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

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

Sunset Community Health Center Inc (NPI 1063433720)

Field	Value
Entity Type	Organization
Organization	Sunset Community Health Center Inc
Address	2060 W 24th St
City	Yuma
State	AZ
ZIP	85364
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	July 21, 2006

Payer Source	Total Paid
Medicaid	$82.3M
Medicare	$0

Key Findings

SUNSET COMMUNITY HEALTH CENTER INC is effectively a Medicaid-centric operation: there is no Medicare billing on file while lifetime Medicaid revenue totals $82.3M, indicating the provider’s financial footprint is almost entirely tied to state Medicaid payments rather than dual-payer mix. This single‑payer concentration should frame any payer/provider analysis of revenue exposure and contracting leverage.

Revenue is extremely concentrated in a single code: T1015 accounts for $81.8M in Medicaid revenue (375.2K claims at $218 avg paid/claim) and represents 99.4% of the provider’s Medicaid revenue, and the top 3 Medicaid codes by revenue account for 99.7% of this provider’s total Medicaid revenue. That concentration makes the organization highly sensitive to reimbursement or policy changes affecting T1015 and to any administrative changes in how FQHC/all‑inclusive clinic visits are paid.

The code mix and taxonomy are consistent with an FQHC primary‑care model: T1015 (Clinic visit/encounter, all-inclusive) dominating revenue reflects bundled, clinic‑level reimbursement typical of Federally Qualified Health Centers, and the presence of chronic care/general care management activity (G0511: 4.6K claims, $41.6K revenue) supports a population‑health, primary‑care delivery model. The patient mix implied by high volumes of preventive and well‑child codes (99393, 99392, 99391, 99394) indicates broad family and pediatric services alongside adult primary care.

Competitive standing within Arizona is strong on the clinic/visit front: T1015 ranks #6 of 357 providers in‑state (99th percentile; notably above typical state volume for this code), marking the center as a major state‑level provider for bundled clinic visits. At the same time, certain E/M codes (99213 ranks #11 of 2775, 100th percentile; 99214 ranks #40 of 3041, 99th percentile) are flagged as extreme outliers or near‑extreme outliers in statewide volume, which underscores unusually high claim volumes relative to peers.

Several codes are statistical outliers in volume even though they contribute little to revenue: 99213 (179.3K claims, $1 avg paid/claim) and 99214 (80.9K claims, $1 avg paid/claim) are described as extreme outliers, and procedure/measure codes such as 0011A, 0012A and 0064A are also noted as extreme outliers in rank/percentile. These patterns—very high claim counts paired with very low average paid per claim—suggest billing patterns where many encounters are recorded under low‑value E/M line items while the primary financial driver remains the T1015 bundled encounter payment.

The provider delivers a high volume of preventive and well‑visit services: 99393 has 10.3K claims ($10.3K revenue) and ranks in the 95th percentile in‑state, and related well‑visit codes (99392, 99391, 99394, 99395, 99396) also appear in high percentiles. This mix reinforces that the center’s case mix includes routine preventive care and pediatric services, consistent with an FQHC serving families and population health needs.

SUNSET COMMUNITY HEALTH CENTER’s NPI was enumerated 2006-07-21 (~20 years ago), indicating a long tenure in the community; combined with the code and rank profile, this suggests an established local provider with sustained Medicaid volume rather than a recent entrant or a small clinic. Longevity plus dominant T1015 volume points to a stable operational focus on federally qualified clinic services in Yuma, AZ.

From an operational and payer‑risk perspective, the dependence on one dominant code creates vulnerability: because T1015 represents the vast majority of revenue ($81.8M, 99.4%), any changes to FQHC/T1015 policy, coding guidance, or reimbursement rates would have outsized impact on the center’s finances. Analysts and payers should treat contract negotiations, rate‑setting scenarios, and utilization audits with attention to T1015 reimbursement mechanics and to the unusual, extreme‑outlier volumes reported for multiple E/M and procedure codes.

Medicaid: Complete Services Breakdown

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

192 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	375,240	$220	$81.8M
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…	179,280	$1	$179.3K
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…	80,920	$1	$80.9K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	70	$710	$51.8K
59514	The provider admits the patient to the hospital for delivery, delivers the fetus and placenta via an abdominal incision, and provides care immediately after delivery on the same date of service. This…	60	$850	$49.5K
G0511	Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral…	4,620	$10	$41.6K
99219	N/A	280	$50	$14K
99243	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a low level of medical decision making or the provider spends at…	1,280	$10	$11.5K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	10,260	$1	$10.3K
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…	9,740	$1	$9.7K

Showing 1–10 of 192

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Sunset Community Health Center Inc — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

192 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	6	360	3,640	$230	$7.7M
T1016	Case management, each 15 minutes	959	1,160	2,110	$30	$1.2M
93303	The provider performs a complete transthoracic echocardiography to obtain images of the heart structures through the chest wall in patients born with heart defects. This study includes visualization…	20	20	160	$270	$1.1M
H0004	Behavioral health counseling and therapy, per 15 minutes	863	1,150	1,700	$90	$1M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	188	400	200	$120	$403K
H0031	Mental health assessment, by non-physician	378	810	280	$120	$360.5K
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…	40	3,040	750	$50	$343.9K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	10	20	60	$890	$339.2K
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…	156	240	660	$120	$309.1K
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…	11	2,780	600	$50	$267K

Showing 1–10 of 192

Related Providers

Other providers that share a Tax Identification Number (TIN) with Sunset Community Health Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Francisco Ordaz-chavez	AZ	Family Medicine Physician	$5.1K	$0
Jose Vega	AZ	Family Medicine Physician	$1.5K	$0
Lori Burris	NV	Family Medicine Physician	$1.5K	$0
Julia Luevanos	AZ	Family Nurse Practitioner	$800	$0
Melissa Pritchett	AZ	Family Nurse Practitioner	$760	$0
Angeles Olivarez	AZ	Medical Physician Assistant	$720	$0
April Rojas	NY	Nurse Practitioner	$690	$0

Nearby Providers

Other providers in the same ZIP code as Sunset Community Health Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Yuma Regional Medical Center	AZ	General Acute Care Hospital	$0	$278.5M
Saguaro Foundation	AZ	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$73.5M
Community Intervention Associates	AZ	Community/Behavioral Health Agency	$0	$58.9M
Yuma Dentistry 4 Kids PLLC	AZ	General Practice Dentistry	$0	$16.6M
Colorado River Behavioral Health System	AZ	Community/Behavioral Health Agency	$0	$13M
Dva Healthcare Renal Care Inc	AZ	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$12.8M
Easter Seals Blake Foundation	AZ	Community/Behavioral Health Agency	$0	$12.7M
City Of Yuma	AZ	Land Ambulance	$896.2K	$10.7M
Crossroads Mission	AZ	Substance Abuse Rehabilitation Facility	$0	$11M
Community Medical Services Arizona-private, LLC	AZ	Methadone Clinic	$92.1K	$10.3M

Sunset Community Health Center 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

Related Providers

Nearby Providers

Frequently Asked Questions

References