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.

Saint Alphonsus Regional Medical Center Inc (NPI 1861676298)

Key Findings

Field	Value
Entity Type	Organization
Organization	Saint Alphonsus Regional Medical Center Inc
Address	712 Aviation Way
City	Caldwell
State	ID
ZIP	83605
Taxonomy	Family Medicine Physician
NPI Enumerated	December 20, 2007

Payer Source	Total Paid
Medicaid	$32.6M
Medicare	$0

SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC reports no Medicare billing on file and is effectively single‑payer in the data set, with all lifetime public payer revenue coming from Medicaid ($32.6M). This concentration means Medicaid reimbursement dynamics will largely determine the provider’s public-payer financial profile.

Revenue concentration is highly focused: the precomputed top three Medicaid codes (99214, 99213, and 99392) account for 70.1% of the provider’s Medicaid revenue. In particular, 99214 alone generates $10M (32.6% of Medicaid revenue) from 127K claims at $79 avg paid/claim, and 99213 contributes $9.7M (31.6%) from 167.6K claims at $58 avg paid/claim, which underscores a heavy dependence on ambulatory E/M office visits.

The code mix indicates this is primarily a high‑volume primary care/ambulatory operation with substantial preventive care throughput: major codes include 99214 and 99213 (established patient E/M) and preventive medicine codes 99392, 99391, 99393, and 99394 across pediatric and adult age groups. Preventive services are material—99392 generates $1.8M (5.9% of Medicaid revenue) with 17.9K claims at $101 avg paid/claim—and the presence of large vaccination codes 90471 (56.4K claims, $1M) and 90472 (28.9K claims, $577.7K) reinforces a strong immunization/well‑visit workflow.

Competitive standing within Idaho is dominant for many top codes: 99214 ranks #2 of 618 providers and is labeled an "extreme outlier," while 99213 ranks #4 of 669 (also "extreme outlier"). Preventive code 99392 ranks #1 of 79 ("extreme outlier"), and several procedure and testing codes such as 90471, 90472, 87426, 87880, and 76811 likewise rank at or near #1 in‑state (100th percentile), indicating the provider is a major statewide volume leader for core ambulatory and preventive services.

Beyond ambulatory care, the billing mix includes hospital and advanced services at meaningful volumes: 99233 (subsequent inpatient care) shows 7.5K claims and $413.5K revenue, 99223 (initial inpatient) and 99232 are also present, and 99291 (critical care) appears with 2.8K claims and $325.3K revenue, where it ranks #1 of 11 providers (100th percentile). These items suggest the organization maintains inpatient/observation and some higher‑acuity care capability in addition to its dominant outpatient footprint.

Operational implications: the provider’s reliance on high volumes of established patient E/M (99214/99213) and preventive visits plus immunizations implies sensitivity to visit throughput, clinic capacity, and primary care access patterns. Any payer policy, eligibility shifts, or operational changes that reduce outpatient visit volume could disproportionately affect revenue because a large share of Medicaid dollars flows through a narrow set of ambulatory codes.

Tenure and stability: the NPI was enumerated on 2007-12-20 (~19 years ago), indicating a long‑standing presence in the market. That tenure, combined with the provider’s high in‑state rankings across many codes, is consistent with an established system or clinic network with entrenched referral and patient panels.

Statistical outlier profile is pronounced and consistent across code types: multiple codes are explicitly labeled as "extreme outlier" or at the 100th percentile in‑state (e.g., 99214, 99213, 99392, 90471, 90472, 87426, 87880, 76811). For payers and competitors, this pattern signals a dominant high‑volume provider for both routine primary/preventive care and select procedural/testing services in Idaho, rather than a modest or occasional participant for these codes.

Medicaid: Complete Services Breakdown

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

177 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	127,030	$80	$10M
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…	167,630	$60	$9.7M
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…	17,860	$100	$1.8M
99391	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…	17,270	$90	$1.5M
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…	8,920	$120	$1.1M
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	56,390	$20	$1M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	9,220	$100	$921.9K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	28,890	$20	$577.7K
99204	The provider sees a new 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 provider…	4,570	$120	$558K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	5,850	$80	$491.1K

Showing 1–10 of 177

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

Saint Alphonsus Regional Medical Center Inc — 19 of 25 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

177 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1013	Sign language or oral interpretive services, per 15 minutes	10	40	960	$70	$461.2K
J0585	Injection, onabotulinumtoxina, 1 unit	7	10	300	$510	$359.7K
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…	4	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…	2	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…	139	410	740	$60	$174.3K
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…	1	80	450	$80	$171.3K
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…	29	30	1,450	$50	$160K
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	15	20	200	$90	$158.3K
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…	17	60	1,370	$50	$151.3K
99391	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…	1	80	380	$70	$151.1K

Showing 1–10 of 177

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Alphonsus Regional Medical Center Inc	ID	General Acute Care Hospital	$0	$5.1M
Saint Alphonsus Regional Medical Center Inc	ID	General Acute Care Hospital	$0	$4.2M
James Earl	ID	Retina Specialist (Ophthalmology) Physician	$3.1M	$0
Saint Alphonsus Regional Medical Center Inc	ID	General Acute Care Hospital	$0	$1.9M
Jasmit Minhas	WA	Internal Medicine Physician	$965.4K	$0
Xiuqing Ru	NE	Hematology & Oncology Physician	$275K	$0
Adam Grimaldi	ID	Clinical Cardiac Electrophysiology Physician	$247.1K	$0
Ryan Williams	ID	Internal Medicine Physician	$224K	$0
Saint Alphonsus Caldwell Cancer Treatment Center LLC	ID	Radiation Therapy Radiologic Technologist	$218.6K	$0
Jenny Jin	ID	Orthopaedic Surgery Physician	$205K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Alphonsus Regional Medical Center Inc	ID	Rural Health Clinic/Center	$0	$9.9M
Human Supports Of Idaho	ID	General Practice Physician	$0	$9.4M
County Of Canyon Canyon Co School Dist 132	ID	Local Education Agency (LEA)	$0	$8.3M
West Valley Medical Center, Inc.	ID	General Acute Care Hospital	$0	$7.8M
Carepoint Health Emergency Medicine Idaho, PLLC	ID	Emergency Medicine Physician	$0	$4.3M
Mana Resources LLC	ID	Community/Behavioral Health Agency	$0	$3.1M
Family Eyecare Specialists PLLC	ID	Optometrist	$0	$2.9M
Hope House, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$2.4M
West Valley Medical Group LLC	ID	Internal Medicine Physician	$0	$2.1M
Easterseals-goodwill Northern Rocky Mountain, Inc	ID	Community/Behavioral Health Agency	$0	$2M

Saint Alphonsus Regional Medical Center Inc — Billing Profile & Reimbursement Data

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Saint Alphonsus Regional Medical Center Inc — 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