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.

Providence Health & Services - Oregon (NPI 1912282369)

Key Findings

Field	Value
Entity Type	Organization
Organization	Providence Health & Services - Oregon
Address	1500 Division St
City	Oregon City
State	OR
ZIP	97045
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 18, 2011

Payer Source	Total Paid
Medicaid	$19.5M
Medicare	$0

This provider is effectively a Medicaid-only biller: Medicare shows none (no Medicare billing on file) while total Medicaid revenue is $19.5M, so all reported fee-for-service revenue in the dataset is concentrated in Medicaid. That single-payer footprint creates exposure to Medicaid reimbursement and utilization trends rather than Medicare policy shifts.

Revenue is highly concentrated in emergency department E/M codes: the top three Medicaid codes (99285, 99284, 99283) account for 84.3% of the provider's total Medicaid revenue, with 99285 generating $6.6M (33.8%), 99284 $6.2M (31.6%), and 99283 $3.7M (18.9%). This concentration indicates the ED is the primary revenue driver for the facility.

Operational profile is consistent with high ED throughput across acuity levels: claims volumes are large for the three ED codes (17.9K for 99285, 22.3K for 99284, 20.6K for 99283) and the revenue mix skews toward higher-acuity visits (combined share heavily weighted to 99285 and 99284). Taken together, the code mix and volumes point to an acute-care hospital operating a busy emergency department handling a broad range of severity.

Competitive standing for core ED billing is modest rather than dominant statewide: 99285 ranks #26 of 129 providers in-state (80th percentile; typical, unremarkable volume for this code), 99284 ranks #43 of 145 providers in-state (71th percentile; typical, unremarkable volume for this code), and 99283 ranks #46 of 137 providers in-state (67th percentile; typical, unremarkable volume for this code). These placements indicate typical peer-level ED activity rather than a leading statewide market share for ED E/M revenue.

Infusion and IV administration codes show above-typical state activity relative to peers: 96374 ($1.8M revenue) ranks #5 of 62 providers in-state (93th percentile; typical, unremarkable volume for this code), 96375 ($370.7K) ranks #4 of 63 providers in-state (95th percentile; typical, unremarkable volume for this code), and 96361 ($294.9K) ranks #2 of 51 providers in-state (98th percentile; notably above typical state volume for this code). Those high ranks and percentiles suggest the hospital delivers a substantial volume of IV medications and fluids, consistent with emergency and acute inpatient care patterns.

Lab and imaging activity is visible but mixed in contribution: multiplex respiratory testing 87636 produced $215K (2.8K claims, ranks #4 of 22, 86th percentile) and CT/chest radiography codes appear among top services, while high-volume lab panels show large claim counts with no paid amounts on file (85025: 36.2K claims, $0 avg paid/claim, $0 revenue; 80053: 34.1K claims, $0 avg paid/claim, $0 revenue). The $0 paid entries likely reflect bundling, non–fee-for-service arrangements, or reporting artifacts and suggest substantial diagnostic throughput not visible in paid-revenue totals.

The provider has been enumerated for an extended period, listed as NPI enumerated 2011-10-18 (~15 years ago), indicating multi-year operational tenure in the market which supports established referral and service patterns observed in the Medicaid data.

Business risk implication: because 84.3% of Medicaid revenue is tied to three ED E/M codes and there is no Medicare revenue on file, the provider faces concentrated revenue risk from changes in ED utilization or Medicaid payment policies. Payer and service-line concentration suggests monitoring Medicaid reimbursement trends and ED visit volumes will be central to forecasting the provider's near-term revenue trajectory.

Medicaid: Complete Services Breakdown

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

61 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	17,900	$370	$6.6M
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.	22,260	$280	$6.2M
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.	20,570	$180	$3.7M
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	15,820	$110	$1.8M
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	9,760	$40	$370.7K
96361	The provider administers intravenous, or IV, fluids with electrolytes through an already established intravenous route for each additional hour to treat more severe dehydration.	8,940	$30	$294.9K
87636	The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic…	2,760	$80	$215K
G0463	Hospital outpatient clinic visit for assessment and management of a patient	1,540	$70	$112.2K
71045	In this diagnostic procedure, the provider performs a single radiological view of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and nearby…	2,130	$50	$106.5K
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…	1,700	$30	$54.4K

Showing 1–10 of 61

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

Providence Health & Services - Oregon — 2 of 23 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

61 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.	43	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.	26	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.	46	140	10,160	$130	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	29	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.	5	60	3,620	$90	$623.7K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	33	60	420	$60	$405.1K
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…	55	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.	69	80	1,130	$90	$327.2K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	42	80	1,210	$40	$294.3K
74177	The provider performs computed tomography of the abdomen and pelvis with contrast material to diagnose the cause of abdominal or pelvic pain or other abnormalities of the internal organs.	55	100	250	$80	$268K

Showing 1–10 of 61

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charles Cannan	AZ	Cardiovascular Disease Physician	$114K	$0
Aly Rahimtoola	OR	Cardiovascular Disease Physician	$102.9K	$0
Kevin Woolf	OR	Cardiovascular Disease Physician	$86.9K	$0
Alexander Morss	OR	Cardiovascular Disease Physician	$86.6K	$0
Kristina Moon	OR	Cardiovascular Disease Physician	$84.7K	$0
Geoffrey Wilson	OR	Cardiovascular Disease Physician	$80.5K	$0
Veselina Korcheva	OR	Dermatopathology (Pathology) Physician	$75.6K	$0
Dale Hirsch	OR	Cardiovascular Disease Physician	$74.5K	$0
Craig Walsh	OR	Cardiovascular Disease Physician	$72.9K	$0
Michael Layoun	OR	Cardiovascular Disease Physician	$72.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Clackamas County	OR	Federally Qualified Health Center (FQHC)	$0	$26M
Bryan Harvey	OR	Oral and Maxillofacial Pathology Dentistry	$0	$4.8M
New Proactive LLC	OR	Physical Therapy Clinic/Center	$0	$4.7M
Emergency Medicine Specialists LLC	OR	Emergency Medicine Physician	$0	$4.1M
Oregon City Medical Nw Inc.	OR	Family Medicine Physician	$0	$2.3M
Cascadia Health	OR	Mental Illness Community Based Residential Treatment Facility	$0	$2.3M
Uptown Providers PC	OR	Urgent Care Clinic/Center	$0	$2.2M
County Of Clackamas Office Of County Auditor	OR	Case Management Agency	$0	$1.6M
Neurotherapeutic Pediatric Therapies Inc	OR	Occupational Therapist	$0	$1.6M
Willamette Falls Pediatric Group	OR	Pediatrics Physician	$0	$1.5M

Providence Health & Services - Oregon — 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