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.

Warm Springs Health And Wellness Dhhs Ihs Warm Springs Service Unit (NPI 1417084708)

Field	Value
Entity Type	Organization
Organization	Warm Springs Health And Wellness Dhhs Ihs Warm Springs Service Unit
Address	1270 Kot Num Rd
City	Warm Springs
State	OR
ZIP	97761
Taxonomy	Clinic/Center
NPI Enumerated	February 27, 2007

Payer Source	Total Paid
Medicaid	$21.1M
Medicare	$0

Key Findings

This provider is effectively single‑payer at scale: there is no Medicare billing on file while Medicaid billing totals $21.1M, indicating its revenue and operational footprint are concentrated in the Medicaid population rather than split across Medicare and Medicaid. The absence of Medicare activity suggests the clinic’s patient mix, payer relationships, or services are oriented primarily toward Medicaid beneficiaries.

Revenue concentration is high: the precomputed top three Medicaid codes account for 75.9% of the provider’s total Medicaid revenue. Those top three are 99213 ($7.1M, 33.8%), 99212 ($6.9M, 33.0%), and D0140 ($1.9M, 9.1%), which together dominate the clinic’s Medicaid earnings and point to reliance on a small set of service lines.

The code mix and descriptions point to a primary ambulatory clinic model with integrated dental services: the leading codes 99213 and 99212 are office/outpatient E/M visits for established patients, while D0140 (limited oral evaluation – problem focused) and other dental codes (D0150, D0120, D0220) show a substantial dental care component. This suggests the Warm Springs Service Unit operates as a community clinic/center offering routine medical follow-up visits alongside on‑site dental evaluation and basic dental procedures.

One standout competitive signal is 99212, which is an extreme outlier in the state: the provider reports 18.7K claims and $6.9M revenue for 99212 and ranks #3 of 573 providers in-state (100th percentile; extreme outlier). This ranking indicates uniquely high volume for straightforward established‑patient visits compared with peers and implies the clinic is a major local source for low‑complexity office care.

99213 and D0140 also show strong state-level standing but are less extreme: 99213 (22.7K claims, $7.1M) ranks #69 of 1591 providers in-state (96th percentile) and D0140 (6.4K claims, $1.9M) ranks #12 of 555 providers in-state (98th percentile). These percentiles indicate robust, above‑typical volumes for both routine E/M care and problem-focused dental evaluations relative to in‑state peers, reinforcing the clinic’s dual focus on ambulatory medicine and dental services.

The operational profile favors high-volume, low‑intensity visits with a measurable tail of higher‑complexity services: 99211 (3.9K claims, $1.2M, 5.9%) and 99214 (1.3K claims, $488.6K, 2.3%) show that most visits are lower complexity but the clinic also handles moderate complexity encounters. The presence of telephonic/remote codes (e.g., 98966) and vaccine/testing codes indicates a mix of visit modalities and public‑health activity in addition to face‑to‑face outpatient care.

Public‑health and preventive operations are visible: U0002 (4.2K claims, $147.6K) ranks #2 of 21 providers in-state (95th percentile; notably above typical state volume) and 90471 (3.9K claims, $335.8K) ranks #18 of 403 providers in-state (96th percentile). High ranks on these COVID testing and vaccine administration codes suggest active involvement in testing and immunization programs alongside routine clinical visits.

The provider is long‑tenured: the NPI was enumerated on 2007-02-27 (~19 years ago), indicating established participation in Medicaid billing and likely sustained operational relationships within its community. Coupled with the concentrated Medicaid revenue base and the state‑level rank positions, this tenure supports a profile of a mission‑oriented clinic serving a steady Medicaid population over many years.

Medicaid: Complete Services Breakdown

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

84 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…	22,680	$310	$7.1M
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,…	18,670	$370	$6.9M
D0140	Limited oral evaluation – problem focused	6,400	$300	$1.9M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	3,910	$310	$1.2M
D0150	Comprehensive oral evaluation – new or established patient	2,390	$290	$701.1K
D0191	N/A	1,650	$370	$615.6K
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…	1,340	$370	$488.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	3,910	$90	$335.8K
D0120	Periodic oral evaluation - established patient	1,020	$230	$232.9K
99441	N/A	600	$380	$225.2K

Showing 1–10 of 84

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

Warm Springs Health And Wellness Dhhs Ihs Warm Springs Service Unit — 5 of 25 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

84 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	570	1,500	650	$70	$312.4K
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…	69	1,590	590	$50	$236.5K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…	50	90	140	$180	$233.1K
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.	113	140	5,430	$10	$147.7K
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…	154	170	300	$80	$133.1K
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…	112	180	220	$90	$124.6K
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…	157	250	460	$80	$121.3K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	124	260	200	$100	$72.7K
92340	Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal	103	210	450	$50	$68.8K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	27	50	120	$60	$62.9K

Showing 1–10 of 84

Nearby Providers

Other providers in the same ZIP code as Warm Springs Health And Wellness Dhhs Ihs Warm Springs Service Unit, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Confederated Tribes Of The Warm Springs Reservation Of Oregon	OR	Clinic/Center	$0	$7.6M
Kacey Conyers	OR	Registered Dietitian	$3.1K	$0

Warm Springs Health And Wellness Dhhs Ihs Warm Springs Service Unit — Billing Profile & Reimbursement Data

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Warm Springs Health And Wellness Dhhs Ihs Warm Springs Service Unit — 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

Nearby Providers

Frequently Asked Questions

References