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NPI 1497786412 · Pine Ridge, SD · General Acute Care Hospital
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Pine Ridge Indian Health Service Hospital is a general acute care hospital provider located in Pine Ridge, South Dakota. This profile covers 5 Medicare and 105 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Pine Ridge Indian Health Service Hospital |
| Address | East Highway 18 |
| City | Pine Ridge |
| State | SD |
| ZIP | 57770 |
| Taxonomy | General Acute Care Hospital |
| NPI Enumerated | July 6, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $37.3M |
| Medicare | $186.4K |
This provider is overwhelmingly Medicaid-driven: total Medicaid revenue is $37.3M compared with total Medicare revenue of $186.4K, indicating Medicaid accounts for the vast majority of reported billing activity and financial scale. The small absolute Medicare figure suggests the hospital’s payer mix is heavily weighted toward state programs rather than fee-for-service Medicare beneficiaries.
Medicare revenue is highly concentrated in ambulance and transport services — the top three Medicare codes (A0425, A0428, A0427) account for 74.9% of this provider's total Medicare revenue. A0425 alone represents 40.7% of Medicare revenue and is the single largest Medicare line, so Medicare activity appears to be driven by emergency and non-emergency ambulance transports rather than inpatient or complex procedural care.
Medicaid billing is concentrated in outpatient evaluation-and-management visits: the top three Medicaid codes (99213, 99214, 99212) account for 52.7% of this provider's total Medicaid revenue. High claim volumes for 99213 (23.5K claims, $9.3M revenue) and 99214 (18.6K claims, $6.4M revenue) indicate a heavy emphasis on primary care / clinic visits within the Medicaid population.
Competitive standing for Medicare ambulance codes is modest at the national level. A0425 ranks #2080 of 8934 providers (77th percentile) and is labeled as typical/unremarkable volume, while A0428 (46th percentile) and A0427 (31st percentile) also sit in typical ranges — together these positions indicate the provider is a functioning participant in ambulance services nationally but not a dominant national operator.
Within the state Medicaid market the provider is a major presence for routine outpatient and related services: 99214 ranks #7 of 260 providers in-state (98th percentile, notably above typical state volume), 99213 ranks #13 of 344 (97th percentile), and 99212 ranks #4 of 155 (98th percentile, extreme outlier). Several codes are labeled as extreme outlier or 100th-percentile statewide (for example 99211, 0001A, 0002A, 0072A, 0071A), which together indicate this hospital is a dominant local provider for many core outpatient and procedure lines.
The provider also shows strong public-health and dental activity in Medicaid billing: vaccination administration 90471 (4.1K claims, $1.7M revenue), topical fluoride D1206 (3.7K claims, $1.3M revenue), limited oral evaluation D0140 (2.9K claims, $1.2M revenue), and intraoral radiograph D0220 (3.6K claims, $731K revenue). These volumes and dollar levels point to an integrated clinic/dental/preventive services footprint that supports Medicaid beneficiaries across age groups.
Ambulance services are significant on the Medicaid side as well: A0428 (2.5K claims, $335.1K revenue) and A0426 (1.7K claims, $273K revenue) both rank #1 in-state for their lines, and A0425 appears with 5.8K claims and $601.8K revenue. This pattern implies the hospital functions as a primary local ambulance/transport provider for Medicaid patients and likely supplies a meaningful portion of regional EMS billings.
The provider has an established presence with an NPI enumerated on 2006-07-06 (~20 years ago), consistent with the large, entrenched Medicaid volumes and multiple 100th-percentile code ranks observed in-state. Combined with the Medicaid-dominant revenue mix, the tenure and code mix suggest a longstanding, community-facing hospital whose core operations are centered on outpatient primary care, preventive/dental services, and regional ambulance transport rather than high-volume Medicare inpatient or specialty procedural lines.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0425 | Ground mileage, per statute mile | 9,600 | $10 | $76.8K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 140 | $230 | $32.7K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 80 | $410 | $31.8K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 100 | $280 | $28.2K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 50 | $370 | $19.1K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
105 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… | 23,510 | $400 | $9.3M |
| 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… | 18,560 | $340 | $6.4M |
| 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,… | 5,800 | $410 | $2.4M |
| 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. | 7,010 | $300 | $2.1M |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 4,060 | $410 | $1.7M |
| D1206 | Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients | 3,710 | $340 | $1.3M |
| D0140 | Limited oral evaluation – problem focused | 2,940 | $420 | $1.2M |
| 0001A | N/A | 3,340 | $360 | $1.2M |
| 0002A | N/A | 3,080 | $380 | $1.2M |
| 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… | 2,370 | $410 | $977.7K |
Showing 1–10 of 105
How this provider's Medicaid billing volume and revenue compare to other South Dakota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Dakota median
105 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… | 13 | 340 | 1,010 | $100 | $511K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 15 | 40 | 270 | $180 | $281.6K |
| 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. | 28 | 40 | 340 | $90 | $234.9K |
| 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… | 7 | 260 | 860 | $80 | $222.6K |
| 43235 | The provider inserts an endoscope through the mouth and down into the esophagus, stomach, and duodenum for diagnostic purposes; the provider may collect specimens by brushing or washing. | 1 | 10 | 110 | $390 | $206.4K |
| 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. | 18 | 60 | 680 | $60 | $205.7K |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 15 | 30 | 300 | $150 | $195.3K |
| 47900 | The provider uses sutures to repair an injury in the extrahepatic biliary duct. | 1 | 10 | 830 | $230 | $191.1K |
| 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… | 20 | 40 | 1,100 | $80 | $181.3K |
| 90832 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 32 | 70 | 200 | $80 | $176.7K |
Showing 1–10 of 105
Other providers in the same ZIP code as Pine Ridge Indian Health Service Hospital, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Black Hills Dialysis, LLC | SD | End-Stage Renal Disease (ESRD) Treatment Clinic/Center | $0 | $5.3M |
| Apollo Medflight, LLC | SD | Air Ambulance | $748.6K | $1.5M |
| Winckler Vision Center, Inc. | SD | Optometrist | $0 | $2.2M |
| Ost Ambulance Service | SD | Ambulance | $0 | $1.8M |
| Joyce Achenjang | SD | Internal Medicine Physician | $68K | $0 |
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