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

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

Southern Idaho Health Partners LLC (NPI 1952701401)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southern Idaho Health Partners LLC
Address	875 S Vanguard Way
City	Meridian
State	ID
ZIP	83642
Taxonomy	General Practice Physician
NPI Enumerated	September 2, 2014

Payer Source	Total Paid
Medicaid	$9.2M
Medicare	$0

SOUTHERN IDAHO HEALTH PARTNERS LLC shows effectively single‑payer activity on file with no Medicare billing on file and $9.2M in lifetime Medicaid revenue, and has an NPI enumerated 2014-09-02 (~12 years ago), indicating an established presence in the market. The absence of Medicare billings means the provider’s visible revenue exposure is concentrated entirely in Medicaid reimbursement and state policy changes will materially affect its topline.

Revenue concentration is high: the precomputed top 3 Medicaid codes account for 66.4% of the provider’s total Medicaid revenue, led by 99213 ($3.2M, 35.0%), 99214 ($2.4M, 26.7%), and 99393 ($422.4K, 4.7%). This concentration indicates that a small set of office visit and pediatric preventive codes drive the majority of Medicaid payments to this entity.

The code mix points to a primary care / general practice operating model with a strong outpatient and pediatric preventive focus: 99213 (53.6K claims) and 99214 (31.1K claims) are the top revenue generators, while pediatric well visits 99393 (4.2K claims) and other preventive codes (99392, 99391, 99394) and high vaccination volumes (90471 with 14.2K claims; 90472 with 7.1K claims) indicate robust well‑child throughput and an active immunization program. Together these patterns are consistent with a high‑volume ambulatory primary care clinic serving Medicaid populations.

Competitive standing for routine E/M is strong in‑state: 99213 ranks #12 of 669 providers in Idaho (98th percentile, described as notably above typical state volume), 99214 ranks #10 of 618 (99th percentile, notably above typical state volume), and 99203 ranks #8 of 223 (97th percentile). These ranks indicate the provider is a major Medicaid participant for established and new patient office visits compared with in‑state peers.

There are several code‑level outliers that expand the clinical footprint beyond routine primary care: 99212 is labeled an "extreme outlier" (rank #5 of 208, 98th percentile) and 92012 (intermediate eye exam) is an extreme outlier in the state (rank #1 of 12, 100th percentile). High ranks on diagnostic/lab codes such as 87651 (Strep A testing, rank #5 of 42, 90th percentile) and testing for SARS‑CoV‑2 with U0003 (2.4K claims, rank #4 of 21, 85th percentile) show the practice also bills substantial point‑of‑care laboratory and infectious disease testing.

Ancillary services show supplemental revenue streams: sleep study codes 95810 (850 claims, $349.4K revenue, rank #2 of 10, 89th percentile) and 95811 (87 claims, $32K revenue, rank #2 of 8, 86th percentile) indicate in‑house or affiliated polysomnography capability that generates moderate Medicaid revenue, while ophthalmology code 92012 (1.3K claims, $58.4K, rank #1 of 12) suggests unusually high eye‑exam activity relative to peers. These ancillary services diversify revenue beyond office E/M and preventive care.

For payers and network planners, the provider’s heavy dependence on a few E/M and pediatric preventive codes (66.4% of Medicaid revenue from the top three codes) combined with top percentile ranks in 99213/99214 implies it is an important access point for routine primary care and well‑child services in Meridian and surrounding areas. Contracting, network adequacy assessments, or value‑based arrangements that target high‑volume primary care populations should consider this provider’s outsized role in delivering Medicaid office visits and vaccinations.

The provider’s billing profile and tenure (~12 years since NPI enumeration) together suggest a stable, Medicaid‑focused ambulatory practice with concentrated revenue risk: high state percentiles for routine E/M and vaccination codes point to local market importance, but the lack of Medicare billing on file leaves the organization exposed to state Medicaid reimbursement shifts rather than federal Medicare trends. Analysts should treat it as a Medicaid‑centric entity when modeling payer mix or financial sensitivity.

Medicaid: Complete Services Breakdown

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

89 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…	53,640	$60	$3.2M
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…	31,050	$80	$2.4M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	4,220	$100	$422.4K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3,920	$100	$399.9K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	850	$410	$349.4K
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…	4,600	$80	$345.3K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	3,300	$90	$293.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	14,170	$20	$255K
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…	1,940	$120	$228.9K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	1,700	$110	$186.4K

Showing 1–10 of 89

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Southern Idaho Health Partners LLC — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

89 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
42820	The provider removes the tonsils and adenoids in a patient younger than 12 years old.	6	20	110	$840	$224.4K
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…	12	670	740	$40	$193.6K
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…	10	620	560	$60	$191.8K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	13	80	450	$80	$171.3K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	17	80	380	$70	$151.1K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	16	20	100	$450	$102.5K
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…	4	20	270	$60	$101K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	53	160	320	$90	$92.8K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8	80	130	$80	$91.4K
95810	Polysomnography refers to the continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for six or more hours with physician review,…	2	10	50	$200	$78.2K

Showing 1–10 of 89

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Lukes Clinic-treasure Valley LLC	ID	Family Medicine Physician	$0	$59.2M
Mark Rasmus	ID	Specialist	$110.9K	$0
Liang Wu	ID	Nephrology Physician	$109.8K	$0
John Ader	ID	Rheumatology Physician	$92.3K	$0
Michael Dee	ID	Internal Medicine Physician	$83.6K	$0
Rick Roberts	ID	Family Medicine Physician	$80.6K	$0
Nathan Green	WA	Cardiovascular Disease Physician	$46.4K	$0
Shannon Gardiner	ID	Surgical Physician Assistant	$40K	$0
Nicole Funk	ID	Surgical Physician Assistant	$15.6K	$0
Jonathan Subaitani	ID	Physician Assistant	$12.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Norco, Inc.	ID	Durable Medical Equipment & Medical Supplies	$0	$41M
Joint School District No. 2	ID	Local Education Agency (LEA)	$0	$34.2M
Chatterbox Speech & Language Center	ID	Speech-Language Pathologist	$0	$10.6M
St. Fillan's, LLC	ID	In Home Supportive Care Agency	$0	$10.5M
Gem State Developmental Center LLC	ID	Developmentally Disabled Services Day Training Agency	$0	$9.1M
Addus Healthcare, Inc.	ID	In Home Supportive Care Agency	$0	$6.1M
Northwest Neurobehavioral Health, LLC	ID	Clinical Social Worker	$0	$5.2M
Idaho Pediatric Therapy Clinic PLLC	ID	Physical Therapist	$0	$3.1M
Cpapnow Inc	ID	Durable Medical Equipment & Medical Supplies	$0	$3.1M
Slh Hti West Manager, LLC	ID	Assisted Living Facility	$0	$2.9M

Southern Idaho Health Partners LLC — Billing Profile & Reimbursement Data

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Southern Idaho Health Partners LLC — 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