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NPI 1053955120 · Hilo, HI · Federally Qualified Health Center (FQHC)
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Whchc - Hawaii Island Community Health Center is a federally qualified health center (fqhc) provider located in Hilo, Hawaii. This profile covers 0 Medicare and 46 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Whchc - Hawaii Island Community Health Center |
| Address | 450 Kilauea Ave Ste 105 |
| City | Hilo |
| State | HI |
| ZIP | 96720 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | November 1, 2019 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $8.1M |
| Medicare | $0 |
This entity is effectively a Medicaid-focused operation: there is no Medicare billing on file and lifetime Medicaid revenue is $8.1M, indicating the provider’s financial footprint is concentrated in the state Medicaid program rather than dual-payer billing. The absence of Medicare activity should be treated as a material factor when modeling payer mix or network access for Medicare populations.
Revenue is highly concentrated in a small set of outpatient evaluation and dental codes: the precomputed top-3 Medicaid codes account for 69.3% of this provider’s total Medicaid revenue. Specifically, 99213 contributes $2.9M (35.9%), 99214 contributes $1.3M (16.8%), and D0140 contributes $1.3M (16.7%), so payers should expect most spend to flow through routine E/M and limited oral evaluation services.
The code mix and dollar volumes point to a primary care–centered FQHC with a substantial dental problem-focus: 99213 and 99214 (routine established patient E/M visits) together make up more than half of Medicaid revenue, while D0140 (limited oral evaluation – problem focused) is a major dental revenue driver at $1.3M. This combination suggests integrated primary care plus on-site dental/problem-focused oral services are key service lines for the organization.
Competitive standing varies by code: for 99213 the provider ranks #22 of 707 in-state (97th percentile) and for 99214 it ranks #43 of 690 (94th percentile), which places the clinic in the upper tier for primary care E/M volume statewide even while descriptions label the volumes as "typical, unremarkable." By contrast, D0140 is an extreme outlier (rank #2 of 119, 99th percentile), indicating the provider is one of the leading state sources of limited oral evaluations.
Behavioral health and telehealth/telephonic management are present but represent smaller revenue streams: 90832 (short psychotherapy) generated $408.1K (5.1% of Medicaid revenue) and 98968 (telephone discussion by a nonphysician) generated $355.9K (4.4%). These line items point to an embedded behavioral health capability and non-face-to-face care channels that complement the primary care and dental services.
Despite the provider’s Federally Qualified Health Center (FQHC) taxonomy, the FQHC-specific visit code G0467 represents a relatively small share of Medicaid revenue ($51.3K, 0.6%) and ranks #20 of 33 providers in-state (41st percentile). This suggests either much Medicaid billing is routed through standard E/M and dental codes rather than billed under the FQHC encounter code, or FQHC-designated wraparound billing is limited in scale compared with peers.
Operational tenure is moderate: the NPI was enumerated 2019-11-01 (~7 years ago), which provides several years of claims history to assess trends but also indicates the organization is not a long-established legacy provider. Analysts should combine this tenure with the concentrated code mix when forecasting growth or assessing competitive dynamics.
Clinical breadth is indicated by multiple preventive and pediatric well-visit codes (99391–99394, 99393) and cervical screening G0101, but each of these contributes modestly to overall Medicaid revenue (individual line items generally under 2%). The presence of these preventive codes alongside high-volume E/M and dental problem codes signals a mixed ambulatory practice that emphasizes routine primary care and problem-focused dental access for Medicaid populations.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
46 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… | 15,410 | $190 | $2.9M |
| 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… | 8,250 | $160 | $1.3M |
| D0140 | Limited oral evaluation – problem focused | 7,450 | $180 | $1.3M |
| D9999 | N/A | 3,810 | $200 | $776.2K |
| 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… | 2,190 | $190 | $408.1K |
| 98968 | A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes… | 2,200 | $160 | $355.9K |
| 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,… | 1,010 | $190 | $190.5K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 790 | $200 | $155K |
| 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… | 540 | $220 | $118.7K |
| 99394 | The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17. | 520 | $190 | $98.2K |
Showing 1–10 of 46
How this provider's Medicaid billing volume and revenue compare to other Hawaii providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Hawaii median
46 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| D9999 | N/A | 6 | 20 | 2,200 | $280 | $1.6M |
| 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… | 15 | 70 | 370 | $150 | $457.3K |
| 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… | 22 | 710 | 650 | $90 | $274.1K |
| G0467 | Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which… | 20 | 30 | 1,850 | $60 | $248.9K |
| 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… | 43 | 690 | 650 | $90 | $235.4K |
| 98967 | A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes… | 4 | 10 | 60 | $260 | $199.8K |
| 98968 | A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes… | 3 | 10 | 490 | $190 | $172.3K |
| D0140 | Limited oral evaluation – problem focused | 2 | 120 | 400 | $140 | $150.2K |
| 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,… | 40 | 190 | 190 | $100 | $122.8K |
| 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… | 63 | 80 | 320 | $100 | $119.2K |
Showing 1–10 of 46
Other providers in the same ZIP code as Whchc - Hawaii Island Community Health Center, ranked by combined Medicare and Medicaid revenue.
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