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 1437300829)

Field	Value
Entity Type	Organization
Organization	Providence Health & Services - Washington
Address	12800 Bothell Everett Hwy
City	Everett
State	WA
ZIP	98208
Taxonomy	Pediatrics Physician
NPI Enumerated	October 4, 2008

Payer Source	Total Paid
Medicaid	$6.8M
Medicare	$0

Medicaid: Complete Services Breakdown

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

74 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…	24,470	$80	$1.9M
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…	12,480	$100	$1.2M
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…	11,990	$90	$1.1M
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…	9,620	$110	$1M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5,050	$100	$504.9K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	8,800	$20	$140.7K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	7,110	$20	$106.7K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	9,780	$10	$88K
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…	410	$160	$63.7K
90680	This code represents a live pentavalent rotavirus vaccine given by mouth in a three–dose schedule to protect against rotavirus infection.	3,920	$20	$62.7K

Showing 1–10 of 74

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 — 5 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

74 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…	205	1,820	480	$60	$379.6K
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…	117	1,860	610	$40	$295.5K
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	280	540	$70	$166.5K
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…	11	300	400	$80	$164.4K
D0120	Periodic oral evaluation - established patient	558	920	690	$20	$131.3K
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…	166	540	130	$90	$128.6K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	158	210	690	$40	$114.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	31	320	290	$70	$104.8K
87631	The lab analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus,…	56	60	730	$60	$102.1K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	561	730	730	$20	$98.5K

Showing 1–10 of 74

Related Providers

Other providers that share a Tax Identification Number (TIN) with Providence Health & Services - Washington, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services-wa	WA	General Acute Care Hospital	$0	$62.4M
Georgetown Memorial Hospital	SC	General Acute Care Hospital	$0	$27.6M
Providence Health & Services- Washington	WA	General Practice Physician	$0	$7.6M
Providence Health & Services - Washington	WA	Family Medicine Physician	$0	$7.6M
Providence Health & Services - Washington	WA	General Practice Physician	$0	$6M
Providence Health & Services-washington	WA	Pediatrics Physician	$0	$3.2M
Providence Health & Services - Washington	WA	Family Medicine Physician	$0	$2.9M
Express Care Or PC	OR	General Practice Physician	$0	$2.4M
John Fitzharris	OR	Medical Oncology Physician	$672.6K	$0
Amir Mehrvarz Sarshekeh	WA	Hematology & Oncology Physician	$651.1K	$0

Nearby Providers

Other providers in the same ZIP code as Providence Health & Services - Washington, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Health Center Of Snohomish County	WA	Federally Qualified Health Center (FQHC)	$0	$22.9M
Sonu Lamba And Paul S. Kahlon, Ps	WA	Pediatric Dentistry	$0	$18.8M
Sea Mar Community Health Centers	WA	Federally Qualified Health Center (FQHC)	$0	$5.5M
South Snohomish County Fire & Rescue Regional Fire Authority	WA	Land Ambulance	$1.4M	$3.2M
Western Washington Medical Group, Inc Ps	WA	Ambulatory Surgical Clinic/Center	$447.4K	$178.6K
Julie Furlan	WA	Retina Specialist (Ophthalmology) Physician	$443.3K	$0
Thomas Richardson	WA	Cardiovascular Disease Physician	$261.3K	$0
Ravilla Mahidhar	WA	Interventional Cardiology Physician	$157.8K	$760
Ya-lan Huang	WA	Nephrology Physician	$136.8K	$0
Niket Nathani	WA	Critical Care Medicine (Internal Medicine) Physician	$135.8K	$0

Providence Health & Services - Washington — Billing Profile & Reimbursement Data

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Providence Health & Services - Washington — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References