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

Why is the Medicaid comparison limited to Oregon 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. Oregon (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.

Northwest Medical Foundation Of Tillamook (NPI 1871575225)

Key Findings

Field	Value
Entity Type	Organization
Organization	Northwest Medical Foundation Of Tillamook
Address	1000 3rd St
City	Tillamook
State	OR
ZIP	97141
Taxonomy	Critical Access Hospital
NPI Enumerated	November 18, 2005

Payer Source	Total Paid
Medicaid	$22.4M
Medicare	$0

This provider effectively operates as a Medicaid-focused facility: there is no Medicare billing on file while total Medicaid revenue is $22.4M, so its financial footprint in the claims datasets is essentially single‑payer (Medicaid). That concentration has implications for reimbursement risk and contracting leverage with state Medicaid plans rather than with Medicare networks.

Revenue is highly concentrated in a small set of E/M codes: the precomputed top three Medicaid codes (99284, 99213, 99283) together account for 60.1% of the provider's total Medicaid revenue, and individually represent $6.2M (28.5%), $3.5M (16.2%), and $3.3M (15.4%) respectively. This level of concentration indicates the facility derives the majority of Medicaid dollars from emergency department and routine outpatient evaluation-and-management services.

The code mix signals a hybrid Critical Access Hospital model with substantial emergency department throughput plus active outpatient/primary care clinics: high-revenue ED codes 99284, 99283 and 99285 alongside very large volumes of outpatient E/M codes such as 99213 and 99214 suggest the organization handles both unscheduled emergency care and established‑patient ambulatory visits. That aligns with the provider taxonomy (Critical Access Hospital) and supports an operational profile that combines ED services, primary care, and ancillary ambulatory procedures.

On competitive standing for primary care/outpatient E/M, the provider is an outlier in the state for established‑patient office visits: 99213 is labeled an "extreme outlier, far above typical state volume" (ranks #24 of 1591 providers in-state, 99th percentile) and 99214 is "notably above typical state volume" (ranks #43 of 1503, 97th percentile). Those rankings indicate this provider is a major in-state source of routine outpatient visits and likely captures a large share of established-patient primary care Medicaid volume in its market.

By contrast, its ED volumes are more typical relative to in‑state peers: 99284 ranks in the mid-to-upper peer range (69th percentile, described as "typical, unremarkable volume") and similar characterizations apply to 99283 and 99285 (60th and 63th percentiles respectively, both described as "typical, unremarkable volume"). That pattern suggests the facility is particularly strong on scheduled/ambulatory E/M activity while its emergency service volumes are steady but not dominant statewide.

Preventive services and immunizations are a notable secondary strength: the provider reports high vaccine administration volumes (90471: ranks #10 of 403 providers in-state, 98th percentile; 90472: ranks #6 of 74, 93th percentile) and nontrivial preventive medicine visits (99391 and 99392 at 83rd and 77th percentiles). These figures point to an active role in immunization and routine preventive care within the Medicaid population.

Ancillary diagnostics and therapy lines contribute modest, diverse revenue supporting the clinical mix: lab panels and common tests (80053 $381.6K / 1.8%, 85025 $313.7K / 1.5%, 84443 $123K / 0.6%, 83036 $92.2K / 0.4%) along with physical/occupational therapy codes (97110 $213.4K / 1.0%, 97530 $64.8K / 0.3%) indicate integrated lab and rehab capabilities that complement both ED and outpatient visits rather than driving revenue independently. This spread of smaller ancillary codes is consistent with a CAH offering basic inpatient/ED support services plus outpatient diagnostics.

The provider has an established market presence with stable enrollment: its NPI was enumerated on 2005-11-18 (~21 years ago), which suggests long-tenured operations and continuity of care in the TILLAMOOK, OR service area; that tenure, combined with the high outpatient‑E/M volumes, supports its role as a persistent local provider for Medicaid beneficiaries.

Medicaid: Complete Services Breakdown

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

126 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	21,850	$280	$6.2M
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…	54,570	$60	$3.5M
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.	16,360	$200	$3.3M
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.	8,280	$390	$3.2M
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…	33,230	$80	$2.8M
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.	15,270	$30	$381.6K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	16,510	$20	$313.7K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	2,430	$90	$213.4K
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…	2,300	$90	$200.1K
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…	1,550	$100	$161.3K

Showing 1–10 of 126

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Northwest Medical Foundation Of Tillamook — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

126 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	45	150	7,400	$170	$2.8M
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.	49	130	2,610	$200	$2.3M
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.	55	140	10,160	$130	$2.3M
A0427	Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)	82	90	2,490	$240	$2M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	28	40	3,200	$60	$1.5M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	36	60	3,620	$90	$623.7K
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…	78	80	1,420	$60	$368.8K
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…	695	1,380	540	$140	$363.3K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high…	32	60	460	$40	$327.4K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	50	80	1,130	$90	$327.2K

Showing 1–10 of 126

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cary Sanders	OR	Orthopaedic Surgery Physician	$130.7K	$0
Michael Gardner	OR	Cardiovascular Disease Physician	$56.4K	$0
James Borden	OR	Internal Medicine Physician	$43.1K	$0
Francisco Cruz	OR	Anatomic Pathology & Clinical Pathology Physician	$37K	$0
Meredith Peake	OR	Anatomic Pathology & Clinical Pathology Physician	$28K	$0
Andrew Miller	OR	General Practice Physician	$27.4K	$0
Morio Mcwilliams	OR	Physician Assistant	$17.6K	$0
Angelo Williams	WA	Family Medicine Physician	$11.4K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of Tillamook	OR	Federally Qualified Health Center (FQHC)	$0	$4.3M
Sandcreek Dental LLC	OR	Dental Clinic/Center	$0	$1.3M
Christopher Jenck	OR	Optometrist	$117.5K	$0
Fred Meyer Stores Inc	OR	Community/Retail Pharmacy	$90K	$0
Lee Johnson	OR	Optometrist	$72.9K	$0
Matthew Waxter	OR	Chiropractor	$46K	$0
Paul Dennis	OR	Anesthesiology Physician	$13.8K	$0

Northwest Medical Foundation Of Tillamook — 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