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NPI 1710225271 · Spokane Valley, WA · Home Infusion Therapy Pharmacy
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Providence Health & Services - Washington is a home infusion therapy pharmacy provider located in Spokane Valley, Washington. This profile covers 1 Medicare and 37 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Providence Health & Services - Washington |
| Address | 15918 E Euclid Ave |
| City | Spokane Valley |
| State | WA |
| ZIP | 99216 |
| Taxonomy | Home Infusion Therapy Pharmacy |
| NPI Enumerated | January 17, 2013 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $41.8M |
| Medicare | $27.8K |
Provider is effectively Medicaid-focused: lifetime Medicaid revenue is $41.8M versus total Medicare revenue of $27.8K, indicating Medicaid dominates billed activity by scale. The NPI was enumerated 2013-01-17 (~13 years ago), showing a multi-year presence in the market concentrated on state Medicaid business.
Medicare billing is narrowly concentrated: the precomputed top-3 Medicare codes account for 100.0% of Medicare revenue and the single listed code G0068 accounts for the entire Medicare total (750 claims, $37 avg paid/claim, $27.8K revenue). G0068 ranks #13 of 23 providers nationally (45th percentile), which signals a modest, typical national footprint for home infusion administration services under Medicare rather than market leadership.
Medicaid revenue shows moderate concentration in a few product lines: the precomputed top-3 Medicaid codes account for 53.8% of Medicaid revenue, with B4161 ($11.9M, 28.7%), B4035 ($7.4M, 17.9%), and B4149 ($3M, 7.1%) together driving the majority of reimbursed dollars. This concentration indicates the provider derives substantial Medicaid revenue from a small set of enteral nutrition products and associated supplies.
Code mix and taxonomy align with a home infusion and enteral nutrition specialty: high-volume Medicaid codes are B4161, B4035 and B4149 (enteral formulas and feeding kits), supported by ancillary supply and device codes such as A4222, B4087, B4034, and B9002. The presence of J1745 (infliximab) and infusion-pump codes (E0781, A4223) further demonstrates capabilities in both enteral nutrition and specialty drug infusion services delivered in the home.
Competitive standing in-state is strong and focused: the provider ranks #1 in-state for B4161 (21.4K claims, $11.9M revenue, 100th percentile) and #1 for B4035 (35.5K claims, $7.4M revenue, 100th percentile), with additional #1 positions for B4153 and B4034. Those top-rankings and 100th-percentile designations identify the organization as a leading supplier of pediatric enteral formulas and feeding kits within Washington.
Consistently above-typical in multiple ancillary categories: several Medicaid codes are in high state percentiles (for example B4087 #2 of 12, 91st percentile; B4150 #2 of 18, 94th percentile; B4088 #2 of 17, 94th percentile; A4221 #2 of 11, 90th percentile). This pattern indicates elevated volumes across gastrostomy/jejunostomy items and infusion supply maintenance, reinforcing depth in home nutrition and supply services beyond the top three revenue drivers.
Medicaid-driven pediatric focus is apparent from code detail and volumes: large counts such as 21.4K claims for B4161 and 35.5K claims for B4035, plus multiple pediatric-specific formula codes ranked at or near the top in-state, suggest a substantial pediatric enteral nutrition program rather than a primarily adult infusion business. The mix of formulas, kits, tubes and pumps points to integrated service delivery around tube feeding for children covered by Medicaid.
Operational and reimbursement concentration risk: because 53.8% of Medicaid revenue is concentrated in the top three codes and a large share of Medicaid dollars are tied to enteral product lines, the provider’s revenue is sensitive to state Medicaid reimbursement changes, prior authorization policies, or shifts in supplier contracting for those specific codes. Given the very small Medicare footprint (100.0% of Medicare revenue coming from G0068 at $27.8K), payer diversification is limited and any Medicaid policy shifts would likely have an outsized impact on overall revenue.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G0068 | Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, inotropic, or other intravenous infusion drug or biological (excluding chemotherapy… | 750 | $40 | $27.8K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
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| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| G0068 | 1 | 10 | 520 | $40 | $21.1K |
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
37 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| B4161 | Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding… | 21,430 | $560 | $11.9M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 35,530 | $210 | $7.4M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 9,850 | $300 | $3M |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | 13,190 | $220 | $2.9M |
| B4087 | Gastrostomy/jejunostomy tube, standard, any material, any type, each | 22,290 | $130 | $2.9M |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 1,400 | $2,010 | $2.8M |
| B4160 | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,… | 13,550 | $120 | $1.6M |
| B4153 | Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 3,210 | $510 | $1.6M |
| A4223 | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) | 3,660 | $240 | $866.9K |
| B4150 | Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100… | 5,950 | $140 | $809.3K |
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How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington median
37 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A4223 | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) | 4 | 10 | 3,990 | $610 | $2.8M |
| B4161 | Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding… | 1 | 10 | 1,020 | $540 | $2.7M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 1 | 20 | 6,040 | $210 | $2.1M |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | 3 | 10 | 3,880 | $310 | $2.1M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 2 | 10 | 1,980 | $330 | $1.5M |
| B4087 | Gastrostomy/jejunostomy tube, standard, any material, any type, each | 2 | 10 | 3,320 | $130 | $965.1K |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 4 | 20 | 190 | $1,670 | $956.2K |
| B4160 | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,… | 3 | 10 | 2,060 | $120 | $716.9K |
| B4153 | Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 1 | 10 | 1,140 | $450 | $561.4K |
| 99601 | The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for up to the first two hours of a visit. | 4 | 10 | 2,660 | $110 | $397.1K |
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Other providers in the same ZIP code as Providence Health & Services - Washington, ranked by combined Medicare and Medicaid revenue.
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