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 Oregon for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Oregon 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. Oregon (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 - Oregon (NPI 1689755670)

Key Findings

Field	Value
Entity Type	Organization
Organization	Providence Health & Services - Oregon
Address	1111 Crater Lake Ave
City	Medford
State	OR
ZIP	97504
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 18, 2006

Payer Source	Total Paid
Medicaid	$20.9M
Medicare	$0

PROVIDER is a General Acute Care Hospital located in MEDFORD, OR, with NPI enumerated 2006-10-18 (~20 years ago). The provider reports no Medicare billing on file and $20.9M in lifetime Medicaid revenue, indicating the current dataset reflects an effectively single-payer (Medicaid-focused) billing footprint rather than a mixed Medicare/Medicaid profile.

Revenue concentration is extremely high: the top three Medicaid codes 99284, 99283, and 99285 together account for 85.1% of this provider's total Medicaid revenue. Individually these codes generate $6.9M (33.1%), $5.6M (27.2%), and $5.2M (24.8%) respectively, demonstrating that emergency department evaluation-and-management services are the dominant revenue drivers.

The code mix — dominated by 99284, 99283, and 99285 — points to a high-volume emergency department operation as the hospital’s primary service line. These are ED E/M codes covering straightforward to high-complexity evaluations, and the large claim counts reported (28.1K for 99284, 34.4K for 99283, 15.3K for 99285) are consistent with an ED-centered acute care workflow.

Competitive standing within Oregon for the top ED codes is modest rather than dominant: 99284 ranks #26 of 145 (83th percentile), 99283 ranks #27 of 137 (81th percentile), and 99285 ranks #34 of 129 (74th percentile). The data labels these volumes as "typical, unremarkable volume for this code," which supports a characterization of the provider as a solid regional participant in emergency care but not an outlier or market leader on these specific measures.

Ancillary service mix reinforces an ED/acute-care orientation: 96374 (IV push medication) contributes $1.7M (8.0% of Medicaid revenue) and ranks #11 of 62 (84th percentile, typical, unremarkable volume for this code), while additional codes for IV fluids (96361), CT abdomen/pelvis with contrast (74177), and various lab and imaging codes appear in the top 25 at much smaller revenue shares. This cluster suggests frequent ED-based procedures and diagnostics supporting the evaluation-and-management workload rather than large diversified outpatient or specialty clinics.

The provider’s absence of Medicare billing prevents assessment of national Medicare competitive standing or payer diversification; comparisons and percentile-based competitive claims in the dataset therefore reflect only Medicaid activity. For analysts, this means benchmarking against Medicare peers is not possible with the available data and any network negotiations should account for a Medicaid-centric revenue base.

The concentration risk is notable: with 85.1% of Medicaid revenue coming from three ED E/M codes, fluctuations in ED utilization patterns, policy changes affecting ED reimbursement, or shifts in Medicaid enrollment could materially affect the provider’s revenue profile. Analysts should treat ED visit volumes and associated IV/diagnostic support services as the primary operational and financial levers for this facility.

Secondary codes show typical statewide positioning across a range of support services and diagnostics (many entries labeled "typical, unremarkable volume for this code" and percentiles generally in the mid-to-high range), indicating consistent but not exceptional performance outside the core ED revenue drivers. This pattern suggests reliable throughput for routine hospital-based testing and procedures without strong evidence of dominant specialty lines in the Medicaid data provided.

Medicaid: Complete Services Breakdown

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

96 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	28,140	$240	$6.9M
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.	34,400	$160	$5.6M
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.	15,330	$340	$5.2M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	12,790	$130	$1.7M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	2,870	$90	$264K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	5,270	$40	$226.4K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	4,040	$50	$198.1K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	2,420	$70	$157.4K
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	2,660	$30	$85K
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	300	$230	$69.1K

Showing 1–10 of 96

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Providence Health & Services - Oregon — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

96 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	26	150	7,400	$170	$2.8M
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.	34	130	2,610	$200	$2.3M
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.	27	140	10,160	$130	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	34	40	3,200	$60	$1.5M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	11	60	3,620	$90	$623.7K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	39	60	420	$60	$405.1K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	27	60	460	$40	$327.4K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	31	80	1,130	$90	$327.2K
45385	The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a…	30	40	310	$420	$325.7K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	50	80	1,210	$40	$294.3K

Showing 1–10 of 96

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services - Oregon	OR	Clinical Pathology Physician	$0	$6.1M
Patrick Davol	OR	Urology Physician	$274.2K	$0
Adam Cabalo	OR	Orthopaedic Surgery of the Spine Physician	$258.1K	$0
Thong Bui	OR	Urology Physician	$238K	$0
Cihan Cevik	CO	Interventional Cardiology Physician	$218.9K	$0
David Killion	WA	Urology Physician	$174.6K	$0
Piyush Dhanuka	CA	Gastroenterology Physician	$164.5K	$0
Emilia Arden	OR	Cardiovascular Disease Physician	$136.2K	$0
Charles Cannan	AZ	Cardiovascular Disease Physician	$114K	$0
Michael Potter	OR	Sports Medicine (Family Medicine) Physician	$110.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Asante	OR	General Acute Care Hospital	$0	$29.7M
Addictions Recovery Center, Inc.	OR	Substance Abuse Rehabilitation Facility	$0	$29.2M
Asante Physician Partners	OR	Family Medicine Physician	$0	$27.2M
Mercy Flights Incorporated	OR	Ambulance	$3.6M	$19.4M
Crc Health Oregon, LLC	OR	Methadone Clinic	$193K	$13M
James Kolby Robinson, Dmd	OR	Pediatric Dentistry	$0	$11.6M
Valley Immediate Care, LLC	OR	Urgent Care Clinic/Center	$0	$9.4M
Lincare Inc	OR	Durable Medical Equipment & Medical Supplies	$0	$7.1M
Southern Oregon Pediatrics, LLP	OR	Pediatric Hospice and Palliative Medicine Physician	$0	$6.5M
Surgery Center Of Southern Oregon, LLC	OR	Ambulatory Surgical Clinic/Center	$2.7M	$3.2M

Providence Health & Services - Oregon — Billing Profile & Reimbursement Data

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Providence Health & Services - Oregon — 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