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

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

Quinault Indian Nation (NPI 1881320711)

Field	Value
Entity Type	Organization
Organization	Quinault Indian Nation
Address	511 W Heron Street
City	Aberdeen
State	WA
ZIP	98520
Taxonomy	Substance Use Disorder Rehabilitation Clinic/Center
NPI Enumerated	July 25, 2022

Payer Source	Total Paid
Medicaid	$39.3M
Medicare	$0

Key Findings

QUINAULT INDIAN NATION is effectively a Medicaid-focused substance use disorder rehabilitation clinic: it has no Medicare billing on file and reports $39.3M in lifetime Medicaid revenue, indicating operations and reimbursement activity are concentrated in the Medicaid program rather than Medicare. The provider’s NPI was enumerated on 2022-07-25 (~4 years ago), so this Medicaid revenue has been generated during a relatively short tenure since enrollment.

Medicaid revenue is extremely concentrated in a single all-inclusive clinic encounter code: T1015 accounts for $36.7M or 93.6% of the provider’s total Medicaid revenue, and the precomputed top-3 codes together account for 96.5% of Medicaid revenue. This concentration implies the organization bills primarily bundled clinic visit/encounter services rather than a diverse mix of discrete procedure codes.

The code mix and top codes align with a clinic-based behavioral health and SUD service model. High volume for T1015 (clinic visit/encounter, all-inclusive) combined with counseling and group/behavioral health codes such as H0004, 96164, and 96165, and medication service H0020, point to routine clinic encounters, group psychotherapy or multi-patient sessions, and medication-assisted treatment components in the service offering. These patterns are consistent with a substance use disorder rehabilitation clinic that delivers bundled outpatient visits plus counseling and medication services.

Despite very high absolute volume for T1015, the provider’s in-state competitive standing for that code is typical rather than dominant: T1015 ranks #45 of 652 providers in Washington (93rd percentile), which places the clinic above many peers but still within a broad band of providers delivering similar volumes. The other high-volume codes show generally strong percentiles (for example, 96164 and 96165 are in the 89th percentile statewide), indicating above-typical utilization for group behavioral services but not extreme outlier status.

Several ancillary services appear at much lower revenue shares, reflecting a narrow revenue base beyond the main clinic encounter. H0004 ($613.3K, 1.6% of Medicaid revenue), 96165 ($526K, 1.3%), and 96164 ($468.4K, 1.2%) individually contribute small shares relative to T1015, suggesting the clinic’s financial model relies on high-volume bundled encounters with supplemental billing for discrete counseling and group therapy units. Other codes such as H0020, 99212, and H0001 each contribute under 1% of Medicaid revenue, further underscoring limited diversification of reimbursement sources.

Operationally, the listing of group/session codes with large claim counts (e.g., 96164 and 96165 with ~21K claims each) implies the clinic uses multi-patient behavioral health formats and shorter per-patient reimbursements (low avg paid/claim of $22–$25). That combination supports a throughput-focused outpatient program delivering many brief, standardized encounters rather than infrequent high-intensity individual services.

From a payer/contracting perspective, the absence of Medicare revenue means payer mix is effectively single-payer (Medicaid). For payers or care-management programs evaluating capacity or network adequacy, this provider should be viewed as a Medicaid-serving SUD clinic with limited exposure to Medicare populations, which may influence contracting priorities, reimbursement expectations, and care coordination responsibilities tied to Medicaid beneficiaries.

Medicaid: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	66,570	$550	$36.7M
H0004	Behavioral health counseling and therapy, per 15 minutes	8,070	$80	$613.3K
96165	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	21,040	$30	$526K
96164	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	21,290	$20	$468.4K
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	19,890	$20	$377.9K
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,…	4,000	$30	$135.8K
H0001	Alcohol and/or drug assessment	810	$140	$114.7K
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…	820	$100	$78K
H0033	Oral medication administration, direct observation	5,170	$10	$62K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	2,670	$10	$34.7K

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Quinault Indian Nation — 0 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	45	650	4,110	$250	$4.9M
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	30	60	18,030	$10	$4.1M
H0004	Behavioral health counseling and therapy, per 15 minutes	71	320	2,080	$60	$495.5K
96165	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	25	220	2,880	$50	$431K
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…	1,706	1,820	480	$60	$379.6K
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…	1,465	1,860	610	$40	$295.5K
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…	428	930	680	$60	$259.2K
H0038	Self‑help/peer services, per 15 minutes	98	130	990	$30	$192.6K
96164	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	26	230	3,070	$20	$135.6K
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…	441	540	130	$90	$128.6K

Showing 1–10 of 28

Nearby Providers

Other providers in the same ZIP code as Quinault Indian Nation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Grays Harbor Community Hospital	WA	General Acute Care Hospital	$0	$34M
Wchs, Inc.	WA	Methadone Clinic	$596.7K	$12.2M
Grays Harbor Community Hospital	WA	Rural Health Clinic/Center	$0	$11.3M
Harbor Kids Dental PLLC	WA	General Practice Dentistry	$0	$10.9M
Coastal Community Action Program	WA	Case Manager/Care Coordinator	$0	$9.9M
City Of Aberdeen	WA	Ambulance	$440.4K	$5.1M
Sea Mar Community Health Centers	WA	Federally Qualified Health Center (FQHC)	$0	$5M
Sea Mar Community Health Centers	WA	Federally Qualified Health Center (FQHC)	$0	$3.3M
Renal Care Group Northwest, Inc.	WA	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.8M
Lincare Inc.	WA	Durable Medical Equipment & Medical Supplies	$0	$2.8M

Quinault Indian Nation — 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

Nearby Providers

Frequently Asked Questions

References