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.

Eagle Butte Indian Health Service Hospital (NPI 1558395848)

Field	Value
Entity Type	Organization
Organization	Eagle Butte Indian Health Service Hospital
Address	24276 166th Street
City	Eagle Butte
State	SD
ZIP	57625
Taxonomy	Public Health or Welfare Agency
NPI Enumerated	July 10, 2006

Payer Source	Total Paid
Medicaid	$19.2M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $19.2M in lifetime Medicaid revenue, making its visible payer footprint effectively single-payer (Medicaid) in the available claims data. Analysts should treat Medicaid patterns as the primary driver of this facility’s revenue profile rather than expecting a mixed Medicare/Medicaid mix.

Revenue is highly concentrated in a small set of evaluation-and-management (E/M) office visit codes: the top three Medicaid codes (99213, 99211, 99214) together account for 73.3% of the provider’s total Medicaid revenue. In particular, 99213 alone represents $8.8M (45.6% of Medicaid revenue), showing that routine outpatient E/M visits are the dominant revenue source.

The code mix indicates the facility operates as an ambulatory-focused primary care and clinic hub: large volumes of 99213 (20.4K claims, $429 avg), 99211 (5K claims, $543 avg) and 99214 (5.7K claims, $461 avg) point to sustained throughput of established patient office visits across low- to moderate-complexity encounters. This pattern aligns with a community clinic or hospital outpatient practice that relies on high-frequency face-to-face visits rather than procedure-driven specialty revenue.

Several codes show unusually high state-level volume relative to peers: 99212 is an "extreme outlier, far above typical state volume," ranking #2 of 155 providers (99th percentile) with 6.7K claims and $1.5M revenue (8.0% of Medicaid revenue), and 99211 ranks #4 of 57 (95th percentile) and is described as "notably above typical" with $2.7M (14.0%). These ranked positions imply the provider delivers exceptionally high volumes of short or lower-complexity established-patient visits compared with most in-state peers.

The provider also operates a nontrivial transport/EMS footprint within its Medicaid mix: A0425 (ground mileage) contributed $760.8K (4.0% of Medicaid revenue) with 3.5K claims (rank #6/57, 91st percentile) and S0215 (non-emergency transportation mileage) added $459.1K (2.4%, rank #4/16). Emergency ambulance codes such as A0429 and A0427 appear as smaller but material line items, indicating on-site or closely affiliated ambulance services are part of the overall service offering.

A broader set of ancillary and specialty services are present but make up modest shares of revenue: therapeutic exercise 97110 generated $344.8K (1.8%), and ophthalmology 92014 generated $301.4K (1.6%). These entries indicate available rehabilitative and eye-care services on-site or via associated clinics, complementing the dominant primary care visit volume.

Some high-claim, low-dollar items suggest operational or administrative high-volume activity: W0037 shows 7.8K claims at $24 avg for $187.5K (1.0% of Medicaid revenue), and 99281 (lowest-level ED visit) shows 1.8K claims with $82.2K (0.4%) and ranks #2 of 16 providers (93rd percentile). These patterns point to frequent brief encounters or billing of many small-unit services alongside the heavier E/M workload.

This entity has a long-standing NPI (enumerated 2006-07-10, approximately ~20 years ago), which supports the interpretation that the concentrated Medicaid billing patterns and the mix of clinic, transport, and ancillary services reflect an established, stable service model rather than a recent operational shift. Analysts should consider this tenure when assessing network relationships and historical utilization trends.

Medicaid: Complete Services Breakdown

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

47 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…	20,420	$430	$8.8M
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.	4,960	$540	$2.7M
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…	5,730	$460	$2.6M
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,…	6,740	$230	$1.5M
A0425	Ground mileage, per statute mile	3,470	$220	$760.8K
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…	1,030	$530	$547.5K
S0215	Non-emergency transportation; mileage, per mile	3,480	$130	$459.1K
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…	630	$550	$344.8K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	550	$550	$301.4K
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	1,840	$140	$254.5K

Showing 1–10 of 47

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

Eagle Butte Indian Health Service Hospital — 2 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

47 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…	16	340	1,010	$100	$511K
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	7	40	270	$180	$281.6K
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…	30	260	860	$80	$222.6K
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.	52	60	680	$60	$205.7K
A0429	Ambulance service, basic life support, emergency transport (bls-emergency)	7	30	300	$150	$195.3K
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…	33	40	1,100	$80	$181.3K
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.	4	60	120	$210	$171.2K
S0215	Non-emergency transportation; mileage, per mile	4	20	900	$100	$169.9K
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.	24	70	1,150	$50	$155.9K
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…	37	50	410	$80	$127.2K

Showing 1–10 of 47

Nearby Providers

Other providers in the same ZIP code as Eagle Butte Indian Health Service Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cheyenne River Sioux Tribe Field Health Clinic	SD	Primary Care Clinic/Center	$0	$8M
Blackhills Dialysis, L.L.C.	SD	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$5.6M
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$2.3M
Missouri Breaks Industries Research, Inc.	SD	Durable Medical Equipment & Medical Supplies	$0	$2M
Cheyenne River Dental Clinic	SD	Public Health Dentistry	$0	$1.6M
Margaret Upell	SD	Family Medicine Physician	$21.2K	$377.7K
Medicine Wheel Village	SD	Assisted Living Facility	$0	$119.7K
Jaime Aguilar	SD	Physician Assistant	$8K	$0

Eagle Butte Indian Health Service Hospital — Billing Profile & Reimbursement Data

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Eagle Butte Indian Health Service Hospital — 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