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

Why is the Medicaid comparison limited to Arizona 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. Arizona (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.

Dhhs Ihs Phoenix Area (NPI 1427335140)

Key Findings

Field	Value
Entity Type	Organization
Organization	Dhhs Ihs Phoenix Area
Address	200 West Hospital Drive
City	Whiteriver
State	AZ
ZIP	85941
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 9, 2011

Payer Source	Total Paid
Medicaid	$91M
Medicare	$0

This provider is effectively a Medicaid-centric operation: Medicare revenue is none (no Medicare billing on file) while reported Medicaid revenue is $91M. The absence of Medicare billing indicates the provider’s payer exposure and contracting considerations will be driven almost entirely by Medicaid reimbursement and policy changes rather than by Medicare dynamics.

Medicaid revenue is extremely concentrated in a very small set of E/M codes: the precomputed top three Medicaid codes (99211, 99212, 70450) account for 99.5% of this provider’s total Medicaid revenue. The single dominant line is 99211, which alone generates $89.2M (98.0% of Medicaid revenue), indicating the bulk of cashflow depends on one service type.

The code mix points to a high-throughput, low-acuity outpatient service model: 99211 (an established patient outpatient visit that may not require a physician) has 164K claims with an avg paid/claim of $544, and 99212 has 10.5K claims with an avg paid/claim of $122. Together these volumes and code descriptions suggest operations focused on brief office or clinic encounters (including nursing or ancillary visits) rather than inpatient or specialty procedural care.

Competitive standing within Arizona is concentrated and extreme for the top code: 99211 ranks #2 of 395 providers in-state and is labeled an extreme outlier at the 100th percentile, meaning this provider bills far more 99211 volume than typical state peers. By contrast 99212 ranks #30 of 852 (97th percentile), which denotes high but less singular dominance for that slightly higher-complexity outpatient visit.

Imaging and higher-acuity services are present but financially immaterial: 70450 (CT head without contrast) appears as the third top revenue driver with 2.3K claims, $45 avg paid/claim, and $104.5K revenue (0.1% of Medicaid revenue), ranking #80 of 177 (55th percentile). This indicates on-site basic CT capacity or referral imaging activity exists, but it does not meaningfully diversify the provider’s Medicaid revenue base.

The reimbursement profile amplifies the revenue concentration risk: 99211’s avg paid/claim is $544 on 164K claims, which is the primary source of the $89.2M figure attributed to that code. Because such a large share of Medicaid revenue comes from a single E/M code and payment level, any policy or coding shifts affecting 99211 could materially affect overall revenue.

The provider has an established billing history with an NPI enumerated on 2011-11-09 (~15 years ago), which suggests this Medicaid-focused operating pattern has been in place for a substantial period. Analysts evaluating network adequacy, market share, or risk should treat this entity as a long-tenured, Medicaid-dominated ambulatory services provider rather than a mixed Medicare/Medicaid hospital outpatient competitor.

Medicaid: Complete Services Breakdown

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

44 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	163,970	$540	$89.2M
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,…	10,480	$120	$1.3M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	2,320	$50	$104.5K
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…	5,580	$10	$72.5K
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…	930	$70	$61.2K
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.	540	$110	$59.1K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	1,280	$30	$39.5K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	420	$90	$35.7K
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	410	$80	$32.4K
72125	In this diagnostic procedure, the provider performs a computed tomography, or CT, examination of the cervical spine without contrast material.	420	$50	$22K

Showing 1–10 of 44

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Dhhs Ihs Phoenix Area — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

44 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.	250	260	3,030	$190	$3.4M
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.	196	260	2,600	$170	$2.6M
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.	113	180	1,490	$320	$2.2M
74176	The provider performs computed tomography of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	95	150	1,040	$240	$764.4K
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.	131	160	1,640	$110	$710.7K
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	80	180	1,770	$80	$635.2K
72125	In this diagnostic procedure, the provider performs a computed tomography, or CT, examination of the cervical spine without contrast material.	74	110	1,070	$170	$482K
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.	2	400	200	$120	$403K
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…	2,251	3,040	750	$50	$343.9K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	321	480	960	$40	$308.1K

Showing 1–10 of 44

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
White Mountain Apache Tribe	AZ	Land Ambulance	$0	$38.9M
Robert Evans	AZ	Foot & Ankle Surgery Podiatrist	$87K	$0
Algimantas Jecius	AZ	Surgery Physician	$40.4K	$0

Dhhs Ihs Phoenix Area — Billing Profile & Reimbursement Data

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Dhhs Ihs Phoenix Area — 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