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

Why is the Medicaid comparison limited to North 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. North 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 Medical Center Fargo (NPI 1528009412)

Field	Value
Entity Type	Organization
Organization	Sanford Medical Center Fargo
Address	801 Broadway N
City	Fargo
State	ND
ZIP	58122
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 9, 2006

Payer Source	Total Paid
Medicaid	$50.2M
Medicare	$0

Key Findings

This provider effectively bills only Medicaid in the available data: Total Medicare revenue: none (no Medicare billing on file) while Total Medicaid revenue: $50.2M. The absence of Medicare activity in the feed indicates that analysts should treat Sanford Medical Center Fargo as a Medicaid-dominated billing entity for payer-mix and utilization comparisons in this dataset.

Medicaid revenue is highly concentrated: the top three Medicaid codes account for 71.5% of this provider's total Medicaid revenue. Those top drivers are G0463 ($16.2M, 34.1% of Medicaid revenue; 238.4K claims), 99285 ($12.4M, 26.1% of Medicaid revenue; 37.8K claims), and 99283 ($5.3M, 11.2% of Medicaid revenue; 32.2K claims), so a small set of outpatient and ED codes dominate receipting.

The service-line mix points to very high-volume emergency and hospital outpatient clinic activity: G0463 (hospital outpatient clinic visit) is the single largest revenue line at $16.2M and 238.4K claims, and the ED E/M codes 99285, 99283, and 99284 together represent multiple millions more in Medicaid revenue. This combination is consistent with a general acute care hospital operating a large emergency department and substantial outpatient clinic throughput rather than a revenue base driven by inpatient DRGs or Medicare outpatient billing.

State-level competitive standing is strong for core outpatient and ED services: G0463 ranks #1 of 10 providers in-state (100th percentile) and 99285 and 99283 rank near the top (#2 of 19 at the 94th percentile; #2 of 48 at the 98th percentile). Those rankings indicate Sanford is a major statewide provider for clinic and ED volume, frequently at or near the top of peers for these high-revenue Medicaid codes.

Ancillary throughput and diagnostics are significant operational drivers: phlebotomy (36415, 40.7K claims) and the comprehensive metabolic panel (80053, 43.4K claims) are both labeled as extreme outlier, far above typical state volume. High volumes for 96374/96375 infusion administration and 96361 IV fluids (all with top-in-state ranks) further support a model in which ED and outpatient encounters generate large volumes of lab and infusion services.

Specialty procedural footprint extends beyond ED and basic outpatient care: Sanford reports notable state-leading volumes for endoscopy (43239, $558.7K; ranks #1 of 11), ophthalmology procedures (92014 and 66984), and interventional pain/injection services (62323 and 64615). These procedure-level revenues, while smaller than core ED/clinic lines, show breadth across outpatient specialties and ancillary procedural care.

Several individual codes are flagged as extreme outliers or notably above typical state volume, which has implications for capacity and contracting: 0241U (2.4K claims, $320.3K) and 96375 (11.4K claims, $238.6K) are both extreme outliers at the 100th percentile, and 36415 and 80053 are also extreme outliers. Analysts should account for these concentrated, high-throughput lines when benchmarking per-encounter costs, lab capacity, and outpatient resource utilization against in-state peers.

Sanford's NPI tenure (NPI enumerated: 2006-06-09 (~20 years ago)) indicates an established market presence; combined with repeated #1 and top-percentile ranks across multiple Medicaid codes, the facility appears to be an entrenched regional hub for emergency, outpatient clinic, diagnostic, and infusion services. That longevity plus the heavy Medicaid revenue concentration should be factored into network negotiations, population health planning, and state-level capacity assessments.

Medicaid: Complete Services Breakdown

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

302 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	238,370	$70	$16.2M
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.	37,840	$330	$12.4M
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.	32,180	$170	$5.3M
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.	18,620	$250	$4.7M
J0585	Injection, onabotulinumtoxina, 1 unit	7,160	$300	$2.2M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	20,700	$40	$910.6K
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	3,340	$230	$768K
62323	The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)…	1,180	$540	$634.8K
64615	The provider bilaterally administers a chemical compound to the muscles innervated by the trigeminal, facial, cervical spinal, and accessory nerves. The goal of this procedure is to paralyze the…	3,520	$180	$619.3K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	910	$610	$558.7K

Showing 1–10 of 302

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Sanford Medical Center Fargo — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

Full comparison — all codes billed, vs. North Dakota median

302 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0035	Mental health partial hospitalization, treatment, less than 24 hours	2	10	9,910	$360	$3.6M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	1	10	4,940	$60	$2.3M
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.	2	20	1,120	$220	$2M
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.	5	30	1,280	$180	$1.4M
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.	2	50	670	$150	$829.9K
J0585	Injection, onabotulinumtoxina, 1 unit	1	10	140	$380	$576.6K
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…	151	210	360	$100	$498.2K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	26	70	1,950	$60	$387K
Q3014	Telehealth originating site facility fee	11	30	130	$180	$355.8K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	18	60	1,860	$60	$348.7K

Showing 1–10 of 302

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center Fargo	ND	Family Medicine Physician	$0	$75.9M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Sanford Health Of Northern Minnesota	MN	Internal Medicine Physician	$0	$27.2M
Sanford Medical Center Fargo	ND	Air Ambulance	$0	$12M
Sanford Clinic North	ND	Clinical Medical Laboratory	$1.4M	$7M
Sanford Health Network North	MN	Multi-Specialty Clinic/Center	$0	$5.2M
Sanford Medical Center Fargo	ND	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3.6M
Max Johnson	ND	Retina Specialist (Ophthalmology) Physician	$2.8M	$0
Gregory Pippin	ND	Otolaryngology Physician	$48.4K	$1.7M
Sanford Medical Center Fargo	ND	Home Health Agency	$0	$1M

Nearby Providers

Other providers in the same ZIP code as Sanford Medical Center Fargo, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ashish Regulagadda	ND	Nephrology Physician	$145.4K	$0
Anthony Charbonneau	ND	Orthopedic Physical Therapist	$126.8K	$0
Ross Meidinger	ND	Gastroenterology Physician	$123.7K	$0
Puneet Sharma	ND	Interventional Cardiology Physician	$103.9K	$0
Jeffrey Hunt	ND	Internal Medicine Physician	$72.3K	$0
Manisha Balhara	ND	Hospitalist Physician	$70.6K	$0
Kim Belzberg	ND	Internal Medicine Physician	$64K	$0
Erik Heitkamp	ND	Hospitalist Physician	$55.9K	$0
Jared Velgersdyk	ND	Internal Medicine Physician	$53.4K	$0
Suchita Kotnala	ND	Family Medicine Physician	$51.9K	$0

Sanford Medical Center Fargo — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References