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.

Sanford Clinic (NPI 1487923991)

Field	Value
Entity Type	Organization
Organization	Sanford Clinic
Address	1500 W 22nd St
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Maternal & Fetal Medicine Physician
NPI Enumerated	December 29, 2011

Payer Source	Total Paid
Medicaid	$1.2M
Medicare	$0

Medicaid: Complete Services Breakdown

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	2,020	$100	$204.1K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	5,170	$40	$191.3K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	3,200	$40	$134.6K
76805	In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks…	1,980	$50	$107K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	2,300	$40	$92K
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…	2,090	$40	$81.6K
76825	The provider performs real–time fetal echocardiography, with or without M–mode recording, for complete evaluation of a fetal cardiovascular system.	970	$70	$67.2K
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…	1,100	$60	$67K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	2,960	$20	$59.1K
76827	The provider performs a complete fetal Doppler echocardiography by pulsed or continuous sound waves with spectral display to assess blood flow in the fetus.	1,040	$40	$41.6K

Showing 1–10 of 29

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

Sanford Clinic — 1 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

29 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…	120	340	1,010	$100	$511K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	3	10	2,020	$100	$303.8K
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…	115	260	860	$80	$222.6K
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…	55	70	400	$40	$172.5K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	3	10	670	$40	$165.4K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	4	10	420	$120	$93.5K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	3	20	260	$40	$90.3K
99203	The provider sees a new 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 provider…	51	100	160	$60	$64.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	146	160	180	$40	$59.6K
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	4	10	1,230	$20	$53.4K

Showing 1–10 of 29

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Sanford Medical Center	SD	Clinical Medical Laboratory	$1.8M	$18M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Sanford Health Network	MN	Rural Acute Care Hospital	$0	$7.6M
Sanford Health Network	IA	Family Medicine Physician	$0	$6.6M
Sanford Clinic	SD	Diagnostic Radiology Physician	$0	$6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M

Nearby Providers

Other providers in the same ZIP code as Sanford Clinic, 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
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera Mckennan	SD	Emergency Medicine Physician	$0	$4.1M
Avera Mckennan	SD	General Acute Care Hospital	$0	$3.7M

Sanford Clinic — Billing Profile & Reimbursement Data

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Sanford Clinic — 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