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.

Rural Health Care, Inc (NPI 1669027678)

Field	Value
Entity Type	Organization
Organization	Rural Health Care, Inc
Address	1900 Grassland Dr Ste 103
City	Mitchell
State	SD
ZIP	57301
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	August 6, 2019

Payer Source	Total Paid
Medicaid	$4.4M
Medicare	$0

Key Findings

This provider reports no Medicare billing on file and $4.4M in lifetime Medicaid revenue, making its operational footprint effectively single‑payer Medicaid based on the available claims data. The NPI was enumerated on 2019-08-06 (~7 years ago), indicating enrollment as an FQHC in the past decade and a Medicaid-focused revenue stream since then.

Revenue is highly concentrated in a small set of outpatient evaluation-and-management and preventive codes: the precomputed top three Medicaid codes account for 79.4% of this provider's total Medicaid revenue. The three codes driving that concentration are 99213 ($2.3M, 52.7%), 99214 ($930.8K, 21.0%), and 99391 ($250.8K, 5.7%), which together show the provider relies heavily on established-patient visits and routine preventive encounters for Medicaid income.

The predominance of 99213 and 99214 indicates a primary care–centric FQHC operation where ongoing chronic care and higher-acuity established visits form the bulk of clinical activity. 99213 alone generates $2.3M (52.7% of Medicaid revenue) and 99214 contributes $930.8K (21.0%), consistent with a practice model that manages longitudinal outpatient care rather than procedure-heavy specialties.

State-level competitive standing for the top E/M codes is strong but not exceptional: 99213 ranks #21 of 344 in-state (94th percentile) and 99214 ranks #20 of 260 (93th percentile). The dataset notes these as "typical, unremarkable volume for this code," so while the provider is in an upper percentile for volume on these E/M codes, the pattern aligns with usual FQHC primary-care throughput rather than a unique outlier.

Preventive and pediatric services are a meaningful secondary service line: 99391 accounts for $250.8K (5.7% of Medicaid revenue) and related well-visit codes 99392/99393/99394/99395 appear on the claim list. Immunization and vaccine administration codes (90471, 90460, 90686) and fluoride application (99188) also appear with high claim counts, highlighting routine preventive care and childhood/adolescent service delivery in the clinic mix.

Behavioral health is present but not dominant: psychotherapy code 90837 generated $124.3K (2.8% of Medicaid revenue) and ranks #61 of 185 in-state (67th percentile), described as "typical, unremarkable volume for this code." This indicates integrated mental-health encounters are part of the service portfolio but do not drive a large share of total Medicaid revenue.

The provider delivers many low-reimbursement, high-volume ancillary services typical for community health centers: 87880 (rapid strep) shows 2K claims at $3 avg paid/claim ($5.9K) and 90686 (influenza vaccine) shows 1.6K claims at $2 avg paid/claim ($3.1K). These items contribute modest revenue individually but underline a broad preventive and point-of-care testing footprint consistent with FQHC operations.

Although the provider is categorized as an FQHC, the FQHC-specific visit code G0467 is used minimally (26 claims, $442), ranking #6 of 9 in-state (38th percentile). This suggests the clinic bills Medicaid largely through standard E/M and preventive codes rather than relying on the G0467 per‑visit FQHC bundle in the observed Medicaid claims set.

Medicaid: Complete Services Breakdown

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

55 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…	17,940	$130	$2.3M
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…	8,460	$110	$930.8K
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…	1,680	$150	$250.8K
W0037	N/A	7,660	$30	$191.6K
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…	1,210	$160	$186.9K
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…	1,110	$110	$124.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	600	$160	$93K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	480	$150	$72.8K
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,…	420	$130	$55.5K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	2,020	$30	$52.6K

Showing 1–10 of 55

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

Rural Health Care, Inc — 1 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

55 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…	21	340	1,010	$100	$511K
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…	20	260	860	$80	$222.6K
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…	14	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.	48	60	120	$210	$171.2K
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…	61	190	430	$90	$154.1K
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…	17	50	410	$80	$127.2K
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…	43	70	130	$100	$99K
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,…	58	160	210	$120	$97.4K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	18	20	260	$40	$90.3K
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.	7	30	150	$40	$72.6K

Showing 1–10 of 55

Related Providers

Other providers that share a Tax Identification Number (TIN) with Rural Health Care, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Rural Health Care, Inc	MN	Federally Qualified Health Center (FQHC)	$0	$15.9M
Rural Health Care, Inc	MN	Federally Qualified Health Center (FQHC)	$0	$10.1M
Rural Health Care, Inc	SD	Federally Qualified Health Center (FQHC)	$0	$2.1M
City Of Brookings	SD	Multi-Specialty Clinic/Center	$0	$1.2M
Rural Health Care, Inc.	SD	Federally Qualified Health Center (FQHC)	$0	$233.9K
Tarek Mahrous	SD	Interventional Cardiology Physician	$210.6K	$0
Douglas Holum	SD	Family Medicine Physician	$200.8K	$0
Michael Gerlach	SD	Family Medicine Physician	$187.8K	$0
Matthew Casey	MN	Diagnostic Radiology Physician	$187.7K	$0

Nearby Providers

Other providers in the same ZIP code as Rural Health Care, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lifequest	SD	Developmentally Disabled Services Day Training Agency	$0	$53.1M
Abbott House, Inc.	SD	Psychiatric Residential Treatment Facility	$0	$28.1M
Lifequest	SD	Case Manager/Care Coordinator	$0	$13.2M
Dakota Counseling Institute, Inc.	SD	Mental Health Counselor	$0	$9.7M
Dakota Solace Home Care	SD	In Home Supportive Care Agency	$0	$4.9M
Rosewood Court	SD	Assisted Living Facility	$0	$2.7M
Avera Queen Of Peace	SD	Critical Access Hospital	$0	$1.3M
Sanford Clinic	SD	Obstetrics & Gynecology Physician	$0	$1.2M
Dpt Inc	SD	Home Health Agency	$0	$835.1K
Avera Queen Of Peace	SD	Rural Acute Care Hospital	$0	$803.8K

Rural Health Care, Inc — 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