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.

Sanford Health Network (NPI 1639423957)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sanford Health Network
Address	3015 3rd Ave Se
City	Aberdeen
State	SD
ZIP	57401
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 8, 2012

Payer Source	Total Paid
Medicaid	$4.4M
Medicare	$0

SANFORD HEALTH NETWORK in ABERDEEN appears to be effectively a Medicaid-focused biller: there is no Medicare revenue on file while reported Medicaid revenue totals $4.4M, indicating the provider operates with a single-payer footprint in the available claims data. This makes Medicaid the principal revenue source in the dataset and should guide comparative analyses and contracting assumptions.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management and ED codes: the precomputed top 3 Medicaid codes by revenue account for 54.4% of this provider's total Medicaid revenue. Those top contributors are 99213 ($1.3M, 30.7%), 99214 ($554K, 13.1%), and 99284 ($442.2K, 10.5%), so a narrow code mix drives more than half of Medicaid receipts.

The clinical mix suggests a combined ambulatory and emergency care operation: very large volumes of established office visits (99213 and 99214) point to a substantial primary care or outpatient clinic footprint, while 99284 and 99285 volumes indicate a busy emergency department handling moderate-to-high complexity visits. The presence of inpatient/observation discharge and subsequent care codes further supports an integrated hospital-based practice model rather than a pure outpatient clinic.

99213 is a standout relative to in-state peers: 34.1K claims and $1.3M in revenue rank the provider #6 of 344 in the state and place it in the 99th percentile, described explicitly as notably above typical state volume. That ranking signals local market leadership for routine established-patient office visits and suggests this location is a go-to site for ongoing ambulatory care within the region.

Emergency-department activity also compares favorably versus peers: 99284 ranks #8 of 60 (88th percentile) and 99285 ranks #4 of 41 (93rd percentile), indicating above-typical state volumes for both moderate- and high-complexity ED visits. The comparatively high rank for 99285 in particular implies a meaningful share of higher-acuity emergency care relative to other state providers.

Preventive and immunization services form a meaningful secondary revenue stream: codes such as 99391 ($210.9K, 5.0%) and 99392 ($152.4K, 3.6%) appear among the top-coded services, and 90460 ($140.6K, 3.3%) ranks #3 of 27 in-state (92nd percentile). This pattern points to steady pediatric/adolescent and preventive visit volume alongside vaccination activity, consistent with a full-service community hospital that provides routine well-care as well as acute care.

There are several high-claim, lower-paid items that highlight service breadth and throughput: W0037 shows 9.4K claims for $169.3K (4.0%) and ranks #9 of 164 (95th percentile), and 90471 has 5.6K claims for $56.3K (1.3%) and ranks #11 of 159 (94th percentile). The combination of very large claim counts with modest average payments suggests high-volume, low-unit-price services (supplies, injections, or procedure adjacencies) that contribute meaningfully to visit throughput and operational rhythm even if they are not dominant revenue drivers.

The provider has an established NPI tenure (enumerated 2012-11-08, ~14 years ago), which, together with the high percentile rankings on several key Medicaid E/M and ED codes, supports the view that SANFORD HEALTH NETWORK is a long-standing regional provider with entrenched outpatient and emergency service lines in its market. Analysts should treat the Medicaid-dominant profile and concentrated code mix as central to any competitive or utilization benchmarking for this entity.

Medicaid: Complete Services Breakdown

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

115 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…	34,120	$40	$1.3M
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…	11,310	$50	$554K
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.	5,530	$80	$442.2K
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.	3,700	$110	$388.6K
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…	3,300	$60	$210.9K
99203	The provider sees a new 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 provider…	3,600	$60	$205.1K
W0037	N/A	9,410	$20	$169.3K
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…	2,340	$70	$152.4K
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.	4,020	$40	$140.6K
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.	2,500	$50	$132.6K

Showing 1–10 of 115

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

Sanford Health Network — 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

115 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…	6	340	1,010	$100	$511K
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.	4	40	340	$90	$234.9K
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…	14	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.	8	60	680	$60	$205.7K
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…	7	40	1,100	$80	$181.3K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	34	70	400	$40	$172.5K
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.	25	60	120	$210	$171.2K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	7	10	670	$40	$165.4K
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.	21	70	1,150	$50	$155.9K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	28	40	250	$50	$151.7K

Showing 1–10 of 115

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Sanford Health Network	MN	Rural Acute Care Hospital	$0	$7.6M
Sanford Health Network	IA	Family Medicine Physician	$0	$6.6M
Sanford Clinic	SD	Diagnostic Radiology Physician	$0	$6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Sanford Clinic	SD	Hospitalist Physician	$0	$2.9M
Willamette Orthopedic Group LLC	OR	Orthopaedic Surgery Physician	$0	$2.7M
Sanford Clinic	SD	Family Medicine Physician	$0	$2M
Gustavo Westin	FL	Medical Oncology Physician	$2M	$0
Sanford Health Network	SD	General Acute Care Hospital	$0	$1.9M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adjustment Training Center, Inc.	SD	Developmentally Disabled Services Day Training Agency	$0	$40.3M
Northeastern Mental Health Center	SD	Mental Health Counselor	$0	$10.1M
Vision Care Associates, LLP	SD	Optometrist	$0	$6M
John Bormes	SD	Ophthalmology Physician	$2.6M	$0
Avera St. Luke's	SD	Family Medicine Physician	$0	$2.3M
Avera At Home	SD	Home Health Agency	$0	$1.6M
Avera St Lukes	SD	General Acute Care Hospital	$0	$1.5M
Ty Hanson	SD	Dermatology Physician	$1.2M	$0
Fettig And Drake Dds PC	SD	General Practice Dentistry	$0	$1M
Isurgery, LLC	SD	Ambulatory Surgical Clinic/Center	$998.3K	$0

Sanford Health Network — Billing Profile & Reimbursement Data

Sign up for Sanford Health Network — Billing Profile & Reimbursement Data policy alerts

Sanford Health Network — Billing Profile & Reimbursement Data

Sign up for Sanford Health Network — Billing Profile & Reimbursement Data policy alerts

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