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.

Elbowoods Memorial Health Center (NPI 1831365519)

Field	Value
Entity Type	Organization
Organization	Elbowoods Memorial Health Center
Address	1251 Elbowoods Loop
City	New Town
State	ND
ZIP	58763
Taxonomy	Clinic/Center
NPI Enumerated	May 2, 2008

Payer Source	Total Paid
Medicaid	$9.3M
Medicare	$0

Key Findings

ELBOWOODS MEMORIAL HEALTH CENTER is effectively a Medicaid-focused clinic: there is no Medicare billing on file while Medicaid revenue totals $9.3M, indicating the provider’s patient population and payer mix are overwhelmingly Medicaid-based rather than balanced across Medicare and Medicaid. The absence of Medicare claims suggests this entity functions primarily within a payer environment dominated by Medicaid reimbursement.

Revenue is extremely concentrated in a single outpatient E/M code: 99212 accounts for $9.3M and represents 99.6% of the provider’s total Medicaid revenue, per the precomputed share. This concentration indicates that the clinic’s principal revenue driver is low-complexity established-patient office visits rather than a diverse set of procedures or higher-complexity services.

The service-line profile implied by the top codes points to primary care and basic outpatient services as the core operation: 99212 and 99213 together are standard evaluation-and-management office visits, and ancillary codes such as 92012 (intermediate eye exam), vaccine administration (90471, 90656, 90688, 90686), lab tests (80061, 83036, 36415), and COVID testing (87635) support a general outpatient clinic model offering routine medical care, immunizations, basic lab work, and some optometry services. The code mix suggests broad primary care scope with limited procedural or specialty volume.

Competitive standing within the state is highly uneven: the provider ranks #1 of 58 in-state for 99212 and is labeled an "extreme outlier, far above typical state volume for this code," marking it as a dominant statewide provider for that specific service. For other common codes (99213, 92012, 87635, 90471) the provider sits around mid-to-lower percentiles (e.g., 44th, 16th, 33rd, 33rd percentiles respectively), indicating that outside its dominant 99212 volume the clinic’s activity is typical or modest compared with peers.

Operational implications of the 99212 dominance include sensitivity to Medicaid outpatient E/M reimbursement policy and volume shifts: because 99.6% of Medicaid revenue is tied to a single low-level E/M code, changes to reimbursement rates, visit mix, or utilization of higher-level visits could materially affect revenue. Payer or policy changes that impact reimbursement per claim for 99212 or that shift care to alternative settings would disproportionately impact financial performance.

Tenure and potential market anchoring: the provider’s NPI was enumerated on 2008-05-02 (~18 years ago), indicating long-standing presence in the market. This longevity, combined with the extreme volume on 99212, suggests an established role as a routine outpatient access point for Medicaid enrollees in New Town, ND.

While many ancillary and preventive services are present, their revenue contribution is negligible relative to 99212: codes such as 99213 ($23.9K, 0.3% of Medicaid revenue), 92012 ($4.7K), and vaccine and lab codes each account for only a small fraction of total Medicaid revenue. This pattern signals that although the clinic offers a range of basic services, they are not material revenue drivers and are likely supplemental to high-volume primary care visits.

Medicaid: Complete Services Breakdown

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

21 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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,…	18,860	$490	$9.3M
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…	240	$100	$23.9K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	30	$140	$4.7K
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	$90	$3.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	90	$30	$2.8K
0012A	N/A	30	$50	$1.5K
0011A	N/A	30	$30	$830
0064A	N/A	20	$40	$600
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.	30	$20	$580
99347	The provider sees an established patient for a home or residence visit involving evaluation and management (E/M). The visit involves straightforward medical decision making or the provider spends at…	20	$30	$440

Showing 1–10 of 21

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

Elbowoods Memorial Health Center — 1 of 17 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

21 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	116	210	360	$100	$498.2K
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,…	1	60	130	$190	$242.5K
92012	For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any…	17	20	150	$100	$100.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	65	100	170	$20	$34.7K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	24	20	520	$10	$28K
92015	The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced.	75	80	370	$10	$21.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	85	90	400	$1	$20.7K
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.	16	20	110	$60	$14.3K
83036	Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).…	21	20	540	$10	$14.1K
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…	13	20	210	$60	$11.2K

Showing 1–10 of 21

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Elbowoods Memorial Health Center	ND	Dentist	$0	$730.2K
Valentine Chikwendu	ND	Cardiovascular Disease Physician	$167.3K	$0
Farzodd Hanjani	ND	Diagnostic Radiology Physician	$137.4K	$0
Thompson Kamba	ND	Diagnostic Radiology Physician	$122.5K	$0
Judy Humphreys	FL	Family Nurse Practitioner	$118K	$0
Leszek Jaszczak	ND	Diagnostic Radiology Physician	$76.6K	$0
Scott Lewis	ND	Diagnostic Radiology Physician	$62.5K	$0
James Miller	ND	Diagnostic Radiology Physician	$59.4K	$0
Robert Heninger	ND	Diagnostic Radiology Physician	$47.1K	$0
Ravindra Joshi	ND	Orthopaedic Surgery Physician	$44.2K	$0

Nearby Providers

Other providers in the same ZIP code as Elbowoods Memorial Health Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
New Town Ambulance Service Inc	ND	Land Ambulance	$65.4K	$791.8K
Kelcey Lee	ND	Primary Care Nurse Practitioner	$30.7K	$0
Lori Jepson	ND	Nurse Practitioner	$5.4K	$0
David Emmons	ND	Family Nurse Practitioner	$5K	$0

Elbowoods Memorial Health Center — Billing Profile & Reimbursement Data

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Elbowoods Memorial Health 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