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 1780639971)

Field	Value
Entity Type	Organization
Organization	Dhhs, Phs, Naihs, Shiprock Hospital
Address	Us Highway 491 North
City	Shiprock
State	NM
ZIP	87420
Taxonomy	General Acute Care Hospital
NPI Enumerated	May 24, 2006

Payer Source	Total Paid
Medicaid	$190.6M
Medicare	$0

Key Findings

This provider is effectively single‑payer in the available dataset: there is no Medicare billing on file and all reported federal program revenue is Medicaid‑sourced, totaling $190.6M. The absence of Medicare claims combined with a sizable Medicaid revenue pool positions the hospital as primarily Medicaid‑focused in payer mix for the observed period.

Medicaid revenue is highly concentrated: the top three Medicaid codes account for 84.4% of total Medicaid revenue, driven by 99211 ($71.2M, 37.5%), 99212 ($49.6M, 26.2%), and 99213 ($39.3M, 20.7%). This degree of concentration indicates the facility’s financial performance is materially dependent on a narrow set of outpatient evaluation-and-management services.

The code mix signals an outpatient/ambulatory service model: 99211, 99212, and 99213 are all established‑patient E/M visit codes and together represent the vast majority of Medicaid revenue. Supporting codes consistent with outpatient clinic operations include G0463 (hospital outpatient clinic visit, $5M, 2.6%) and the high claim volumes for the 9921x series (e.g., 99211 with 144.9K claims and 99212 with 121.3K claims), suggesting sustained, high-volume ambulatory throughput.

Telehealth and public‑health activities are visible in the Medicaid mix: Q3014 (telehealth originating site facility fee, $5.5M, 2.9%) and 87635 (SARS‑CoV‑2 amplified NAAT, $3.6M, 1.9%) indicate the hospital billed both telehealth originating‑site fees and COVID testing at nontrivial levels. Q3014 ranks #16 of 179 in‑state (92th percentile; typical, unremarkable volume) while 87635 ranks #8 of 113 (94th percentile), showing these services are part of regular operations but not the primary revenue drivers.

The provider is a dominant statewide performer for low‑acuity outpatient visits: 99211 ranks #1 of 138 providers in‑state at the 100th percentile and is labeled an "extreme outlier," and 99212 also ranks #1 of 380 providers in‑state at the 100th percentile and is labeled an "extreme outlier." 99213 ranks #12 of 932 providers (99th percentile; notably above typical state volume), underscoring unusually high market share for these E/M visit levels within New Mexico.

Multiple codes with no public description appear as state‑level extremes, which may reflect concentrated operational activities tied to specific procedures or program billing. Examples include 0124A, 0064A, 0054A, 0004A, and 0071A, each ranking #1 of their peer sets at the 100th percentile and flagged as "extreme outlier," plus several additional unlabeled codes ranking in the 97th–99th percentiles; this pattern suggests the hospital reports high volumes on a set of discrete procedure codes beyond the standard E/M series.

The presence of high-volume vaccination and administration codes reinforces a public‑health role: 90480 (COVID vaccine administration) generates $1.5M and ranks #1 of 32 in‑state at the 100th percentile (extreme outlier), while multiple vaccine/administration‑style codes (e.g., 0002A, 0001A, 0003A) also appear high in state rank. These entries, together with testing codes, indicate the hospital played a prominent role in vaccine delivery and related activities to Medicaid patients.

Operationally and historically, this is an established provider: the NPI was enumerated on 2006-05-24 (~20 years ago), and the combination of long tenure with concentrated Medicaid revenue suggests a sustained role as a community hospital primarily serving Medicaid beneficiaries. That reliance on a small set of outpatient codes (84.4% from the top three) creates a material sensitivity to any policy or reimbursement changes affecting those specific service lines.

Medicaid: Complete Services Breakdown

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

84 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.	144,910	$490	$71.2M
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,…	121,350	$410	$49.6M
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…	74,360	$530	$39.3M
Q3014	Telehealth originating site facility fee	10,540	$520	$5.5M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	22,430	$220	$5M
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	6,940	$520	$3.6M
0002A	N/A	4,250	$500	$2.1M
0001A	N/A	4,090	$490	$2M
0124A	N/A	2,840	$530	$1.5M
90480	The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19.	2,640	$550	$1.5M

Showing 1–10 of 84

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 — 17 of 25 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

84 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	70	80	12,050	$160	$3.9M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	8	40	3,670	$80	$3.2M
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.	71	80	10,650	$130	$2.4M
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	50	60	3,070	$210	$1.4M
70450	The provider performed computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.	50	60	2,820	$110	$799.5K
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.	1	140	130	$220	$568.5K
Q3014	Telehealth originating site facility fee	16	180	620	$160	$546.7K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	37	40	880	$80	$527.4K
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…	12	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…	235	960	1,010	$90	$490K

Showing 1–10 of 84

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
Trc - Four Corners Dialysis Clinics LLC	NM	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.3M
Dhhs, Phs, Naihs, Shiprock Hospital	NM	Ambulatory Surgical Clinic/Center	$38.3K	$126K
Akinloye Makanjuola	NM	Internal Medicine Physician	$128.3K	$0
John Mohs	NM	Family Medicine Physician	$61.4K	$0
Stephen Shanks	NM	Family Medicine Physician	$59.6K	$0
Margaret Miller	NM	Anesthesiology Physician	$56.5K	$0
Matthew Spiva	NM	Podiatrist	$45K	$0
Douglas Accountius	NM	Acute Care Nurse Practitioner	$17.5K	$0
Justin Ritter	NM	Acute Care Nurse Practitioner	$7K	$0
Tracy Kurek	NM	Physician Assistant	$6.4K	$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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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References