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

Why is the Medicaid comparison limited to South 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. South 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 Medical Center (NPI 1821017880)

Field	Value
Entity Type	Organization
Organization	Sanford Medical Center
Address	1305 W 18th St
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	General Acute Care Hospital
NPI Enumerated	July 19, 2006

Payer Source	Total Paid
Medicaid	$24.4M
Medicare	$0

Key Findings

SANFORD MEDICAL CENTER (SIOUX FALLS, SD) is a General Acute Care Hospital with an NPI enumerated on 2006-07-19 (~20 years ago), indicating long-standing presence in the state market and institutional tenure that supports high aggregate Medicaid activity. The facility’s declared lifetime Medicare revenue is none (no Medicare billing on file), so observed commercial scale in our dataset is driven entirely by Medicaid activity ($24.4M total Medicaid revenue).

Medicaid revenue at this provider is highly concentrated: the precomputed top 3 Medicaid codes account for 86.0% of the provider's total Medicaid revenue. Those top three contributors are J3490 ($18.3M, 76.0%), G0463 ($1.6M, 6.7%), and 99283 ($800.5K, 3.3%), which together dominate the payer mix in the available data.

The single largest driver is J3490 (J3490 – Unclassified drugs): 88.1K claims and $18.3M revenue (76.0% of Medicaid revenues), where the provider ranks #1 of 23 in-state and is described as an extreme outlier, far above typical state volume for this code. This suggests a business model with heavy reliance on high-volume or high-cost drug administration or passthrough billing captured under an unclassified drug code, making drug-related services the primary revenue engine.

G0463 (Hospital outpatient clinic visit) is the next-largest contributor with 107.8K claims and $1.6M revenue (6.7% of Medicaid revenues), where the provider also ranks #1 of 45 in-state and is labeled an extreme outlier. The combination of massive claim counts for outpatient clinic visits and the large J3490 drug line implies very substantial outpatient throughput and clinic-administered therapies as core service lines.

Emergency department activity appears meaningful but not uniquely dominant: 99283 shows 9K claims and $800.5K revenue (3.3% of Medicaid revenue) and ranks #7 of 66 in-state at the 91th percentile (described as typical, unremarkable volume). Additional ED codes (99284 at 6.9K claims, $340.3K; 99285 at 2.9K claims, $118K) similarly rank in high-but-ordinary percentiles (around the 88th–90th percentiles), indicating a busy emergency department consistent with a large acute care hospital rather than an outlier ED billing pattern.

Several ancillary and diagnostic codes further illustrate scale and service mix: 93005 has 36.9K claims and $443.3K revenue (1.8%) and ranks #1 of 38 in-state as an extreme outlier; Q9967 (contrast material) has 16.3K claims and $359.3K revenue (1.5%) and ranks #1 of 16 as an extreme outlier; G0008 (influenza vaccine) has 4.9K claims and $49.2K revenue (0.2%) and ranks #1 of 41 as an extreme outlier. These patterns point to very high volumes of routine diagnostics, imaging/support supplies, and preventive services delivered through hospital-based outpatient channels.

The provider’s dominance on multiple in-state benchmarks is clear: several codes are ranked #1 in the state and flagged as extreme outliers or notably above typical state volume (examples include J3490, G0463, 93005, Q9967, and G0008). For payers and competitors, this positions SANFORD MEDICAL CENTER as a major Medicaid service hub for drug administration, outpatient clinic visits, and high-volume diagnostics within South Dakota.

Operationally, the concentration of $24.4M Medicaid revenue into a single large unclassified drug code (J3490 at $18.3M, 76.0%) represents a potential sensitivity in revenue forecasting and peer comparisons because J3490 is an unclassified code. Reliance on an unclassified drug line can lead to variability driven by product mix, payer adjudication practices, or reporting conventions, so analysts should monitor drug-specific claim detail and payer contract terms when evaluating sustainability and comparability.

Medicaid: Complete Services Breakdown

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

117 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J3490	Unclassified drugs	88,120	$210	$18.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	107,770	$20	$1.6M
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.	8,990	$90	$800.5K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	4,770	$150	$720.1K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	36,940	$10	$443.3K
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	16,330	$20	$359.3K
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.	6,940	$50	$340.3K
A9270	Non-covered item or service	24,640	$10	$295.7K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	970	$260	$254.8K
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	210	$1,100	$229.6K

Showing 1–10 of 117

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Sanford Medical Center — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

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

117 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J3490	Unclassified drugs	1	20	1,200	$170	$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.	6	40	340	$90	$234.9K
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.	7	60	680	$60	$205.7K
J0585	Injection, onabotulinumtoxina, 1 unit	4	10	230	$420	$201.7K
G0378	Hospital observation service, per hour	3	10	3,790	$10	$178.2K
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.	7	70	1,150	$50	$155.9K
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…	64	190	430	$90	$154.1K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	1	50	1,650	$10	$125.4K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	45	60	1,050	$20	$108.2K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	18	20	210	$50	$104.8K

Showing 1–10 of 117

Related Providers

Other providers that share a Tax Identification Number (TIN) with Sanford Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Columbus Radiology Corp	OH	Diagnostic Radiology Physician	$0	$49.9M
Somc Medical Care Foundation, Inc.	OH	Family Medicine Physician	$0	$25.3M
Sanford Medical Center	SD	Clinical Medical Laboratory	$1.8M	$18M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Sanford Clinic	SD	Diagnostic Radiology Physician	$0	$6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M
Sanford Clinic	SD	Hospitalist Physician	$0	$2.9M
Sanford Clinic	SD	Family Medicine Physician	$0	$2M
Sanford Clinic	SD	Maternal & Fetal Medicine Physician	$0	$1.2M

Nearby Providers

Other providers in the same ZIP code as Sanford Medical Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Dakota Achieve	SD	Developmental Disabilities Clinic/Center	$0	$166.9M
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Southeastern Behavioral Healthcare	SD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$59.1M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Avera Mckennan	SD	Air Ambulance	$0	$5.3M
Avera Mckennan	SD	Emergency Medicine Physician	$0	$4.1M
Avera Mckennan	SD	General Acute Care Hospital	$0	$3.7M

Sanford Medical Center — 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