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 District of Columbia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to District of Columbia 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. District of Columbia (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.

Providence Health Services Inc (NPI 1669453809)

Field	Value
Entity Type	Organization
Organization	Providence Health Services Inc
Address	1160 Varnum St Ne
City	Washington
State	DC
ZIP	20017
Taxonomy	Family Medicine Physician
NPI Enumerated	November 6, 2005

Payer Source	Total Paid
Medicaid	$13.4M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid operation: Medicare revenue is none (no Medicare billing on file) while reported Medicaid revenue totals $13.4M. The absence of Medicare billing on file means all measurable fee-for-service volume in this dataset is driven by Medicaid flows and associated program codes.

Revenue is highly concentrated in a very small set of codes: the precomputed top 3 Medicaid codes account for 85.0% of this provider's total Medicaid revenue. Those top three are 99214 (55.3% of Medicaid revenue; 101.2K claims, $7.2M revenue), 99213 (18.6%; 47.4K claims, $2.4M revenue), and T2022 (11.1%; 11.5K claims, $1.4M revenue), indicating most dollars come from established E/M encounters plus monthly case management.

The code mix points to a high-volume primary care and care-coordination model with embedded behavioral-health services: dominant use of 99214 and 99213 signals heavy ambulatory established-patient office visits, while T2022 (case management, per month) and T2023 (targeted case management) show ongoing monthly care coordination activity. Additional presence of psychotherapy (90834) and psychiatric evaluation (90792) in the top codes indicates the practice also bills mental-health services alongside primary care.

99214 is an outsized driver for the provider and a statewide outlier: with 101.2K claims and $7.2M revenue it ranks #3 of 305 providers in-state and is labeled an "extreme outlier, far above typical state volume for this code" (99th percentile). 99213 also posts unusually high volumes (47.4K claims, $2.4M revenue), ranking #12 of 316 and described as "notably above typical state volume" (97th percentile), which together position the provider as a major state-level source of established-office E/M Medicaid billing.

T2022 (case management) contributes a material share of revenue (11.1% of Medicaid revenue; 11.5K claims, $1.4M) and ranks #2 of 14 in-state, but is characterized in the dataset as "typical, unremarkable volume for this code" (92th percentile). This suggests that while case management is a meaningful revenue stream, its per-provider frequency in the state is not uniquely unusual relative to peers.

Several ancillary and program-specific codes show concentrated, state-level outlier behavior despite smaller dollar amounts: 0012A ($75.2K, ranks #1 of 38, 100th percentile) and 0011A ($70K, ranks #1 of 38, 100th percentile) are labeled "extreme outlier, far above typical state volume" and 99442 (telephone/telehealth) ranks #2 of 32 (97th percentile; "notably above typical state volume"). These flags indicate specialized billing patterns or focused program usage that are disproportionately represented in-state.

Preventive and well-patient visits appear as secondary components of the mix: 99396 (established well visit, 40–64) generates $120.6K and ranks #2 of 40 (97th percentile; "notably above typical state volume"), while pediatric/adolescent well-visit codes (99393, 99394, 99395) are present at modest levels. This spread suggests the provider delivers a continuum of primary/preventive care across age groups in addition to high-volume established-patient visits.

The provider has a long tenure in NPI records (enumerated 2005-11-06, ~21 years), which combined with $13.4M Medicaid revenue and the concentrated code mix implies an established Medicaid-facing practice built around high-volume ambulatory E/M visits and recurring case-management services. That operational profile—long-standing presence plus heavy dependence on a few codes—may make the provider particularly sensitive to changes in Medicaid E/M reimbursement or program-level case-management funding.

Medicaid: Complete Services Breakdown

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

118 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	101,170	$70	$7.2M
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…	47,390	$50	$2.4M
T2022	Case management, per month	11,460	$130	$1.4M
T2023	Targeted case management; per month	3,260	$160	$505.5K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	3,870	$70	$271K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	1,020	$120	$120.6K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	950	$110	$105K
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…	3,880	$30	$104.7K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	1,630	$60	$89.8K
99442	N/A	1,680	$50	$77.1K

Showing 1–10 of 118

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other District of Columbia providers billing the same CPT/HCPCS codes.

Claims Volume vs. District of Columbia Distribution

Providence Health Services Inc — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — District of Columbia

Full comparison — all codes billed, vs. District of Columbia median

118 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2022	Case management, per month	2	10	2,540	$120	$728.6K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	15	20	310	$530	$605.1K
T2023	Targeted case management; per month	3	10	1,230	$180	$599.4K
99291	Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is…	12	30	1,050	$120	$581.4K
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,…	39	130	290	$140	$579.2K
92550	The provider uses this global service code, which bundles tympanometry and reflex threshold measurement when the provider performs both tests to evaluate the middle ear and inner ear, respectively,…	4	10	1,330	$180	$505K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	12	10	180	$790	$490.4K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	17	30	450	$130	$439.5K
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…	19	50	580	$60	$424.9K
94640	The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that…	18	20	80	$210	$398.8K

Showing 1–10 of 118

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Hospital	DC	General Acute Care Hospital	$0	$12.2M
Farzad Davoudian	VA	Psychiatry Physician	$73.1K	$401.1K
Philip Proctor	MD	Urology Physician	$346.6K	$0
Muhammad Shibli	DC	Pulmonary Disease Physician	$320.3K	$0
Joseph Oppong	MD	Interventional Pain Medicine Physician	$300.3K	$0
Javier Quant-gonzalez	MD	Internal Medicine Physician	$298.7K	$0
Candice Fori	MD	Physician Assistant	$291.7K	$0
Rafic Jarrah	DC	Internal Medicine Physician	$156.8K	$104.3K
Providence Health Services, Inc	DC	Physiological Laboratory	$100.6K	$142.5K
Jennifer Dreiling	CT	General Practice Physician	$218.3K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
My Own Place, Inc.	DC	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$48.7M
Anchor Mental Health Association	DC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$22M
Hsc Home Care, LLC	DC	Home Health Agency	$0	$14.7M
American Health Care Services Inc	DC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$5.3M
Hospital For Sick Children	DC	Special Hospital	$0	$4.7M
United Cerebral Palsy Of Washington & No. Virginia, Inc.	DC	Developmentally Disabled Services Day Training Agency	$0	$4.4M
Gerald Family Care	DC	Family Medicine Physician	$0	$3.2M
Cheryl Lee	DC	Dentist	$0	$2.5M
Providence Opticians Designer Eyewear Inc	DC	Eyewear Supplier	$0	$2.1M
On With Life Therapies, Inc	DC	Home Health Agency	$0	$1.8M

Providence Health Services 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