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.

Nez Perce Tribal Health Authority (NPI 1790795888)

Field	Value
Entity Type	Organization
Organization	Nez Perce Tribal Health Authority
Address	111 Bever Grade
City	Lapwai
State	ID
ZIP	83540
Taxonomy	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
NPI Enumerated	August 9, 2006

Payer Source	Total Paid
Medicaid	$8.5M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and is effectively single‑payer from the available claims data: total Medicaid revenue is $8.5M with no recorded Medicare revenue, so Medicaid dominates the provider’s recorded reimbursement streams. The lack of Medicare payments indicates analyses of financial risk and growth should focus primarily on Medicaid dynamics rather than dual‑payer mix.

Revenue is extremely concentrated in a very small set of Medicaid codes: the precomputed top three codes account for 99.9% of the provider’s Medicaid revenue, with T1015 alone responsible for $6.6M (78.5% of Medicaid revenue). That concentration signals that the provider’s financial position is highly dependent on a single encounter-type service and on stable Medicaid reimbursement for that code.

T1015 (clinic visit/encounter, all-inclusive) is the dominant operational driver in the billing mix, both by revenue and claim volume (13K claims, $509 avg paid/claim, $6.6M revenue). The prominence of T1015 suggests the organization operates as a clinic-oriented ambulatory provider delivering broad bundled visit services rather than relying on high-priced procedure codes.

D0999 is the second-largest Medicaid revenue source at $1.7M (20.6% of Medicaid revenue) across ~4K claims with a $432 avg paid/claim, but the code is listed without a description in the file. Its statewide rank (#16 of 32, 52nd percentile) places it near the middle of in‑state peers for that code, indicating typical participation for whatever miscellaneous or unspecified service D0999 represents.

99213 and related E/M codes appear frequently but contribute only a small share of revenue: 99213 accounts for $69.7K (0.8% of Medicaid revenue) across 3.9K claims with a low $18 avg paid/claim, and 99214 accounts for $7K (0.1% of Medicaid revenue). Despite modest revenue impact, 99213 ranks #141 of 669 providers in-state (79th percentile), which means the provider delivers a relatively high volume of standard established‑patient E/M visits compared with peers even though those visits are low‑reimbursing under Medicaid.

Several service lines show claims recorded with zero paid revenue in the file (examples include 92015, 90837, 91301 and multiple dental codes listed with $0 revenue), which may indicate services recorded but not paid through the Medicaid claims extract used here or billed under other arrangements. Analysts should treat those line items as activity signals rather than contributors to present Medicaid revenue when modeling this provider’s financials.

Competitive standing is modest and specialized: for the largest code T1015 the provider ranks #42 of 143 in-state (71st percentile) and is characterized as a typical, unremarkable volume performer rather than a dominant statewide center. Overall the ranking profile (T1015 at the 71st percentile, D0999 at the 52nd percentile, and 99213 at the 79th percentile) points to a provider that participates actively in common ambulatory encounter codes but does not appear as a market leader by revenue concentration or breadth of high‑revenue procedures.

The provider has long tenure in the NPI registry — enumerated on 2006-08-09 (~20 years ago) — which supports interpretation of the observed billing patterns as established and persistent behavior rather than a recent startup artifact. Given that longevity and the heavy reliance on a few Medicaid encounter codes, payer negotiations or policy changes that affect T1015 or D0999 reimbursement would likely have outsized impact on the provider’s revenue base.

Medicaid: Complete Services Breakdown

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

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	13,040	$510	$6.6M
D0999	N/A	4,030	$430	$1.7M
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…	3,870	$20	$69.7K
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…	2,330	$1	$7K
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,…	30	$50	$1.6K
D0140	Limited oral evaluation – problem focused	340	$1	$690
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	60	$10	$590
D0220	Intraoral - periapical first radiographic image	490	$1	$490
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…	40	$10	$350
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	40	$10	$200

Showing 1–10 of 38

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Nez Perce Tribal Health Authority — 0 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

38 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	42	140	5,470	$180	$2.6M
D0999	N/A	16	30	3,960	$250	$1.5M
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…	141	670	740	$40	$193.6K
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…	156	620	560	$60	$191.8K
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…	290	410	740	$60	$174.3K
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…	149	160	320	$90	$92.8K
D9999	N/A	3	10	230	$330	$92.8K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	261	320	310	$80	$80.8K
D8670	N/A	22	30	280	$70	$55.9K
92004	The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.	86	130	120	$110	$50.2K

Showing 1–10 of 38

Related Providers

Other providers that share a Tax Identification Number (TIN) with Nez Perce Tribal Health Authority, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Walter Griffiths	VT	Geriatric Medicine (Internal Medicine) Physician	$38.9K	$28.1K
Edward Smith	ID	Family Medicine Physician	$39.1K	$0
Penny Buckland	ID	Nurse Practitioner	$36.8K	$0
Brenda Sellner	ID	Family Nurse Practitioner	$22.8K	$0
Miles Robinson	ID	Family Nurse Practitioner	$17.3K	$0

Nez Perce Tribal Health Authority — Billing Profile & Reimbursement Data

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Nez Perce Tribal Health 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

Frequently Asked Questions

References