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 Bismarck (NPI 1538245634)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sanford Bismarck
Address	300 N 7th St
City	Bismarck
State	ND
ZIP	58501
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 31, 2006

Payer Source	Total Paid
Medicaid	$12.5M
Medicare	$0

SANFORD BISMARCK is effectively a single-payer inpatient/outpatient provider in our dataset: it has no Medicare billing on file and all reported federal revenue is from Medicaid, with total Medicaid revenue of $12.5M. This concentration indicates the provider’s public-reimbursement exposure is focused on Medicaid populations rather than Medicare fee-for-service beneficiaries.

Revenue concentration is high: the precomputed top 3 Medicaid codes account for 63.6% of the provider’s total Medicaid revenue, signaling that a small set of service lines—primarily emergency department evaluation-and-management visits—drives most of Medicaid receipts. This level of concentration suggests operational and financial sensitivity to utilization shifts or reimbursement changes for those core codes.

Emergency department E/M visits dominate the coding mix by dollars and volume. Codes 99284 ($3.7M, 30.3% of Medicaid revenue), 99283 ($3M, 24.9%), and 99285 ($1M, 8.4%) together form the top revenue-generating services, reflecting a high-volume ED and hospital-based acute care focus rather than an outpatient specialty clinic profile. The combination of moderate, low, and high complexity ED E/M codes implies a broad case mix presenting to the ED.

Relative to in-state peers, Sanford Bismarck reports strong volume on several ED and acute-care codes but is not uniformly the statewide leader. For example, 99283 ranks #4 of 48 providers in-state (94th percentile) and 99284 ranks #7 of 33 (81th percentile), indicating above-typical to typical but not dominant statewide market share for those ED services. Conversely, the provider is the state leader for 69436 (tympanostomy) at rank #1 of 10 (100th percentile), representing a notable concentration and a local specialty volume for that ENT surgical procedure.

Other procedure-level signals point to a full-service hospital outpatient operation: high claim counts for 36415 (23.1K claims, ranks #6 of 91, 94th percentile) and 80053 (19.2K claims, ranks #4 of 47, 93th percentile) show extensive lab and phlebotomy throughput, while procedure codes such as 62323 (epidural/spinal injection) and 45385 (colonoscopic polypectomy) demonstrate capacity for interventional pain management and endoscopy. Together these codes corroborate an acute-care hospital with both ED-driven and procedural revenue streams.

Several codes show materially higher-than-typical state volumes for specific services, flagging local service-line strengths: 69436 (tympanostomy) is described as notably above typical state volume and ranks #1, and 36415 (venipuncture) and 80053 (comprehensive metabolic panel) are described as notably above typical state volume with high percentiles (94th and 93th respectively). These patterns are consistent with a busy hospital ED and outpatient lab supporting high-volume specimen processing and pediatric ENT procedures.

Tenure data indicate stability in enrollment: the provider’s NPI was enumerated on 2006-10-31 (~20 years ago). This long active period supports interpretation of observed volumes as established, ongoing service lines rather than a short-term spike or new entrant anomaly.

Where the provider’s Medicaid code mix shows competitive depth, some service lines remain more modest in statewide standing. For example, 99285 (high-complexity ED E/M) ranks #8 of 19 providers (61th percentile) and many therapeutic and infusion codes (e.g., 97530, 92507, 96361) sit in typical percentile ranges; these indicate competent provision of those services but not statewide dominance. This suggests Sanford Bismarck is a broad acute-care provider with pockets of leadership rather than a monopolist across all hospital services.

Medicaid: Complete Services Breakdown

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

169 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	14,860	$250	$3.7M
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.	16,820	$180	$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.	3,760	$280	$1M
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…	9,980	$80	$808.5K
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.	17,750	$40	$727.6K
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)…	1,370	$510	$702.1K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	15,620	$20	$312.4K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	460	$640	$296K
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.	2,360	$120	$276.6K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	7,750	$30	$240.2K

Showing 1–10 of 169

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 Bismarck — 2 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

169 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	4	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.	8	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.	7	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.	4	50	670	$150	$829.9K
J0585	Injection, onabotulinumtoxina, 1 unit	5	10	140	$380	$576.6K
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.	7	70	1,950	$60	$387K
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…	13	60	1,860	$60	$348.7K
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)…	2	10	660	$320	$235.6K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	18	30	450	$110	$198.3K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	10	20	1,200	$50	$190.6K

Showing 1–10 of 169

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 Bismarck	ND	Multi-Specialty Clinic/Center	$0	$43.9M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Bismarck	ND	Clinical Medical Laboratory	$726.9K	$4.3M
Sanford Bismarck	ND	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3.5M
Robert Reynolds	ND	Radiation Oncology Physician	$1.4M	$0
Sanford Bismarck	ND	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.2M
Sanford Bismarck	ND	Multi-Specialty Clinic/Center	$0	$771.3K
Myles Mitsunaga	CA	Diagnostic Radiology Physician	$510.8K	$113.9K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Enable, Inc.	ND	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$40.8M
Heartview Foundation	ND	Substance Use Disorder Rehabilitation Clinic/Center	$0	$13.6M
Bismarck Public Schools Early Intervention	ND	Early Intervention Provider Agency	$0	$12M
West Central Behavioral Health Clinic	ND	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.2M
D. Michael Goebel D.d.s., PC	ND	Pediatric Dentistry	$0	$5.8M
Poppy's Promise LLC	ND	Community/Behavioral Health Agency	$0	$5.6M
St. Alexius Medical Center	ND	Specialist	$0	$3.6M
Lasting Love Homecare	ND	In Home Supportive Care Agency	$0	$3.6M
St. Alexius Medical Center	ND	General Acute Care Hospital	$0	$3.5M
West Central Behavioral Health Clinic	ND	Community/Behavioral Health Agency	$0	$3.4M

Sanford Bismarck — 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