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.

Lower Brule Health Center Ihs (NPI 1881719425)

Key Findings

Field	Value
Entity Type	Organization
Organization	Lower Brule Health Center Ihs
Address	601 Gall Street
City	Lower Brule
State	SD
ZIP	57548
Taxonomy	Clinic/Center
NPI Enumerated	March 20, 2007

Payer Source	Total Paid
Medicaid	$6.3M
Medicare	$0

This provider is effectively a Medicaid-focused clinic: there is no Medicare billing on file while total Medicaid revenue is $6.3M, so payment activity is dominated by a single public payer rather than a mixed Medicare/Medicaid practice. The absence of any Medicare revenue on file indicates the provider’s financial footprint and payer risk are concentrated entirely in Medicaid.

Revenue is highly concentrated in a very small set of services: the precomputed top 3 Medicaid codes by revenue account for 92.5% of this provider's total Medicaid revenue. In particular, 99213 alone accounts for $5.3M (84.1% of Medicaid revenue), making routine established outpatient visits the dominant revenue driver for the organization.

The code mix and top drivers indicate an ambulatory primary-care and community clinic operating model: 99213 (established patient E/M visits) is the primary revenue source, supplemented by point-of-care testing and immunization activity (87635 COVID testing and 90471 vaccine administration). This pattern—high E/M volume combined with high-volume diagnostic testing and immunizations—is consistent with an integrated clinic that provides same-day testing and vaccinations alongside routine outpatient care.

Competitive standing on the primary revenue code 99213 is strong within the state: the provider ranks #37 of 344 in-state (90th percentile) for 99213 volume, which indicates a relatively high statewide share of established outpatient visit volume even though the underlying note classifies that volume as "typical, unremarkable" compared with large institutional peers. In short, the clinic is a meaningful statewide participant for routine ambulatory visits despite Medicaid being its near-exclusive payer.

Diagnostic testing and specimen services are a notable outlier area: 87635 (COVID nucleic acid testing) is 3.2K claims and $354K revenue and ranks #2 of 37 in-state (97th percentile), described as "notably above typical state volume." Other test codes also show elevated standing—87804 (rapid flu) ranks #4 of 66 (95th percentile) and 81002 (dipstick urinalysis) ranks #1 of 9 (100th percentile)—signaling above-typical testing activity relative to peers. These lab/testing volumes position the clinic as a regional hub for infectious disease testing and basic point-of-care diagnostics.

Immunization and injection services contribute meaningfully but at much smaller scale than E/M visits: 90471 (vaccine administration) generated $176.3K (2.8% of Medicaid revenue) and ranks #46 of 159 in-state (72nd percentile), while 96372 (therapeutic/prophylactic injection) produced $94.5K (1.5% of Medicaid revenue) and ranks #18 of 69 (75th percentile). Together these codes show a steady immunization and injection practice consistent with primary-care preventive services rather than a specialty immunization clinic.

Many laboratory and specimen codes appear across the top code list but generate low per-claim payments and modest overall revenue, indicating high-volume, low-acuity testing: examples include 85025 (CBC) with 1K claims and $18 avg paid/claim, 87651 (Strep A NAAT) with 1.3K claims and $40 avg paid/claim, and multiplex influenza/respiratory codes such as 87502 with 1.3K claims and $3 avg paid/claim. This pattern reflects operational emphasis on in-office, rapid diagnostics that support ambulatory visits rather than high-revenue specialty lab services.

The provider has an established operational tenure: the NPI was enumerated on 2007-03-20 (~19 years ago), suggesting a long-standing presence in its community. Combined with the concentrated Medicaid revenue base and the code mix dominated by routine E/M, testing, and vaccinations, the data portray a stable community clinic model serving primarily Medicaid patients with strong state-level testing and E/M volumes.

Medicaid: Complete Services Breakdown

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

35 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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…	11,740	$450	$5.3M
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…	3,220	$110	$354K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	1,060	$170	$176.3K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	640	$150	$94.5K
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,…	150	$480	$73.1K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	1,350	$40	$53.8K
W0037	N/A	2,630	$20	$42K
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…	80	$480	$39.6K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	60	$610	$38.3K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	440	$60	$26.6K

Showing 1–10 of 35

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

Lower Brule Health Center Ihs — 3 of 23 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

35 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…	37	340	1,010	$100	$511K
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…	217	260	860	$80	$222.6K
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…	44	50	410	$80	$127.2K
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,…	90	160	210	$120	$97.4K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	51	110	990	$20	$82.9K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	46	160	180	$40	$59.6K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	14	50	420	$30	$54.1K
0072A	N/A	19	30	60	$280	$51.1K
W0037	N/A	42	160	690	$20	$50.1K
0071A	N/A	14	30	70	$240	$48.5K

Showing 1–10 of 35

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lower Brule Mental Health	SD	Community/Behavioral Health Agency	$0	$440.2K
Lower Brule Sioux Tribe	SD	Non-emergency Medical Transport (VAN)	$0	$307K
Lower Brule Sioux Tribe	SD	Land Ambulance	$21K	$66.9K

Lower Brule Health Center Ihs — Billing Profile & Reimbursement Data

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Lower Brule Health Center Ihs — 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