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 Washington for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Washington 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. Washington (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 Washington (NPI 1376624981)

Key Findings

Field	Value
Entity Type	Organization
Organization	Providence Health & Services Washington
Address	914 S Scheuber Rd
City	Centralia
State	WA
ZIP	98531
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 18, 2006

Payer Source	Total Paid
Medicaid	$40.4M
Medicare	$0

This provider effectively operates as a Medicaid-focused hospital: there is no Medicare billing on file and total Medicaid revenue on record is $40.4M, so Medicaid is the dominant and functionally sole public-payer revenue stream in the data set. That single-payer orientation will shape payer mix, reimbursement risk, and contracting considerations for analysts evaluating revenue stability.

Revenue concentration is meaningful: the top three Medicaid codes (J9271, 96361, 99283) together account for 39.5% of the provider’s total Medicaid revenue. Individually those codes represent $5M (15.8%), $4.3M (13.6%), and $3.2M (10.1%) of Medicaid revenue respectively, indicating a relatively concentrated set of revenue drivers.

The code mix points to a substantial oncology and infusion operation. J9271 (pembrolizumab) is the single largest Medicaid revenue code at $5M and additional chemotherapy/infusion codes such as 96413, 96365, 96366, and 96415 also appear in the top codes list, suggesting an active outpatient infusion/chemotherapy service line rather than exclusively inpatient oncology care. This pattern is consistent with a hospital that supports oncology protocols and an infusion center.

Emergency department services are another key service line. High-volume ED E/M codes 99283 ($3.2M), 99284 ($2.5M), and 99285 ($2.2M) appear among the top revenue codes with 99283 ranked at the 81st percentile statewide; the combination of large claim counts and material revenue indicates significant ED throughput and a mix of low-to-high acuity visits.

Obstetrics/perinatal monitoring is a distinct strength: code 59025 accounts for $2M of Medicaid revenue and ranks at the 97th percentile in-state, labeled as notably above typical state volume. That unusually high relative standing for fetal heart-rate testing suggests the facility handles a heavier-than-typical obstetric caseload or regional maternity referrals.

Imaging and diagnostics form a consistent secondary revenue stream. High-value imaging codes appear across CT and PET services (74177 $1.5M, 70450 $868.3K, 78815 $502.1K, 71275 $355.2K) and ultrasound codes (76830 $419K, 76705 $418.8K), with several of these in the upper percentiles statewide (78815 at 91st, 74177 at 79th). This mix indicates substantial outpatient imaging capacity that complements ED, surgical, and oncology demand.

Competitive standing is mixed by service line: for several top codes the provider sits in the upper-middle range statewide rather than as an outlier or dominant provider (e.g., J9271 at 77th percentile and called typical, 96361 at 72nd percentile typical, 99283 at 81st percentile typical). However, it is a clear regional leader in select services—notably 59025 (97th percentile) and 96413 (91st percentile)—so the hospital is an important specialty player in obstetrics and some chemotherapy services while remaining a modest participant for many other high-volume codes.

The provider has long tenure in enrollment, with its NPI enumerated on 2006-10-18 (~20 years ago), indicating an established facility with multi-year operational history. Coupled with the Medicaid concentration, that tenure suggests stable local market presence but also a potential exposure to Medicaid reimbursement changes given the lack of Medicare volume to diversify public-payer revenue.

Medicaid: Complete Services Breakdown

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

391 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J9271	Injection, pembrolizumab, 1 mg	1,170	$4,310	$5M
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.	14,290	$300	$4.3M
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.	29,600	$110	$3.2M
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.	27,910	$90	$2.5M
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.	25,690	$90	$2.2M
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	12,120	$160	$2M
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.	9,500	$160	$1.5M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	12,030	$120	$1.5M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	11,040	$110	$1.2M
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	4,240	$220	$912K

Showing 1–10 of 391

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.

Claims Volume vs. Washington Distribution

Providence Health & Services Washington — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

391 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	39	100	2,830	$80	$3.8M
J9271	Injection, pembrolizumab, 1 mg	4	10	270	$3,820	$2.9M
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.	30	110	5,950	$270	$2.6M
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.	54	230	5,440	$90	$1.8M
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.	46	230	6,220	$100	$1.8M
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.	43	190	5,130	$100	$1.8M
77412	The provider delivers radiation therapy at level 3 complexity. This includes photon therapy delivered to multiple isocenters, photon therapy with active motion management, total skin electron…	7	10	1,470	$400	$1.2M
J9355	Injection, trastuzumab, excludes biosimilar, 10 mg	3	10	1,000	$1,030	$1.1M
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.	30	140	2,830	$150	$1.1M
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…	44	100	1,940	$70	$1M

Showing 1–10 of 391

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Clinicops, LLC	OR	Family Medicine Physician	$0	$9.8M
Providence Health & Services Washington	WA	Radiation Oncology Clinic/Center	$515.5K	$0
Lina Dorfmeister	OR	Pain Medicine Physician	$211K	$0
John Delhagen	TX	Anesthesiology Physician	$92.5K	$0
Alison Erway-brewer	AZ	Certified Registered Nurse Anesthetist	$76.4K	$0
Judy Wong	CA	Certified Registered Nurse Anesthetist	$62.7K	$0
Kelly Knollmann	AR	Certified Registered Nurse Anesthetist	$61K	$0
Kaori Donohue	WA	Certified Registered Nurse Anesthetist	$55.2K	$0
Leslie Hughes	AL	Certified Registered Nurse Anesthetist	$53.9K	$0
Angela Torres	CA	Certified Registered Nurse Anesthetist	$53.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
N W Pediatric Center Inc P S	WA	Pediatrics Physician	$0	$19.1M
Cascade Community Healthcare	WA	Community/Behavioral Health Agency	$0	$14.2M
Pope's Kids Place	WA	Home Health Agency	$0	$9.9M
Kids Dental Of Centralia, P.C.	WA	General Practice Dentistry	$0	$8.9M
N W Pediatric Center Inc P S	WA	Pediatrics Physician	$0	$5.2M
Community Integrated Health Services, LLC	WA	Community/Behavioral Health Agency	$0	$4.8M
American Medical Response Ambulance Service Inc	WA	Ambulance	$925.9K	$3.7M
Huy Dang	WA	Podiatrist	$249.2K	$0
Floyd Smith	WA	Internal Medicine Physician	$236.4K	$0
Keith Birchard	WA	Orthopaedic Surgery Physician	$201.1K	$0

Providence Health & Services Washington — 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