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.

Avera Mckennan (NPI 1699985267)

Key Findings

Field	Value
Entity Type	Organization
Organization	Avera Mckennan
Address	1325 S Cliff Ave
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Emergency Medicine Physician
NPI Enumerated	May 23, 2007

Payer Source	Total Paid
Medicaid	$4.1M
Medicare	$0

This provider is effectively single‑payer in the available data: Total Medicare revenue is listed as none (no Medicare billing on file) while Total Medicaid revenue is $4.1M, so Medicaid accounts for the entire reported lifetime revenue base in our dataset. That concentration in a single public payer dominates any payer‑mix analysis for AVERA MCKENNAN.

Revenue is highly concentrated in three emergency department E/M codes: 99284 ($1.8M, 44.1%), 99285 ($1.1M, 26.2%), and 99283 ($780.8K, 19.3%) — together these top three codes account for 89.5% of the provider’s Medicaid revenue. This profile indicates the practice’s Medicaid revenue is driven almost entirely by ED visit volume and acuity-level billing.

The mix of high‑volume codes points to an emergency‑department–centric operation: the top codes are ED E/M services (99284, 99285, 99283) with supporting critical/acute care and procedure codes present at smaller volumes, for example 99291 (324 claims, $37.6K, 0.9%), 11042 (953 claims, $34.3K, 0.8%), and 12011 (90 claims, $8.4K, 0.2%). These patterns are consistent with an ED or hospital‑based emergency medicine practice that also bills for wound care, minor procedures, and short critical care encounters.

State competitive standing for the principal ED codes is strong: 99284 ranks #4 of 60 providers in‑state (95th percentile; notably above typical state volume for this code), 99285 ranks #3 of 41 providers in‑state (95th percentile; typical, unremarkable volume for this code), and 99283 ranks #4 of 66 providers in‑state (95th percentile; notably above typical state volume for this code). Those rank/percentile placements indicate AVERA MCKENNAN is a high‑volume Medicaid ED provider in South Dakota for the mid- and high-acuity ED visit codes.

Despite the dominance of higher-acuity ED codes, the practice is the statewide leader for one lower‑level ED code: 99282 ranks #1 of 44 providers in‑state (100th percentile; notably above typical state volume for this code) while representing $148.5K (3.7%) of Medicaid revenue. This suggests consistent throughput across acuity levels rather than reliance solely on higher‑level billing.

The provider shows a modest ancillary service footprint beyond E/M visits: routine ECG interpretation 93010 (5K claims, $39.9K, 1.0%) ranks #5 of 47 providers in‑state (91th percentile; typical, unremarkable volume for this code), and codes for dialysis reporting (90999, $31.7K, 0.8%) and influenza vaccination administration G0008 ($2.4K, 0.1%) appear at lower revenue shares. These ancillary lines supplement the ED visit revenue but do not materially change the overall Medicaid revenue composition.

Given that 89.5% of Medicaid revenue derives from three ED E/M codes, the provider’s Medicaid revenue is sensitive to policy or payer changes affecting ED E/M coding, valuation, or utilization patterns; any reimbursement shifts or volume changes for 99284/99285/99283 would have an outsized impact on the $4.1M reported Medicaid revenue. This concentration suggests strategic importance of maintaining ED throughput and documentation practices tied to those codes.

The NPI has been enumerated since 2007-05-23 (~19 years ago), indicating a long tenure in the market that aligns with sustained, high ED billing volumes on Medicaid. That longevity supports the characterization of AVERA MCKENNAN as an established emergency medicine presence in Sioux Falls, SD rather than a recent entrant.

Medicaid: Complete Services Breakdown

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

72 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.	22,300	$80	$1.8M
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.	9,050	$120	$1.1M
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.	15,020	$50	$780.8K
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.	5,500	$30	$148.5K
93010	The provider interprets and reports on the results of a routine 12–lead (or more) electrocardiogram.	4,990	$10	$39.9K
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…	320	$120	$37.6K
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…	2,090	$20	$35.6K
11042	The provider uses surgical instruments to remove the dead tissue in skin down to the subcutaneous layer and including the epidermis and dermis, up to the first 20 cm2.	950	$40	$34.3K
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…	1,400	$20	$32.2K
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	2,440	$10	$31.7K

Showing 1–10 of 72

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

Avera Mckennan — 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

72 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	17	30	3,520	$50	$769.4K
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…	119	340	1,010	$100	$511K
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…	4	10	240	$140	$472K
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	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…	102	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.	4	60	680	$60	$205.7K
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…	33	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.	33	60	120	$210	$171.2K
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.	4	70	1,150	$50	$155.9K
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…	142	190	430	$90	$154.1K

Showing 1–10 of 72

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Dakota Achieve	SD	Developmental Disabilities Clinic/Center	$0	$166.9M
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Southeastern Behavioral Healthcare	SD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$59.1M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Lutheran Social Services Of South Dakota Inc	SD	Voluntary or Charitable Agency	$0	$3.6M

Avera Mckennan — Billing Profile & Reimbursement Data

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Avera Mckennan — 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center Fargo	ND	Family Medicine Physician	$0	$75.9M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Avera Mckennan	SD	Psychiatry Physician	$0	$9.1M
Avera Mckennan	SD	Home Infusion Agency	$0	$6.7M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M
Avera Mckennan	SD	General Acute Care Hospital	$0	$3.7M
Avera Mckennan	SD	Diagnostic Radiology Physician	$0	$3.3M
Avera Mckennan	SD	Hospitalist Physician	$0	$2.6M