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

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

Planned Parenthood/orange And San Bernardino Counties, Inc. (NPI 1912976408)

Field	Value
Entity Type	Organization
Organization	Planned Parenthood/orange And San Bernardino Counties, Inc.
Address	700 S Tustin St
City	Orange
State	CA
ZIP	92866
Taxonomy	Clinic/Center
NPI Enumerated	March 16, 2006

Payer Source	Total Paid
Medicaid	$229.2M
Medicare	$0

Key Findings

This entity is effectively single-payer in scale: there is no Medicare billing on file and all reported lifetime federal program revenue is Medicaid-only, totaling $229.2M. The absence of Medicare activity means analyses of payer mix and reimbursement exposure should focus on state Medicaid policy and contracts rather than dual-payer dynamics.

Revenue is concentrated in a small set of procedures: the precomputed top three Medicaid codes (99214, J7307, 99213) account for 32.7% of the provider's total Medicaid revenue. Specifically, 99214 generated $28.9M (13.2%), J7307 generated $22.7M (10.4%), and 99213 generated $19.9M (9.1%), indicating a heavy dependence on established-patient E/M encounters and contraceptive implant services.

The code mix points clearly to a reproductive health and family-planning service model: high-revenue contraceptive device codes (J7307, J7298, J7304, J7300), medication and procedural abortion codes (S0199, 59840), and IUD services (58300) dominate the top billing lines. This pattern — combined with large volumes of contraceptive supply claims such as S4993 and A4267 — suggests core operations are centered on contraceptive provision, LARC insertion/removal, and abortion care.

Preventive screening and diagnostics are an operational focus, with extremely large testing volumes reported: 87491 (593.2K claims, $17.8M, ranks #4, labeled extreme outlier), 87591 (582.9K claims, $16.9M, ranks #4, extreme outlier), 87806 (217K claims, $5.2M, ranks #2, extreme outlier), and 81025 (586.9K claims, $1.8M, ranks #1, extreme outlier). These high claim counts for Chlamydia, Gonorrhea, HIV, and pregnancy testing indicate routine, high-throughput screening workflows integrated with ambulatory visits.

On ambulatory E/M activity, this provider reports exceptional volume: 99213 (231.8K claims, $19.9M), 99214 (218.7K claims, $28.9M), 99203 (48.1K claims, $10.9M), and related new-patient codes together represent a major share of visit-based revenue. The combination of high per-claim volumes and E/M revenue shows the organization operates at scale as a clinic/center delivering both routine and higher-complexity outpatient visits.

Competitive standing within California is dominant for multiple reproductive-health codes: the provider ranks #1 in-state for J7307, S4993, S0199, J7298, J7304, J7300, 58300, A4267, 11976, and 59840, and is in the 100th percentile for many of these lines (explicitly labeled extreme outlier). Where not #1, it still appears far above typical state volumes (e.g., 87491 and 87591 rank #4 but are called extreme outliers), which collectively identify the provider as a statewide leader in contraceptive services, STI/pregnancy testing, and abortion-related care.

The provider’s long tenure is consistent with its scale: the NPI was enumerated on 2006-03-16 (~20 years ago), indicating an established presence in the market and time to build high-volume service lines and referral relationships. That longevity helps explain the depth of procedure-specific volume and the number of codes where it ranks at or near the top statewide.

The combination of high Medicaid concentration ($229.2M) and a top-3-code share of 32.7% creates a measurable revenue exposure to Medicaid reimbursement and policy changes that affect contraceptive care, abortion services, and outpatient E/M rates. Given the provider’s dominance on many in-state codes, any state-level coverage or rate adjustments for family-planning and STI screening services could materially affect its financials and operational throughput.

Medicaid: Complete Services Breakdown

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

104 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	218,700	$130	$28.9M
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	26,000	$870	$22.7M
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…	231,810	$90	$19.9M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	593,190	$30	$17.8M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	582,900	$30	$16.9M
S4993	Contraceptive pills for birth control	101,120	$140	$13.8M
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…	48,120	$230	$10.9M
S0199	Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to…	20,720	$480	$10M
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…	33,780	$250	$8.5M
J3490	Unclassified drugs	216,630	$40	$8M

Showing 1–10 of 104

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

Planned Parenthood/orange And San Bernardino Counties, Inc. — 25 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

104 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S0199	Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to…	1	120	220	$440	$417.3K
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…	1,551	4,290	780	$140	$400.1K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	1	250	120	$850	$378K
S4993	Contraceptive pills for birth control	1	210	1,290	$110	$295.6K
J7298	Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg	1	90	60	$740	$268.1K
S5001	Prescription drug, brand name	4	30	230	$30	$195.7K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	4	1,140	530	$20	$195.6K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	4	1,270	450	$20	$183.5K
59840	In this procedure, the provider deliberately terminates a pregnancy for elective or therapeutic reasons. He removes the fetus and products of conception by dilating the cervix and then using a…	1	50	180	$180	$180.1K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	773	1,950	500	$80	$179K

Showing 1–10 of 104

Nearby Providers

Other providers in the same ZIP code as Planned Parenthood/orange And San Bernardino Counties, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Onsite Transportation Services, LLC	CA	Non-emergency Medical Transport (VAN)	$0	$30.9M
Bryn Henderson	CA	Family Medicine Physician	$1.6M	$0
Michael Mortazie	CA	MOHS-Micrographic Surgery Physician	$482.8K	$0
Khasha Touloei	CA	Dermatology Physician	$351.4K	$0
Pravin Sharma	CA	Internal Medicine Physician	$262.2K	$0
Lawrence Ehrlich	CA	Family Medicine Physician	$196K	$0
Thomas Hryniewicki	CA	Internal Medicine Physician	$161.7K	$0

Planned Parenthood/orange And San Bernardino Counties, Inc. — Billing Profile & Reimbursement Data

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Planned Parenthood/orange And San Bernardino Counties, Inc. — 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