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

Why is the Medicaid comparison limited to Washington 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. Washington (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-wa (NPI 1700037801)

Key Findings

Field	Value
Entity Type	Organization
Organization	Providence Health & Services-wa
Address	1321 Colby Ave
City	Everett
State	WA
ZIP	98201
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 7, 2008

Payer Source	Total Paid
Medicaid	$62.4M
Medicare	$0

PROVIDENCE HEALTH & SERVICES-WA reports no Medicare billing on file and $62.4M in lifetime Medicaid revenue, making its billed population effectively Medicaid‑centric in the available data. Analysts should treat this profile as single‑payer (Medicaid) for competitive and utilization comparisons because Medicare activity is absent from the record.

Revenue is concentrated in a small set of outpatient and emergency codes: the top three Medicaid codes account for 36.1% of total Medicaid revenue, driven by 96361 ($7.8M, 16.2%), 99283 ($4.8M, 10.1%), and G0463 ($4.7M, 9.8%). This degree of concentration indicates that a little over one‑third of Medicaid dollars are tied to IV/infusion services, emergency evaluation visits, and hospital outpatient clinic management.

The code mix points to a hospital operating with high emergency department throughput and infusion services: multiple ED E/M codes (99283, 99284, 99285) appear among top revenue generators alongside infusion codes (96361, 96365, 96366, 96360) and the clinic visit code G0463. These patterns suggest regular management of acute presentations and frequent use of IV therapies and outpatient clinic visits as primary revenue drivers.

Maternal and perinatal services are a standout line: 59025 ranks #1 of 116 in‑state (100th percentile; extreme outlier) and obstetric ultrasound codes 76805 (rank #2 of 106, 99th percentile) and 76801 (rank #4 of 125, 98th percentile) are also extreme outliers. Together these rankings indicate the provider is a dominant in‑state source for fetal monitoring and pregnancy imaging relative to peers and likely functions as a regional destination for obstetric care.

Imaging and cardiac diagnostic services are substantial components of Medicaid revenue: CT and CTA codes such as 74177, 71275, and head CT 70450 each produce multimillion dollar lines, while cardiac tests like 93306 and nuclear SPECT 78452 generate measurable revenue and rank at or above typical state volumes (93306 at 81st percentile; 78452 at 94th percentile). This breadth of advanced imaging and cardiac diagnostics supports an integrated acute care capability beyond basic ED work.

Some specialty services show mixed statewide positioning: radiation delivery 77412 yields $765.2K but ranks #5 of 10 providers (56th percentile), indicating a present but not dominant radiation program, while wound care bandaging 29581 (rank #3 of 17, 88th percentile) and focused breast ultrasound 76642 (rank #4 of 77, 96th percentile) are comparatively stronger niche offerings. These contrasts suggest the hospital maintains a wide service mix with particular strengths in certain outpatient specialties.

The provider has an established presence with NPI enumeration dated 2008-10-07 (~18 years ago), supporting that these utilization patterns reflect long‑standing operational lines rather than a short‑term shift. Tenure combined with extreme outlier standings in obstetric testing strengthens the interpretation that these are established service strengths rather than transitory spikes.

For downstream analyses, note the absence of Medicare claims prevents national Medicare benchmarking; all competitive comparisons must therefore rely on the in‑state Medicaid ranks and percentiles provided. Given the 36.1% revenue concentration in the top three Medicaid codes, analysts should prioritize monitoring reimbursement or utilization shifts for 96361, 99283, and G0463 when modeling revenue sensitivity for this provider.

Medicaid: Complete Services Breakdown

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

459 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	25,120	$310	$7.8M
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.	43,540	$110	$4.8M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	63,420	$70	$4.7M
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.	52,930	$80	$4.4M
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.	50,430	$90	$4.3M
59025	In this procedure, the provider measures the fetal heart rate of the fetus in response to its own movements.	23,750	$160	$3.8M
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.	12,420	$160	$2M
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	16,100	$120	$2M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	12,900	$130	$1.6M
96366	The provider administers an intravenous infusion or infusions of a medication for an additional hour or subsequent hours after the first hour to prevent, treat, or diagnose a condition or disease.	6,000	$270	$1.6M

Showing 1–10 of 459

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Providence Health & Services-wa — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

459 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0463	Hospital outpatient clinic visit for assessment and management of a patient	21	100	2,830	$80	$3.8M
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.	12	110	5,950	$270	$2.6M
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.	25	230	5,440	$90	$1.8M
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.	31	230	6,220	$100	$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.	17	190	5,130	$100	$1.8M
77412	The provider delivers radiation therapy at level 3 complexity. This includes photon therapy delivered to multiple isocenters, photon therapy with active motion management, total skin electron…	5	10	1,470	$400	$1.2M
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.	17	140	2,830	$150	$1.1M
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…	26	100	1,940	$70	$1M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	3	10	380	$410	$906.2K
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.	13	170	2,120	$40	$779.1K

Showing 1–10 of 459

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Georgetown Memorial Hospital	SC	General Acute Care Hospital	$0	$27.6M
Providence Health & Services- Washington	WA	General Practice Physician	$0	$7.6M
Providence Health & Services - Washington	WA	Family Medicine Physician	$0	$7.6M
Providence Health & Services - Washington	WA	Pediatrics Physician	$0	$6.8M
Providence Health & Services - Washington	WA	General Practice Physician	$0	$6M
Providence Health & Services-washington	WA	Pediatrics Physician	$0	$3.2M
Providence Health & Services - Washington	WA	Family Medicine Physician	$0	$2.9M
Express Care Or PC	OR	General Practice Physician	$0	$2.4M
John Fitzharris	OR	Medical Oncology Physician	$672.6K	$0
Amir Mehrvarz Sarshekeh	WA	Hematology & Oncology Physician	$651.1K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Health Center Of Snohomish County	WA	Dentist	$0	$112.1M
Sunrise Services, Inc.	WA	Community/Behavioral Health Agency	$0	$21.4M
Optum Care Washington PLLC	WA	Multi-Specialty Clinic/Center	$0	$19.5M
North Sound Emergency Medicine PC	WA	Emergency Medicine Physician	$0	$8.7M
Catholic Community Services Western Washington	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$7.9M
Assured Independence, LLC	WA	Emergency Response System Companies	$0	$7M
Pioneer Human Services	WA	Substance Abuse Rehabilitation Facility	$0	$6.2M
Evergreen Recovery Centers	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$5.9M
Sight Partners	WA	Ambulatory Surgical Clinic/Center	$4.9M	$342.1K
Evergreen Recovery Centers	WA	Substance Abuse Rehabilitation Facility	$0	$4.3M

Providence Health & Services-wa — 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