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 1952482275)

Key Findings

Field	Value
Entity Type	Organization
Organization	Providence Health & Services - Oregon
Address	1001 Providence Dr
City	Newberg
State	OR
ZIP	97132
Taxonomy	General Acute Care Hospital
NPI Enumerated	October 17, 2006

Payer Source	Total Paid
Medicaid	$20.1M
Medicare	$0

This provider is effectively single‑payer at scale: there is no Medicare billing on file while total Medicaid revenue is $20.1M, indicating Medicaid accounts for the entirety of recorded government payer revenue in our dataset. Analysts should treat comparative work against Medicare peers as not applicable for this entity and focus on Medicaid and commercial data outside this extract.

Revenue is highly concentrated in emergency department evaluation-and-management services: the top three Medicaid codes (99285, 99284, 99283) together account for 86.3% of this provider's total Medicaid revenue. Those codes individually represent $7M (35.1%), $5.8M (29.1%), and $4.4M (22.1%) respectively, signaling the hospital’s Medicaid revenue base is dominated by ED visits across high, moderate, and low complexity levels.

The code mix strongly implies an ED-centric acute care operation: the three highest‑revenue codes are 99285/99284/99283 (high/moderate/low complexity ED E/M), and the supporting higher-volume ancillary codes are ED‑aligned services such as 93005 ($615.3K, 3.1% of Medicaid revenue) and 96374 ($613.7K, 3.1%). This pattern is consistent with a general acute care hospital whose Medicaid activity is driven by emergency throughput and immediate diagnostics/infusions rather than elective inpatient procedures.

Competitive standing on the core ED codes is modest and broadly typical within Oregon: 99285 ranks #37 of 129 providers (72th percentile), 99284 ranks #55 of 145 (63th percentile), and 99283 ranks #54 of 137 (61th percentile). Those percentiles and rank positions indicate steady, unremarkable state‑level volume for ED work rather than clear dominance; the facility is an established participant but not a top outlier among in‑state peers for these services.

Ancillary services contribute meaningfully but remain a small share of Medicaid revenue: several ancillary codes each account for roughly 0.4–3.1% of total Medicaid revenue (examples include 93005 $615.3K, 96374 $613.7K, 96375 $296.2K, 80053 $244.2K, and 85025 $202.9K). These line items—EKG recording, IV drug administration, lab panels, and CBC—support ED care pathways and suggest the hospital supplies on‑site diagnostics and acute therapies typical for an emergency-focused site.

Statewide statistical signals show typical peer positioning across most ancillary codes: many listed codes are described as "typical, unremarkable volume for this code," even when their percentile is relatively high (for example, 36415 is at the 87th percentile but still labeled typical). There are no codes in the provided list flagged as extreme outliers or notably above typical, so the provider’s Medicaid billing profile reads as concentrated but not atypical versus in‑state peers.

The provider has an established operating tenure, with NPI enumeration dated 2006-10-17 (~20 years ago). Combined with the concentrated Medicaid revenue mix, this longevity suggests a stable, longstanding acute care presence in the market whose current billed volume predominantly serves Medicaid patients through emergency department activity.

Medicaid: Complete Services Breakdown

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

65 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.	12,700	$550	$7M
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.	16,080	$360	$5.8M
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.	17,040	$260	$4.4M
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	8,920	$70	$615.3K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	8,180	$80	$613.7K
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…	2,850	$100	$296.2K
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	27,130	$10	$244.2K
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	28,980	$10	$202.9K
J7030	Infusion, normal saline solution , 1000 cc	3,750	$40	$131.3K
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.	2,570	$40	$107.8K

Showing 1–10 of 65

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 — 0 of 25 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

65 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.	55	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.	37	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.	54	140	10,160	$130	$2.3M
G0463	Hospital outpatient clinic visit for assessment and management of a patient	42	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.	22	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…	56	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…	42	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.	74	80	1,130	$90	$327.2K
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.	72	100	250	$80	$268K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	53	70	610	$60	$150.7K

Showing 1–10 of 65

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Providence Health & Services - Oregon	OR	Clinical Pathology Physician	$0	$13.7M
Providence Health & Services - Oregon	OR	Clinical Pathology Physician	$0	$3.8M
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
Lohith Reddy	OR	Internal Medicine Physician	$86.5K	$0
Kristina Moon	OR	Cardiovascular Disease Physician	$84.7K	$0
Geoffrey Wilson	OR	Cardiovascular Disease Physician	$80.5K	$0
Caroline Tse	OR	Sleep Medicine (Psychiatry & Neurology) Physician	$77.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Newberg Kids Dentist LLC	OR	Dental Clinic/Center	$0	$4.3M
Providence Health & Services - Oregon	OR	Clinic/Center	$0	$3.6M
Katie Nicosia	OR	Family Nurse Practitioner	$0	$1.5M
Intercultural Center For Psychology LLC	OR	Psychologist	$0	$1.4M
Gso Equipment Corp	OR	Endoscopy Clinic/Center	$291.4K	$998.3K
Ann Marie Macasa	OR	Rheumatology Physician	$437K	$0
Kristin Mcvay	OR	Geriatric Physical Therapist	$97.8K	$0
Marsha Green	OR	Clinical Psychologist	$94.1K	$0
Liang-chieh Ko	OR	Podiatrist	$93.7K	$0
Ellen Andrae	OR	Neurology Physician	$87.2K	$0

Providence Health & Services - Oregon — Billing Profile & Reimbursement Data

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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