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

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

Saint Alphonsus Regional Medical Center Inc (NPI 1508198813)

Key Findings

Field	Value
Entity Type	Organization
Organization	Saint Alphonsus Regional Medical Center Inc
Address	315 E Elm St Ste 100
City	Caldwell
State	ID
ZIP	83605
Taxonomy	Rural Health Clinic/Center
NPI Enumerated	February 11, 2010

Payer Source	Total Paid
Medicaid	$9.9M
Medicare	$0

SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC is functionally a Medicaid-focused Rural Health Clinic/Center with no Medicare billing on file and $9.9M in lifetime Medicaid revenue, indicating it operates predominantly within the Medicaid payer mix rather than a dual Medicare/Medicaid model. The provider’s NPI was enumerated on 2010-02-11 (~16 years ago), showing a long tenure in the market which supports sustained Medicaid activity over time. Revenue concentration is extremely high: the single code T1015 accounts for $9.8M and 99.2% of this provider’s Medicaid revenue, and the precomputed top-three codes together account for 99.9% of total Medicaid revenue, signaling near-total dependence on a single all-inclusive clinic visit code for Medicaid receipts. The dominance of T1015 (100K claims, $98 avg paid/claim) and its #3 statewide rank out of 143 providers (99th percentile) suggests the clinic operates at high volume compared with in-state peers and is a major statewide provider for comprehensive clinic encounter billing. Secondary Medicaid codes (99213 at 48.6K claims and 99214 at 10K claims) contribute only a sliver of revenue ($48.6K and $19.9K respectively) despite high claim counts, indicating these E/M office visit codes are used frequently but reimbursed at a much lower rate relative to T1015. Immunization and preventive care codes (e.g., 90471, 90472, 99392–99394, 90686, 90670) show very high claim volumes and high in-state percentiles while contributing negligible Medicaid revenue, which implies substantial preventive and vaccine administration activity possibly bundled into T1015 encounters rather than paid separately. Given the revenue concentration in a single bundled clinic code and the elevated ranking on several pediatric and vaccine codes (some labeled as "notably above typical" or "extreme outlier"), the provider’s operational profile is consistent with a high-throughput rural clinic offering broad primary care and immunization services, with financial performance tightly linked to the use and reimbursement of T1015. From a competitive standpoint within Idaho Medicaid this entity is a top-tier performer for T1015 and several pediatric/preventive service codes (99th–94th percentiles and higher), positioning it as a significant provider of outpatient clinic encounters in its market but with limited diversification of Medicaid revenue sources.

Medicaid: Competitive Analysis & Benchmarks

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	100,000	$100	$9.8M
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…	48,610	$1	$48.6K
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…	9,950	$1	$19.9K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,290	$1	$5.2K
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,…	260	$1	$260
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	200	$1	$200
0001A	N/A	10	$0	$0
0071A	N/A	50	$0	$0
0072A	N/A	60	$0	$0
3008F	No Summary found for this code	1,790	$0	$0

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

Claims Volume vs. Idaho Distribution

Saint Alphonsus Regional Medical Center Inc — 2 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

63 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	3	140	5,470	$180	$2.6M
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…	15	670	740	$40	$193.6K
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…	39	620	560	$60	$191.8K
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…	8	80	450	$80	$171.3K
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…	8	80	380	$70	$151.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5	80	130	$80	$91.4K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	32	80	460	$30	$77.7K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	14	30	790	$30	$68.4K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	11	10	130	$110	$61.8K
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…	106	140	100	$90	$54.4K

Showing 1–10 of 63

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Alphonsus Regional Medical Center Inc	ID	Family Medicine Physician	$0	$32.6M
Human Supports Of Idaho	ID	General Practice Physician	$0	$9.4M
County Of Canyon Canyon Co School Dist 132	ID	Local Education Agency (LEA)	$0	$8.3M
West Valley Medical Center, Inc.	ID	General Acute Care Hospital	$0	$7.8M
Carepoint Health Emergency Medicine Idaho, PLLC	ID	Emergency Medicine Physician	$0	$4.3M
Mana Resources LLC	ID	Community/Behavioral Health Agency	$0	$3.1M
Family Eyecare Specialists PLLC	ID	Optometrist	$0	$2.9M
Hope House, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$2.4M
West Valley Medical Group LLC	ID	Internal Medicine Physician	$0	$2.1M
Easterseals-goodwill Northern Rocky Mountain, Inc	ID	Community/Behavioral Health Agency	$0	$2M

Saint Alphonsus Regional Medical Center Inc — Billing Profile & Reimbursement Data

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Saint Alphonsus Regional Medical Center Inc — 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