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NPI 1902827272 · Portland, OR · Clinic/Center
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Legacy Clinics LLC is a clinic/center provider located in Portland, Oregon. This profile covers 15 Medicare and 153 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Legacy Clinics LLC |
| Address | 1130 Nw 22nd Ave Ste 220 |
| City | Portland |
| State | OR |
| ZIP | 97210 |
| Taxonomy | Clinic/Center |
| NPI Enumerated | July 22, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $48.7M |
| Medicare | $35.6K |
Payer mix is highly skewed toward Medicaid: LEGACY CLINICS LLC reported $48.7M in lifetime Medicaid revenue versus only $35.6K in lifetime Medicare revenue, indicating the organization operates effectively as a Medicaid-dominant clinic. The Medicare footprint exists but is immaterial in scale compared with Medicaid, so strategic changes to Medicaid reimbursement or volumes would have outsized impact on overall revenue.
Medicare revenue is tightly concentrated in imaging: the provider's top three Medicare codes (77067, 77063, 77080) account for 77.2% of its total Medicare revenue, and these codes are all radiology/imaging services (screening mammography, tomosynthesis, and DXA bone density). National ranks for these codes are middling — 77067 at the 52th percentile, 77063 at the 51th percentile, and 77080 at the 68th percentile — which describes a typical, unremarkable national profile rather than a specialized national imaging center.
By contrast, Medicaid revenues are driven by high-volume evaluation & management (E/M) visits: the provider's top three Medicaid codes account for 51.5% of Medicaid revenue and are dominated by office/hospital E/M codes such as 99213, 99214, and 99203. Those E/M codes have extremely high in‑state ranks (for example, 99213 ranks #4 of 1591 and 99203 ranks #1 of 596) and are labeled in the data as "extreme outlier, far above typical state volume," signaling that ambulatory E/M is the operational core of the business under Medicaid.
The provider is a major in-state billing presence across many Medicaid codes: multiple high-volume Medicaid codes (99213, 99214, 99203, 99233, 99291, 87635 and others) are ranked at #1 or in the top several positions in-state and are described as "extreme outlier, far above typical state volume." This pattern shows dominant statewide scale in both routine office visits and certain high-acuity services (e.g., 99291 critical care), implying broad service capacity beyond simple outpatient clinic work.
Medicaid billing breadth extends beyond office visits to inpatient/observation and procedural services: the Medicaid top-25 list includes substantial volumes and top in-state ranks for inpatient/subsequent hospital E/M codes (99233, 99232, 99223, 99222), critical care (99291), high-volume SARS‑CoV‑2 testing (87635), and obstetric/fetal imaging (76816, 76811). Together these entries indicate the Medicaid business line supports both ambulatory care and higher-acuity or specialty services, rather than a narrow single-service practice.
Although Medicaid volume is extreme in-state, the provider is only a modest national participant on Medicare imaging codes: Medicare code 77067 (mammography) ranks #7327 of 15198 (52th percentile) and 77063 ranks #7015 of 14277 (51th percentile), each described as "typical, unremarkable volume for this code." This contrast—dominant in-state Medicaid activity but typical national Medicare imaging volume—suggests the organization’s competitive standing is locally powerful but not nationally differentiated.
The clinic has an established tenure in the data: its NPI was enumerated on 2006-07-22 (~20 years ago). Long enumeration combined with the large Medicaid footprint suggests sustained in-state relationships and scale, which helps explain the repeated top-state rankings across multiple service lines.
Business sensitivity: because Medicare represents only $35.6K of lifetime revenue while Medicaid represents $48.7M, the provider’s financial profile is highly sensitive to Medicaid policy, contract changes, or utilization shifts. Operationally, any payer or programmatic changes that affect high-volume Medicaid codes (for example, 99213, 99214, 99203, 99291, 87635) would likely have substantially larger financial consequences than changes to the modest Medicare imaging business.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 77067 | The provider takes two X–ray views of each breast for routine screening and may use specially designed computer software to help identify any potential abnormalities within the images; the software… | 230 | $80 | $17.4K |
| 77063 | The provider captures three dimensional images of the breast using X–rays at various angles for routine checkup. He checks for the presence of any abnormality within the breasts. Tomosynthesis… | 230 | $30 | $5.9K |
| 77080 | The provider performs an imaging procedure, called dual–energy X–ray absorptiometry (DXA), of one or more bony areas on the trunk to determine the bone mineral density (BMD) and whether the patient… | 140 | $30 | $4.2K |
| 71046 | In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and… | 160 | $20 | $2.4K |
| 72100 | The technician takes 2 or 3 views of the vertebrae in the lumbar region which is the lower part of the spine and the sacrum, the area that connects the spine to the pelvis. Lumbosacral spine X–rays… | 40 | $20 | $950 |
| 73564 | In this procedure, the provider takes four or more X–ray views of the knee joint to check for any fracture, swelling, or reason for pain in the knee area. | 40 | $20 | $870 |
| 73502 | In this diagnostic procedure, the provider takes X–ray images of one hip, either left or right, from two or three projections (directions or angles) to check for any fracture, swelling, or other… | 40 | $20 | $840 |
| 73030 | This particular procedure is for a minimum of 2 X–ray views of the complete shoulder. | 40 | $20 | $580 |
| 73130 | In this procedure, the provider takes a minimum of three X–ray images of a patient’s hand to check for any fracture, swelling, or reason of pain in the hand. | 20 | $20 | $510 |
| 72040 | The patient has a 2– or 3–view X–ray of the neck vertebrae. | 20 | $20 | $440 |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
153 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… | 165,870 | $70 | $10.8M |
| 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… | 101,180 | $80 | $8.4M |
| 99203 | The provider sees a new 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 provider… | 59,290 | $80 | $4.9M |
| 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… | 72,920 | $60 | $4.2M |
| 99291 | Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is… | 28,420 | $130 | $3.8M |
| 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… | 82,290 | $40 | $3.4M |
| 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… | 12,000 | $130 | $1.5M |
| 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,… | 35,330 | $40 | $1.5M |
| 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… | 35,310 | $40 | $1.4M |
| 76816 | The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound. | 14,820 | $100 | $1.4M |
Showing 1–10 of 153
How this provider's Medicaid billing volume and revenue compare to other Oregon providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oregon median
153 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. | 124 | 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. | 113 | 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. | 121 | 140 | 10,160 | $130 | $2.3M |
| J0585 | Injection, onabotulinumtoxina, 1 unit | 14 | 20 | 470 | $460 | $398.7K |
| 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. | 61 | 80 | 1,130 | $90 | $327.2K |
| 99291 | Critical care services include the treatment of vital organ failure or prevention of further life–threatening conditions. Delivering medical care in a moment of crisis and in time of emergency is… | 1 | 40 | 380 | $130 | $326.9K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 17 | 40 | 310 | $420 | $325.7K |
| 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… | 8 | 1,500 | 650 | $70 | $312.4K |
| 19318 | Breast reduction is the removal of excess breast tissue which results from top scarring, calcification, or architectural distortion. | 3 | 10 | 70 | $3,270 | $268K |
| 97530 | The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity. | 284 | 290 | 770 | $60 | $252K |
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Other providers in the same ZIP code as Legacy Clinics LLC, ranked by combined Medicare and Medicaid revenue.
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