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.

Fort Yates Indian Health Service Hospital (NPI 1609851039)

Field	Value
Entity Type	Organization
Organization	Fort Yates Indian Health Service Hospital
Address	10 North River Road
City	Fort Yates
State	ND
ZIP	58538
Taxonomy	Critical Access Hospital
NPI Enumerated	December 8, 2005

Payer Source	Total Paid
Medicaid	$10M
Medicare	$0

Key Findings

This facility is effectively a Medicaid-centric provider: there is no Medicare billing on file and total Medicaid revenue is reported at $10M, indicating the provider operates with a single-payer concentration in the available claims data. The NPI was enumerated 2005-12-08 (~21 years ago), so this organization has an established billing presence and long-tenure in its market despite the single-payer footprint shown here.

Revenue concentration is highly concentrated in a narrow set of outpatient and ED evaluation-and-management services: the precomputed top-3 Medicaid codes account for 90.6% of this provider’s total Medicaid revenue, with 99213 alone contributing $6M (60.0%) and 99283 contributing $2.7M (27.1%). This concentration implies material financial dependence on routine office visits and lower-acuity emergency visits for Medicaid revenue.

The top Medicaid code 99213 (13.4K claims, $447 avg paid/claim, $6M revenue) positions the provider as a strong statewide participant for established outpatient visits — it ranks #10 of 206 providers in-state (96th percentile). High volume for 99213, combined with the Critical Access Hospital taxonomy, suggests the hospital functions as a primary access point for ambulatory care in its region.

Emergency department E/M billing is the second revenue driver: 99283 appears in 6.1K claims at $444 avg paid/claim for $2.7M in revenue and ranks #17 of 48 in-state (66th percentile). This pattern—large absolute counts and significant revenue share from 99283—indicates the hospital maintains substantial ED throughput for lower-acuity urgent care among Medicaid patients.

Ophthalmology services (92012) are a third, smaller driver: 1.1K claims, $318 avg paid/claim, $348.8K revenue (3.5% of Medicaid revenue) and a #5 of 20 in-state rank (79th percentile). While not a primary revenue source, the 92012 placement in the top three shows the facility bills for intermediate-level eye exams at above-typical peer standing and provides some specialty ambulatory care in addition to primary and ED services.

The provider reports top-ranked state-level activity for several procedural codes with small peer sets: 42700 ranks #1 of 3 (100th percentile) and 45500 ranks #1 of 2 (100th percentile), while 51900 and 47900 each rank #1 of 1 (0th percentile, no state peer comparison available). These results indicate the hospital performs certain procedural/surgical services that are either uncommon among state peers or concentrated in very few providers, but the absolute revenue from these codes is modest relative to the top E/M codes.

Per-claim payment levels for the top two revenue drivers are similar: 99213 pays $447 avg per claim and 99283 pays $444 avg per claim, suggesting Medicaid reimbursement rates for ambulatory E/M and lower-acuity ED visits are roughly comparable at this facility. Given the heavy volume on these codes (13.4K and 6.1K claims respectively), small changes in utilization or reimbursement on these E/M codes would materially affect overall Medicaid revenue.

Competitive implications: for core ambulatory and ED services the provider is a meaningful statewide player—especially on 99213 (96th percentile) and 92012 (79th percentile)—but the absence of Medicare billing makes cross-payer competitiveness and scale limited to the Medicaid population in the claims data. The concentration of 90.6% of Medicaid revenue in three codes suggests strategic reliance on high-volume ambulatory and ED services rather than a diversified payer-driven service mix.

Medicaid: Complete Services Breakdown

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

12 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…	13,390	$450	$6M
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.	6,090	$440	$2.7M
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	1,100	$320	$348.8K
42700	The provider uses an incision to drain an abscess next to one of the tonsils.	1,240	$210	$262.5K
45500	In this procedure the provider releases a stenosis of the anorectal area by incising the scar tissue and repairing it with the flaps of nearby tissue.	1,010	$220	$218.1K
51900	A vesicovaginal fistula is an opening between the vagina and the urinary bladder. A urethrovaginal fistula is an opening between the vagina and the urethra. These afflictions often occur following…	1,320	$150	$194.6K
47900	The provider uses sutures to repair an injury in the extrahepatic biliary duct.	730	$240	$172.8K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	130	$410	$52.6K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	70	$320	$22.2K
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.	210	$60	$13.3K

Showing 1–10 of 12

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

Fort Yates Indian Health Service Hospital — 3 of 11 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

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	17	50	670	$150	$829.9K
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…	10	210	360	$100	$498.2K
51900	A vesicovaginal fistula is an opening between the vagina and the urinary bladder. A urethrovaginal fistula is an opening between the vagina and the urethra. These afflictions often occur following…	1	10	1,320	$150	$194.2K
47900	The provider uses sutures to repair an injury in the extrahepatic biliary duct.	1	10	730	$240	$172.4K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	102	140	390	$110	$129.2K
45500	In this procedure the provider releases a stenosis of the anorectal area by incising the scar tissue and repairing it with the flaps of nearby tissue.	1	10	570	$220	$123.8K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	5	20	150	$100	$100.3K
42700	The provider uses an incision to drain an abscess next to one of the tonsils.	1	10	100	$210	$96.9K
92002	The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.	13	10	240	$70	$23.8K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	72	110	230	$20	$23.6K

Showing 1–10 of 12

Related Providers

Other providers that share a Tax Identification Number (TIN) with Fort Yates Indian Health Service Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Radu Raducu	ND	Nephrology Physician	$466.9K	$0
Fort Yates Indian Health Service Hospital	ND	Federal Public Health Clinic/Center	$0	$79.9K
Jeffrey Hostetter	ND	Family Medicine Physician	$69.9K	$0
Douglas Ead	TN	Family Nurse Practitioner	$39.8K	$0
Joel Neumiller	ND	Optometrist	$10.9K	$0
Timothy Wilson	ND	Social Worker	$8K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Standing Rock Sioux Tribe	ND	Land Ambulance	$217.4K	$5.5M
Sanford Bismarck	ND	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.2M
Standing Rock Early Childhood Tracking Program	ND	Early Intervention Provider Agency	$0	$70.1K
Carrie Meckle	ND	Family Nurse Practitioner	$44.2K	$0

Fort Yates Indian Health Service Hospital — Billing Profile & Reimbursement Data

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Fort Yates 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

Related Providers

Nearby Providers

Frequently Asked Questions

References