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.

Fort Thompson Indian Health Service (NPI 1710995907)

Field	Value
Entity Type	Organization
Organization	Fort Thompson Indian Health Service
Address	Hwy 34 & 47
City	Fort Thompson
State	SD
ZIP	57339
Taxonomy	Clinic/Center
NPI Enumerated	August 3, 2006

Payer Source	Total Paid
Medicaid	$10.8M
Medicare	$0

Key Findings

FORT THOMPSON INDIAN HEALTH SERVICE bills Medicaid only on file (no Medicare billing on file) and reports $10.8M in total Medicaid revenue, making it effectively a single-payer (Medicaid) operation in the available claims data. This concentration in one payer means the provider’s financial profile is driven almost entirely by Medicaid policy, rates, and beneficiary utilization patterns.

Revenue is highly concentrated in a narrow set of outpatient evaluation-and-management codes: the precomputed top 3 Medicaid codes account for 70.2% of the provider’s total Medicaid revenue, and 99213 alone represents $5.3M (50.4% of Medicaid revenue). This indicates most dollars flow from routine established outpatient visits rather than from inpatient, surgical, or high-complexity specialty procedures.

The code mix points to a community-based primary care clinic model: the largest revenue drivers are 99213, 99214, and 99212 (established patient office visits), supplemented by preventive/adolescent well visits (99394, 99392), immunizations (90471), and common office procedures (96372). Co-listed services such as D1206 and D0140 (dental) and 92014 (comprehensive eye exam) suggest the site provides integrated primary, pediatric, dental, and basic ophthalmic services rather than being a narrowly focused specialty center.

Competitive standing within the state is generally a solid, service-line-level presence rather than dominance: 99213 ranks #38 of 344 providers in-state (89th percentile) and is described as "typical, unremarkable volume for this code," while 99214 (rank #68 of 260, 74th percentile) and 99212 (rank #27 of 155, 83th percentile) similarly carry the label "typical, unremarkable volume for this code." These ranks place the provider as a meaningful regional participant in primary care E/M volume but not an outlier monopolizing statewide capacity.

Beyond core office visits, the provider shows notable activity in ancillary and access-oriented services: 90471 has 3.2K claims and $420K revenue (4.0% of Medicaid revenue) with an 89th-percentile designation, S0215 non-emergency transportation has 2.1K claims and $225.3K revenue (2.1%) and ranks #6 of 16 (67th percentile), and A0120 has 3.2K claims and $26K revenue (0.2%) and ranks #4 of 20 (84th percentile). These patterns indicate the facility both delivers preventive/primary-care interventions like immunizations and supports patient access with non-emergency transport capacity.

The operations appear focused on preventive and routine chronic care management: substantial receipts for 90471 (immunizations), 99394 (adolescent well visits), and 99392/99393 (well-child visits) alongside frequent E/M coding underscore emphasis on prevention and ongoing outpatient management rather than episodic procedural revenue. This clinical mix is consistent with a community clinic serving a broad age range including children and adolescents.

Dependence on a small set of high-volume visit codes and a single payer creates revenue sensitivity: with 70.2% of Medicaid revenue coming from the top three visit codes and no Medicare billing on file, changes in Medicaid reimbursement, visit frequency, or coding patterns for established visits would materially affect overall revenue. Payers and partners should view this as a concentrated-revenue profile that could amplify the impact of policy or utilization shifts.

Operational tenure is long-standing: the NPI was enumerated 2006-08-03 (~20 years ago), indicating an established presence in the community. Combined with the high absolute volume on codes like 99213 (11.2K claims) and sustained ancillary activity, this tenure supports the interpretation of an entrenched primary care access point for Medicaid beneficiaries in the area.

Medicaid: Complete Services Breakdown

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

92 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	11,150	$480	$5.3M
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…	2,400	$500	$1.2M
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,…	1,650	$550	$903.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	3,180	$130	$420K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	1,170	$280	$330K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	570	$520	$298.1K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	510	$580	$296.1K
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.	660	$370	$248.3K
S0215	Non-emergency transportation; mileage, per mile	2,150	$110	$225.3K
D0140	Limited oral evaluation – problem focused	560	$350	$195.4K

Showing 1–10 of 92

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

Fort Thompson Indian Health Service — 0 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

92 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	38	340	1,010	$100	$511K
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…	68	260	860	$80	$222.6K
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.	14	60	120	$210	$171.2K
S0215	Non-emergency transportation; mileage, per mile	6	20	900	$100	$169.9K
42700	The provider uses an incision to drain an abscess next to one of the tonsils.	2	10	60	$350	$138.1K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	32	50	410	$80	$127.2K
D1351	Sealant - per tooth	39	50	400	$30	$117.3K
A0425	Ground mileage, per statute mile	36	60	680	$50	$106.2K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	22	70	130	$100	$99K
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,…	27	160	210	$120	$97.4K

Showing 1–10 of 92

Nearby Providers

Other providers in the same ZIP code as Fort Thompson Indian Health Service, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$705.3K
Crow Creek Sioux Tribe	SD	Land Ambulance	$37.7K	$202K
John Mcfee	SD	Family Medicine Physician	$25.6K	$0
Renette Kroupa	SD	Medical Physician Assistant	$7.2K	$0
Patricia Hamiel	SD	Family Nurse Practitioner	$3.7K	$0

Fort Thompson Indian Health Service — 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

Nearby Providers

Frequently Asked Questions

References