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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Cherokee Indian Hospital Authority (NPI 1770662348)

Key Findings

Field	Value
Entity Type	Organization
Organization	Cherokee Indian Hospital Authority
Address	1 Hospital Road
City	Cherokee
State	NC
ZIP	28719
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 3, 2006

Payer Source	Total Paid
Medicaid	$86.6M
Medicare	$0

CHEROKEE INDIAN HOSPITAL AUTHORITY has no Medicare billing on file and reports $86.6M in lifetime Medicaid revenue, making its observable commercial/fee-for-service footprint effectively single‑payer in this dataset. Analysts should treat comparisons and forecasts against Medicare-populated peers with caution because this provider’s financial signal in the claims data is driven almost entirely by Medicaid activity rather than a mixed payer mix.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 69.6% of the provider’s total Medicaid revenue, led by 99211 at $42.4M (49.2% of Medicaid revenue), followed by H0020 at $11.2M (13.0%) and 99283 at $6.5M (7.5%). This concentration means most Medicaid dollars flow through a very small set of service lines, which should be a primary lens for any revenue or utilization analysis.

The code mix indicates a clinic-focused operation with heavy low-acuity outpatient throughput: 99211 (an established patient visit not requiring the presence of a physician) is the single largest revenue driver at $42.4M, and additional E/M codes such as 99213 and 99214 show significant outpatient visit volume as well. The presence of D0120 (periodic oral evaluation, $3.4M) also points to on-site dental services, so the organization appears to provide broad ambulatory services beyond higher-acuity inpatient work.

Substance use disorder and behavioral health services are material components of the business. H0020 (methadone administration) contributes $11.2M and ranks #61 of 93 in-state (35th percentile; typical, unremarkable volume), while group and individual psychotherapy codes (90853 at $2.2M, 90834/90832, and 90791 at $423.1K) further show a meaningful behavioral health and SUD treatment program within the clinic mix.

Emergency department evaluation-and-management codes also contribute meaningfully to Medicaid revenue, with 99283 at $6.5M and 99284 at $3.3M supplemented by 99282 at $432.5K. These ED-level codes rank in typical in-state percentiles (99283 ranks #122 of 316, 62th percentile; typical, unremarkable volume), indicating active ED utilization but not statewide dominance in emergency services.

The provider’s competitive standing is sharply bimodal: it is a statewide outlier for 99211—ranking #2 of 571 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code)—but for many other high-revenue codes it is a typical or modest participant. Several behavioral-health and testing codes show elevated state percentiles (for example, 90853 ranks #22 of 234, 91th percentile; 90791 ranks #59 of 866, 93th percentile; U0002 ranks #13 of 104, 88th percentile), suggesting comparative strength in psychotherapy and testing services even as most E/M and ED codes sit at typical volumes.

The provider has an established presence in the NPI registry, enumerated on 2006-11-03 (~20 years ago), indicating roughly two decades of operation under the current enrollment. That tenure supports treating historical Medicaid volumes as coming from a stable, incumbent provider rather than a recent entrant.

The extreme concentration risk around a single dominant code and the top-three concentration (69.6%) creates sensitivity for revenue forecasting and payer negotiations: any policy, reimbursement, or utilization shift affecting 99211 or methadone services would disproportionately affect total Medicaid revenue. Analysts should model downside scenarios tied to changes in outpatient visit reimbursement or SUD payment policies and consider diversification signals in ancillary services (dental, psychotherapy, testing) when assessing financial resilience.

Medicaid: Complete Services Breakdown

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

41 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	88,880	$480	$42.4M
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	18,050	$620	$11.2M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	11,350	$570	$6.5M
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…	8,710	$580	$5.1M
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…	7,410	$550	$4.1M
D0120	Periodic oral evaluation - established patient	4,950	$700	$3.4M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	6,160	$540	$3.3M
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	3,990	$550	$2.2M
U0002	2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc	4,220	$450	$1.9M
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…	1,710	$490	$835.7K

Showing 1–10 of 41

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Cherokee Indian Hospital Authority — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

41 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2035	Alcohol and/or other drug treatment program, per hour	62	70	4,970	$190	$3.7M
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	61	90	45,620	$40	$3.5M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	162	330	6,130	$130	$2.7M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	122	320	6,160	$120	$2.1M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	267	280	2,690	$130	$1.6M
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	100	150	1,340	$80	$395.9K
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…	683	1,710	810	$80	$274.5K
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…	614	4,400	960	$60	$271.3K
99391	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…	446	520	1,080	$80	$262.1K
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…	540	550	970	$90	$258.9K

Showing 1–10 of 41

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Samuel Fleming	NC	Nephrology Physician	$168.8K	$0
Sarah Ciccotto	NC	Cardiovascular Disease Physician	$160.7K	$0
James Sagar	TN	Diagnostic Radiology Physician	$116.5K	$0
Frank Bonomo	NC	Diagnostic Radiology Physician	$101.7K	$0
Bradley Escaravage	VA	Diagnostic Radiology Physician	$98.3K	$0
Jennifer Henderson	NC	Family Nurse Practitioner	$78.5K	$0
Robert Pope	NC	Physician Assistant	$61.6K	$0
Don Mcneel	SC	Family Medicine Physician	$49.2K	$0
Neille Wilson	NC	Diagnostic Radiology Physician	$48.8K	$0

Cherokee Indian Hospital Authority — Billing Profile & Reimbursement Data

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Cherokee Indian Hospital Authority — 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