	$295.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	3,850	$70	$253.8K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	23,190	$10	$231.9K
W0037	N/A	26,870	$10	$188.1K

Showing 1–10 of 142

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

Avera Mckennan — 12 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

142 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…	2	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…	2	260	860	$80	$222.6K
99391	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…	2	40	1,100	$80	$181.3K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	23	70	400	$40	$172.5K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	147	190	430	$90	$154.1K
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…	14	30	270	$70	$138.6K
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…	2	50	410	$80	$127.2K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	21	40	160	$90	$116.9K
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…	9	70	130	$100	$99K
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,…	22	160	210	$120	$97.4K

Showing 1–10 of 142

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center Fargo	ND	Family Medicine Physician	$0	$75.9M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Avera Mckennan	SD	Psychiatry Physician	$0	$9.1M
Avera Mckennan	SD	Home Infusion Agency	$0	$6.7M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M
Avera Mckennan	SD	Emergency Medicine Physician	$0	$4.1M
Avera Mckennan	SD	General Acute Care Hospital	$0	$3.7M
Avera Mckennan	SD	Diagnostic Radiology Physician	$0	$3.3M
Avera Mckennan	SD	Hospitalist Physician	$0	$2.6M

Nearby Providers

Other providers in the same ZIP code as Avera Mckennan, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Dakota Achieve	SD	Developmental Disabilities Clinic/Center	$0	$166.9M
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Southeastern Behavioral Healthcare	SD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$59.1M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Lutheran Social Services Of South Dakota Inc	SD	Voluntary or Charitable Agency	$0	$3.6M

Avera Mckennan — Billing Profile & Reimbursement Data

Sign up for Avera Mckennan — Billing Profile & Reimbursement Data policy alerts

Avera Mckennan — Billing Profile & Reimbursement Data

Sign up for Avera Mckennan — 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