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 Clinic (NPI 1881610889)

Key Findings

Field	Value
Entity Type	Organization
Organization	Sanford Clinic
Address	1600 W 22nd St
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Pediatrics Physician
NPI Enumerated	July 14, 2006

Payer Source	Total Paid
Medicaid	$5.5M
Medicare	$0

This provider effectively operates as a Medicaid-focused pediatric practice: there is no Medicare billing on file while total Medicaid revenue is $5.5M, so the provider’s entire reported payer scale in these datasets is concentrated in Medicaid. That single-payer footprint means analysis of utilization and competitive standing should be interpreted in a Medicaid-specific context rather than across mixed Medicare/Medicaid performance.

Revenue concentration is meaningful at the code level: the top three Medicaid codes — 99480 ($806.9K), 99214 ($593.5K), and 99469 ($588.8K) — together account for 39.0% of the provider’s total Medicaid revenue. Those three codes drive a large share of dollars, so changes in neonatal or higher-complexity outpatient E/M demand would disproportionately affect overall revenue.

The code mix shows a clear neonatal and neonatal critical care orientation: high-revenue neonatal codes 99480 (4.5K claims, $806.9K), 99469 (1.5K claims, $588.8K), 99472 (1.6K claims, $553.9K), 99479 (2.8K claims, $347.3K), 99468 (185 claims, $144.3K) and 99477 (230 claims, $72K) indicate frequent management of low birth weight and neonatal critical care patients. This pattern implies the provider supports NICU-level services and follow-up care for newborns and young infants as a major service line.

Competitive standing is mixed by service line: for outpatient E/M the provider ranks strongly — 99214 is #17 of 260 providers in-state at the 94th percentile, indicating a high statewide presence for established pediatric visits. By contrast, neonatal codes show more modest statewide rank positions (e.g., 99480 is #2 of 4, 67th percentile; 99469 is #3 of 4, 33rd percentile), so the provider is an important but not dominant neonatal claimant in-state.

The provider appears to be a regional leader in pediatric cardiac imaging: 93303 ($119K) ranks #1 of 5 providers in-state at the 100th percentile, 93304 ($57.7K) ranks #1 of 3 at the 100th percentile, and 93320 ($45.4K) ranks #1 of 5 at the 100th percentile. These #1 rankings for multiple echocardiography codes suggest an in-house echo capability or a referral-oriented pediatric cardiology service supporting congenital heart disease workflows.

Case-mix intensity spans outpatient, inpatient, and consult services: high-volume E/M codes (99214 $593.5K; 99213 $336.8K; 99215 $150.9K) plus inpatient/subsequent care (99232 $230.4K; 99233 $133.6K) and inpatient consults (99254 $72.8K; 99253 $43.4K) indicate an integrated practice that manages both ambulatory visits and inpatient pediatric care. This breadth supports the inference that the organization provides episodic and continuous care across settings rather than only office-based pediatrics.

Although several codes show high rank or dollar contribution, the dataset repeatedly classifies volumes as "typical, unremarkable volume for this code" for many entries; even where percentiles are high (for example 99214 at the 94th percentile), the statistical label attached remains typical. In short, the provider shows focused strengths (neonatal services and echoes) without being an extreme statistical outlier across most listed codes.

The NPI tenure indicates long-standing presence: enumeration date ~2006-07-14 (~20 years ago), which supports interpreting observed specialty mix and market position as the result of an established practice rather than a recent entrant. That longevity, combined with $5.5M in Medicaid revenue and concentrated neonatal/echo activity, suggests stable programmatic capability in pediatric inpatient and diagnostic services.

Medicaid: Complete Services Breakdown

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

62 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	4,510	$180	$806.9K
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…	10,230	$60	$593.5K
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	1,510	$390	$588.8K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	1,600	$350	$553.9K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	2,760	$130	$347.3K
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…	8,860	$40	$336.8K
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…	5,240	$40	$230.4K
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…	1,780	$90	$150.9K
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	190	$780	$144.3K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2,260	$60	$133.6K

Showing 1–10 of 62

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 Clinic — 3 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

62 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99469	The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting, after the first day.	3	10	2,010	$410	$839.2K
99480	The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.	2	10	3,630	$180	$789.6K
99472	The provider performs follow up care of a critically ill infant or young child, 29 days through 24 months of age, in an inpatient setting.	2	10	1,710	$380	$640.5K
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…	49	340	1,010	$100	$511K
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	2	10	2,410	$130	$344.9K
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	2	10	110	$40	$284.6K
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…	17	260	860	$80	$222.6K
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…	11	70	400	$40	$172.5K
99468	The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.	2	10	140	$770	$165.1K
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…	164	190	430	$90	$154.1K

Showing 1–10 of 62

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	General Acute Care Hospital	$0	$24.4M
Sanford Medical Center	SD	Clinical Medical Laboratory	$1.8M	$18M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Sanford Health Network	MN	Rural Acute Care Hospital	$0	$7.6M
Sanford Health Network	IA	Family Medicine Physician	$0	$6.6M
Sanford Clinic	SD	Diagnostic Radiology Physician	$0	$6M
Sanford Health Network	SD	General Acute Care Hospital	$0	$4.4M

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 Clinic — Billing Profile & Reimbursement Data

Sign up for Sanford Clinic — Billing Profile & Reimbursement Data policy alerts

Sanford Clinic — Billing Profile & Reimbursement Data

Sign up for Sanford Clinic — Billing Profile & Reimbursement Data policy alerts

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