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

Why is the Medicaid comparison limited to Nebraska 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. Nebraska (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.

Ponca Tribe Of Nebraska (NPI 1710172879)

Field	Value
Entity Type	Organization
Organization	Ponca Tribe Of Nebraska
Address	2602 J St
City	Omaha
State	NE
ZIP	68107
Taxonomy	Clinic/Center
NPI Enumerated	September 12, 2007

Payer Source	Total Paid
Medicaid	$8.9M
Medicare	$0

Key Findings

This provider is effectively single‑payer: Total Medicare revenue: none (no Medicare billing on file) while Total Medicaid revenue: $8.9M, so all reported public fee‑for‑service revenue is concentrated in Medicaid accounts. Analysts should treat Medicaid as the operational revenue base when assessing financial exposure and utilization trends for this entity.

Revenue is extremely concentrated in a single encounter code: the precomputed top‑3 share is 99.4%, and T1015 alone accounts for $8.7M (97.7% of this provider's total Medicaid revenue) over 14.9K claims at a $580 avg paid/claim. This degree of concentration means changes in how payers reimburse or audit T1015 could materially affect the provider's cash flow.

The code mix indicates an all‑inclusive clinic encounter model rather than fee‑for‑service microbilling: T1015 (Clinic visit/encounter, all‑inclusive) dominates receipts, while conventional E/M codes (99213 and 99214) together represent only 1.7% of Medicaid revenue ($106.3K and $45K respectively). This pattern is consistent with a clinic/center taxonomy that bills broad encounter rates and records fewer separately reimbursed office visits.

Competitive standing for the dominant code is modest statewide: T1015 ranks #10 of 44 providers in‑state (79th percentile) and is described as typical/unremarkable volume for this code, so although this provider relies heavily on T1015 for revenue internally, it is not a statewide outlier or dominant payer for that service. Similarly, 99213 ranks #159 of 696 (77th percentile) and 99214 ranks #203 of 596 (66th percentile), both characterized as typical volumes relative to peers.

Several ancillary lab, dental and preventive codes show nontrivial claim counts but $0 avg paid/claim and $0 revenue (examples include D1206: 781 claims, 81002: 202 claims, D0220: 141 claims, 83036: 147 claims). This pattern suggests those services may be reported but are not separately reimbursed — possibly because they are included in the all‑inclusive encounter payment or fall under bundled/capitated arrangements. Analysts should verify how these line items are handled in state Medicaid policy when modeling unit costs or utilization.

The provider delivers some immunizations and diagnostic testing but these are minor revenue contributors: 91322 (21 claims, $89 avg, $1.9K), 90686 (172 claims, $9 avg, $1.5K), and 87635 (407 claims, $2 avg, $814). These services appear operationally available to the patient population but do not materially move overall Medicaid revenue.

Tenure and operational profile support an established ambulatory clinic: NPI enumerated 2007‑09‑12 (~19 years ago) and the registered taxonomy is Clinic/Center. Together with the encounter‑driven billing mix, this points to a stable clinic that has relied on bundled encounter payments for much of its Medicaid revenue over an extended period.

From a payer or competitive risk perspective, the provider’s near‑exclusive dependence on T1015 (97.7% of Medicaid revenue) is a single‑point concentration risk: any statewide policy change, rate adjustment, or audit focus on all‑inclusive clinic encounter billing would have outsized budgetary impact. Monitoring trends in T1015 claim counts and avg paid/claim should be prioritized in ongoing surveillance and contract discussions.

Medicaid: Complete Services Breakdown

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

31 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	14,920	$580	$8.7M
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…	3,800	$30	$106.3K
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…	1,410	$30	$45K
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,…	480	$40	$19.1K
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…	630	$30	$16.9K
D1999	N/A	470	$10	$3.8K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,150	$1	$3.5K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	250	$10	$2K
91322	This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL.	20	$90	$1.9K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	170	$10	$1.5K

Showing 1–10 of 31

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

Ponca Tribe Of Nebraska — 0 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	10	40	1,930	$230	$2.3M
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…	159	700	660	$70	$305.1K
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…	203	600	610	$70	$251.4K
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…	492	510	450	$100	$168.1K
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…	212	510	440	$140	$155.7K
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…	80	90	70	$200	$120.4K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	125	320	460	$20	$62.2K
99204	The provider sees a new 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 provider…	94	130	130	$90	$43.8K
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,…	65	250	140	$60	$29.7K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	37	100	240	$50	$28.4K

Showing 1–10 of 31

Related Providers

Other providers that share a Tax Identification Number (TIN) with Ponca Tribe Of Nebraska, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ponca Tribe Of Nebraska	NE	Clinic/Center	$0	$312.5K
Kham Ung	IA	Foot & Ankle Surgery Podiatrist	$56.3K	$0
Heather Talbott	NE	Family Nurse Practitioner	$11.1K	$0

Nearby Providers

Other providers in the same ZIP code as Ponca Tribe Of Nebraska, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Oneworld Community Health Centers, Inc.	NE	Federally Qualified Health Center (FQHC)	$0	$45.1M
Stephen Center, Inc.	NE	Substance Abuse Rehabilitation Facility	$0	$2.8M
Summit Dental Health - E Street LLC	NE	General Practice Dentistry	$0	$2M
Dva Renal Healthcare Inc	NE	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.1M
Oneworld Community Health Centers, Inc.	NE	Federally Qualified Health Center (FQHC)	$0	$911.2K
Lannie Weak	NE	General Practice Dentistry	$0	$837.2K
Oneworld Community Health Centers, Inc.	NE	Federally Qualified Health Center (FQHC)	$0	$537.4K
Fernando E Correa, M.d., A Professional Corporation	NE	Family Medicine Physician	$0	$350K
Missouri Valley Dental Group, LLC	NE	Dentist	$0	$275.2K
Joshua Medical Centers LLC	NE	Family Medicine Physician	$0	$262.3K

Ponca Tribe Of Nebraska — 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