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.

City Of Sioux Falls (NPI 1932295888)

Field	Value
Entity Type	Organization
Organization	City Of Sioux Falls
Address	521 N Main Ave
City	Sioux Falls
State	SD
ZIP	57104
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	October 5, 2006

Payer Source	Total Paid
Medicaid	$8.6M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $8.6M in Medicaid revenue, so its entire documented commercial claims footprint for the period is effectively single‑payer Medicaid. The absence of Medicare activity means comparisons and strategy should be focused on Medicaid policy, rates, and in‑state competitive dynamics rather than Medicare program considerations.

Revenue is highly concentrated in a small set of outpatient evaluation and dental codes: the precomputed top 3 Medicaid codes by revenue account for 42.2% of this provider's total Medicaid revenue. In particular, 99213 generates $2.1M (26.4%), 99214 generates $727.2K (9.3%), and D0120 generates $511.8K (6.5%), so a large share of Medicaid dollars flows through a handful of primary care E/M and dental exam services.

The code mix indicates a hybrid FQHC operating model that combines routine primary care E/M visits with a substantial dental program. High revenue from 99213 and 99214 (office E/M for established patients) alongside D0120, D1110 ($475.8K), and D0150 ($403.4K) points to co‑located primary care and dental clinics delivering regular chronic care, preventive visits, and dental exams.

Preventive pediatric and immunization services are material to the clinic’s service mix: 90471 accounts for $386.1K (4.9%) and 90472 contributes $72.3K (0.9%), while dental preventive codes such as D1351 (sealant) add $157.3K (2.0%). These lines suggest a meaningful investment in childhood preventive care and school‑age oral health services within the Medicaid population.

The provider also reports substantial laboratory and specimen activity consistent with onsite or closely affiliated ancillary services: 36415 (venipuncture) produced $307.6K (3.9%), 85025 produced $113.8K (1.4%), and panels such as 80053 and 80048 produced $83.9K (1.1%) and $69.8K (0.9%) respectively. This spread of lab codes supports a model of integrated primary care with routine diagnostics bundled into ambulatory visits.

State competitive standing is uneven but strong in dental and FQHC visit measures: D1110 ranks #4 of 144 providers in‑state (98th percentile; notably above typical state volume) and D0150 ranks #3 of 108 (98th percentile; notably above typical state volume), showing above‑typical dental volume. The G0467 FQHC visit code ranks #1 of 9 providers in‑state (100th percentile; notably above typical state volume), indicating this FQHC is a leading Medicaid FQHC visitor among a small set of peers even though the absolute revenue for that code is $92.7K (1.2%).

For primary care E/M volumes, 99213 is at the 95th percentile statewide (ranks #18 of 344; labeled “typical, unremarkable volume”), and 99214 is at the 91st percentile (ranks #25 of 260; labeled “typical, unremarkable volume”), which together indicate strong but not outlier primary‑care throughput compared with many in‑state peers. Analysts should therefore view the provider as a solid regional participant in established‑patient visits rather than an extreme outlier in E/M volume.

The provider’s NPI has been active since 2006-10-05 (~20 years ago), reflecting long tenure in the market; combined with Medicaid‑centric revenue and concentrated top codes (42.2% in the top three), this suggests both an established operational footprint and exposure: significant revenue sensitivity to Medicaid reimbursement or utilization shifts in E/M and dental exam lines should be a focus for risk and contract evaluations.

Medicaid: Complete Services Breakdown

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

102 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…	19,040	$110	$2.1M
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…	6,800	$110	$727.2K
D0120	Periodic oral evaluation - established patient	6,480	$80	$511.8K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	5,730	$80	$475.8K
D0150	Comprehensive oral evaluation – new or established patient	4,530	$90	$403.4K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	3,580	$110	$386.1K
D1120	Prophylaxis–child	4,190	$90	$369K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	7,890	$40	$307.6K
D2392	Post 2 surface resin‑based composite	2,890	$110	$306.3K
D2391	Resin‑based composite – one surface, posterior	3,260	$90	$302.8K

Showing 1–10 of 102

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

City Of Sioux Falls — 7 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

102 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…	18	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…	25	260	860	$80	$222.6K
90832	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…	57	70	200	$80	$176.7K
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…	69	190	430	$90	$154.1K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	7	40	260	$90	$151.5K
D1351	Sealant - per tooth	6	50	400	$30	$117.3K
D2391	Resin‑based composite – one surface, posterior	4	40	150	$80	$115.5K
D2330	Resin-based composite - one surface, anterior	6	10	500	$90	$101.9K
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…	62	70	130	$100	$99K
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,…	122	160	210	$120	$97.4K

Showing 1–10 of 102

Related Providers

Other providers that share a Tax Identification Number (TIN) with City Of Sioux Falls, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
City Of Sioux Falls	SD	Federally Qualified Health Center (FQHC)	$0	$210.4K
City Of Sioux Falls	SD	Federally Qualified Health Center (FQHC)	$0	$126K
City Of Sioux Falls	SD	Federally Qualified Health Center (FQHC)	$0	$121K
Suzanne Tarver	OK	Physician Assistant	$38.7K	$0
James Wilde	SD	Family Medicine Physician	$11.1K	$0
Jennifer Tinguely	SD	Family Medicine Physician	$2.1K	$0

Nearby Providers

Other providers in the same ZIP code as City Of Sioux Falls, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sanford Medical Center	SD	Clinical Medical Laboratory	$1.8M	$18M
Lutheran Social Services Of Sd	SD	Psychiatric Residential Treatment Facility	$0	$15.7M
Iwe Inc.	SD	In Home Supportive Care Agency	$0	$15M
South Dakota Home Care, Inc.	SD	Respite Care	$0	$8.6M
Sanford Clinic	SD	Diagnostic Radiology Physician	$0	$6M
Paramedics Logistics South Dakota LLC	SD	Land Ambulance	$1.9M	$3.6M
Sanford Healthcare Accessories, LLC	SD	Durable Medical Equipment & Medical Supplies	$0	$3.1M
Behavior Care Specialists, Inc	SD	Behavior Analyst	$0	$2.9M
Asana Integrated Medical Group PC	SD	Psychiatry Physician	$0	$2.5M
Rehabilitation Medical Supply	SD	Durable Medical Equipment & Medical Supplies	$0	$2.1M

City Of Sioux Falls — 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