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

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

Sherwin Foster (NPI 1720074990)

Field	Value
Entity Type	Individual
Organization	Sherwin Foster
Address	1986 W Hayden Ave
City	Hayden
State	ID
ZIP	83835
Taxonomy	Nephrology Physician
NPI Enumerated	September 23, 2005

Payer Source	Total Paid
Medicare	$356.3K
Medicaid	$0

Key Findings

Practice profile and service mix: SHERWIN FOSTER is listed as a Nephrology Physician but the Medicare billing pattern is dominated by hospital inpatient and observation evaluation-and-management codes, indicating a hospital-focused practice that spends substantial time on initial and subsequent inpatient care rather than outpatient nephrology procedures. The top-billed codes are 99232, 99222, and 99223, which correspond to subsequent and initial inpatient/observation E/M visits at moderate to high complexity levels, consistent with inpatient consults and ongoing inpatient management of kidney-related conditions.

Revenue concentration: This provider’s Medicare revenue is highly concentrated, with the top 3 Medicare codes accounting for 90.8% of total Medicare revenue. In-dollar terms those top codes are 99232 ($266.5K, 74.6% of Medicare revenue), 99222 ($36.1K, 10.1%), and 99223 ($21.9K, 6.1%), showing the business is overwhelmingly supported by a narrow set of inpatient E/M services.

Volume profile for primary code 99232: The provider billed 4.5K claims for 99232 with an average paid of $59 per claim, producing $266.5K in revenue for that single code. The provider ranks #152 of 177383 nationally for 99232 (100th percentile; extreme outlier), indicating an unusually large national footprint for subsequent inpatient E/M visits relative to peers.

Competitive standing on initial inpatient visits: For the initial hospital inpatient E/M code 99222 the provider reported 372 claims at $97 avg paid/claim for $36.1K in revenue, ranking #604 of 117621 nationally (99th percentile; extreme outlier). This placement signals that the provider is a major national outlier in volume for moderate-complexity initial inpatient evaluations compared with typical providers.

Other inpatient codes and typical volumes: The provider also bills 99223 (171 claims, $128 avg paid/claim, $21.9K revenue) and 99233 (241 claims, $89 avg paid/claim, $21.4K revenue); 99223 ranks #11301 of 139583 (92th percentile; typical, unremarkable volume) while 99233 ranks #26063 of 128818 (80th percentile; typical, unremarkable volume). These patterns suggest exceptional scale in some inpatient E/M activities (notably 99232 and 99222) while other related high-complexity visit codes align more with common peer activity levels.

Payer mix and single-payer exposure: This provider’s lifetime Medicare revenue is $356.3K and there is no Medicaid billing on file, so the practice operates effectively as a Medicare-only biller in available data. The absence of Medicaid billing creates concentrated exposure to Medicare payment and policy changes, with no Medicaid revenue to diversify payer risk.

Tenure and experience signal: The provider’s NPI was enumerated on 2005-09-23 (~21 years ago), indicating long-standing enrollment that aligns with the sustained inpatient billing pattern observed. That tenure supports the interpretation of an established hospital-based practice rather than a recent change in billing behavior.

Implications for contracting and network placement: Given the dominant share of revenue from a small set of inpatient E/M codes (top 3 = 90.8%) and extreme-outlier national ranks for 99232 and 99222, payers and provider network managers should treat SHERWIN FOSTER as a high-volume inpatient E/M resource. Contracting or care-management discussions should focus on inpatient utilization, admission/rounding practices, and coordination of hospital-based nephrology services rather than outpatient procedural capacity.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	4,520	$60	$266.5K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	370	$100	$36.1K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	170	$130	$21.9K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	240	$90	$21.4K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	120	$90	$10.5K
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	20	$60	$920

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Idaho Distribution

Sherwin Foster — 3 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. state median

6 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99233	45	400	60	$90	$9.4K
99232	1	680	60	$60	$7.3K
99223	17	500	30	$120	$6.6K
99239	45	310	40	$80	$5.1K
99222	1	420	20	$90	$2.9K
99238	118	180	20	$60	$1.6K

Related Providers

Other providers that share a Tax Identification Number (TIN) with Sherwin Foster, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kootenai Health, Inc.	ID	General Acute Care Hospital	$0	$7M
Kootenai Health, Inc.	ID	Psychiatry Physician	$0	$6.7M
Kootenai Urgent Care LLC	ID	Family Medicine Physician	$0	$3.8M
Kootenai Health, Inc.	ID	Emergency Medicine Physician	$0	$2.6M
Bonner General Hospital Inc.	ID	Critical Access Hospital	$0	$1.6M
Golden Buckland	ID	Ophthalmology Physician	$1.2M	$0
Dustin Dinning	ID	Rheumatology Physician	$1.1M	$0
Alison Granier	ID	Ophthalmology Physician	$842.5K	$0
David Dance	ID	Ophthalmology Physician	$711.8K	$0
Sara Duke	ID	Ophthalmology Physician	$611.7K	$0

Nearby Providers

Other providers in the same ZIP code as Sherwin Foster, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Renewed Horizons, LLC	ID	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$19.9M
Wellspring Meadows, Inc.	ID	Personal Care Attendant	$0	$3.9M
Dance Dentistry PLLC	ID	General Practice Dentistry	$0	$2.6M
Periwinkle Children's Therapy	ID	Contractor	$0	$1.8M
Renewed Horizons, LLC	ID	Developmentally Disabled Services Day Training Agency	$0	$1.3M
Lookout Behavioral Health LLC	ID	Adult Mental Health Clinic/Center	$0	$888.5K
Public Health District 1	ID	Public Health or Welfare Agency	$0	$843.3K
Shaun Joshi	ID	Nephrology Physician	$523.4K	$0
North Idaho Nephrology Associates, Inc.	ID	Medical Specialty Clinic/Center	$0	$504.4K
Robin Lindauer	ID	Optometrist	$129.3K	$330.6K

Sherwin Foster — Billing Profile & Reimbursement Data

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Sherwin Foster — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References