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

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

Sanford Bismarck (NPI 1811941172)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sanford Bismarck
Address	565 S 7th St
City	Bismarck
State	ND
ZIP	58504
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	May 20, 2006

Payer Source	Total Paid
Medicaid	$43.9M
Medicare	$0

SANFORD BISMARCK’s public payer footprint is effectively single‑payer: there is no Medicare billing on file and the practice reports $43.9M in lifetime Medicaid revenue, indicating that recorded public reimbursement for this entity is concentrated entirely in Medicaid. This single‑payer visibility should be factored into any analysis of community access, payer risk, or contract negotiations because Medicare dynamics are not represented in the claims set shown.

Revenue concentration is highly focused: the top three Medicaid codes (99213, 99214, 99285) account for 68.7% of the provider’s Medicaid revenue, with 99213 contributing 31.7%, 99214 contributing 23.1%, and 99285 contributing 13.8%. Those three codes together drive the majority of the $43.9M Medicaid portfolio, signaling a narrow set of services that produce most of the billed Medicaid dollars.

The code mix indicates a large ambulatory primary care and general E/M operation. High volumes for 99213 (established outpatient visit) and 99214 (higher complexity established visit), plus preventive codes 99392/99391 and vaccine administration codes 90471/90472, point to a busy primary care and preventive medicine capacity handling routine and longitudinal care. At the same time, the presence of 99285/99284 emergency department E/M codes and inpatient E/M codes (99232/99233/99222/99223) shows this entity also delivers acute and hospital‑based services in addition to ambulatory care.

Competitive standing for core primary care E/M is dominant in‑state: 99213 ranks #2 of 206 providers in North Dakota at the 100th percentile and is labeled an "extreme outlier, far above typical state volume for this code," while 99214 ranks #2 of 171 providers at the 99th percentile and is also an "extreme outlier." These rankings indicate SANFORD BISMARCK is a leading Medicaid provider for routine established visits statewide and is operating at substantially higher volume than nearly all peers for those codes.

Emergency and hospital E/M volumes are material but less outsized versus peers: 99285 (ED high complexity) contributes $5.2M (13.8% of Medicaid revenue) and ranks #3 of 19 providers at the 89th percentile, described as "typical, unremarkable volume for this code," while 99284 ranks #4 of 33 at the 91st percentile. In short, emergency care is an important revenue line but not as overwhelmingly dominant versus in‑state competitors as the primary care E/M codes.

The provider shows strong capabilities in imaging, obstetric ultrasound, and targeted diagnostics: 74177 (CT abdomen/pelvis with contrast) ranks #2 of 19 providers at the 94th percentile and 76811 (detailed transabdominal fetal ultrasound) ranks #1 of 6 providers at the 100th percentile, indicating notable in‑state strength in those modalities. Ancillary diagnostic and cardiac imaging activity is also present (e.g., 93306 echo services at a 75th percentile rank), supporting a multi‑specialty clinical footprint that includes radiology and maternal/fetal services.

High relative volume in vaccination and lab testing suggests broad primary care and pediatric throughput. Vaccine administration codes 90471/90472 appear at the 98th and 98th percentiles respectively (90471 labeled an "extreme outlier, far above typical state volume for this code"), and strep testing 87651 ranks #1 of 17 providers at the 100th percentile, reinforcing a profile of frequent preventive and acute ambulatory visits with associated point‑of‑care testing and immunizations.

The NPI was enumerated on 2006-05-20 (~20 years ago), indicating an established presence in the market; combined with the concentrated Medicaid revenue and clear leadership on core outpatient E/M codes, this suggests a mature, Medicaid‑focused multi‑specialty clinic that is a major statewide provider for routine and preventive Medicaid services but carries concentration risk because no Medicare billing appears in the file.

Medicaid: Complete Services Breakdown

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

265 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	167,370	$70	$11.9M
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…	80,960	$110	$8.7M
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.	27,580	$190	$5.2M
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.	22,290	$130	$2.9M
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…	27,210	$50	$1.3M
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.	7,680	$130	$983.3K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	4,520	$150	$655.3K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	8,390	$50	$444.6K
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…	5,200	$80	$436.5K
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…	4,470	$90	$419.8K

Showing 1–10 of 265

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Sanford Bismarck — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

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

265 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	3	20	1,120	$220	$2M
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.	4	30	1,280	$180	$1.4M
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.	21	50	670	$150	$829.9K
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…	2	210	360	$100	$498.2K
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…	3	30	460	$50	$423.5K
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…	2	170	300	$100	$415.8K
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…	4	20	310	$70	$364K
Q3014	Telehealth originating site facility fee	13	30	130	$180	$355.8K
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…	4	10	310	$150	$323.5K
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	60	130	$190	$242.5K

Showing 1–10 of 265

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center Fargo	ND	Family Medicine Physician	$0	$75.9M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Bismarck	ND	General Acute Care Hospital	$0	$12.5M
Sanford Bismarck	ND	Clinical Medical Laboratory	$726.9K	$4.3M
Sanford Bismarck	ND	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$3.5M
Robert Reynolds	ND	Radiation Oncology Physician	$1.4M	$0
Sanford Bismarck	ND	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$1.2M
Sanford Bismarck	ND	Multi-Specialty Clinic/Center	$0	$771.3K
Myles Mitsunaga	CA	Diagnostic Radiology Physician	$510.8K	$113.9K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pride Inc.	ND	Developmentally Disabled Services Day Training Agency	$0	$71.1M
Support Systems, Inc.	ND	Community/Behavioral Health Agency	$0	$37.7M
Bridging The Dental Gap Inc	ND	Dental Clinic/Center	$0	$6.8M
Pride Inc	ND	Community/Behavioral Health Agency	$0	$6.6M
Pride Inc.	ND	Community/Behavioral Health Agency	$0	$5.7M
Pride Inc	ND	Community/Behavioral Health Agency	$0	$4.9M
Dakota Surgery & Laser Center LLC	ND	Ambulatory Surgical Clinic/Center	$1.7M	$28.4K
The Kid's Therapy Center LLC	ND	Community/Behavioral Health Agency	$0	$1.5M
City Of Bismarck	ND	State or Local Public Health Clinic/Center	$111.3K	$1.3M
Dakota Eye Institute PC	ND	Ophthalmology Physician	$0	$1.2M

Sanford Bismarck — 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