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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Dhhs, Phs, Naihs, Shiprock Hospital (NPI 1760427587)

Field	Value
Entity Type	Organization
Organization	Dhhs, Phs, Naihs, Shiprock Hospital
Address	6 Road 7586
City	Bloomfield
State	NM
ZIP	87413
Taxonomy	General Acute Care Hospital
NPI Enumerated	June 17, 2006

Payer Source	Total Paid
Medicaid	$3.5M
Medicare	$0

Medicaid: Complete Services Breakdown

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

11 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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,…	6,790	$390	$2.6M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	1,260	$240	$295.4K
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…	960	$290	$278.4K
Q3014	Telehealth originating site facility fee	440	$440	$190.5K
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…	1,080	$50	$56.3K
42700	The provider uses an incision to drain an abscess next to one of the tonsils.	100	$430	$43.6K
45500	In this procedure the provider releases a stenosis of the anorectal area by incising the scar tissue and repairing it with the flaps of nearby tissue.	60	$460	$26.4K
G0008	Administration of influenza virus vaccine	80	$1	$320
Q2038	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)	40	$1	$80
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…	20	$1	$50

Showing 1–10 of 11

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Dhhs, Phs, Naihs, Shiprock Hospital — 3 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

11 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	27	40	3,670	$80	$3.2M
Q3014	Telehealth originating site facility fee	102	180	620	$160	$546.7K
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…	461	930	910	$80	$521.6K
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…	467	960	1,010	$90	$490K
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,…	18	380	220	$160	$273.9K
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…	127	140	630	$80	$236.9K
45500	In this procedure the provider releases a stenosis of the anorectal area by incising the scar tissue and repairing it with the flaps of nearby tissue.	1	10	50	$410	$18.9K
42700	The provider uses an incision to drain an abscess next to one of the tonsils.	1	10	60	$320	$18.4K
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…	189	220	170	$1	$4.8K
G0008	Administration of influenza virus vaccine	65	150	60	$1	$1.2K

Showing 1–10 of 11

Nearby Providers

Other providers in the same ZIP code as Dhhs, Phs, Naihs, Shiprock Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Krista Berrigan	NM	Occupational Therapist	$90.1K	$0
Kare Inc.	NM	Community/Retail Pharmacy	$23.8K	$0

Dhhs, Phs, Naihs, Shiprock Hospital — Billing Profile & Reimbursement Data

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Dhhs, Phs, Naihs, Shiprock Hospital — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References