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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Shenandoah Valley Medical System, Inc. (NPI 1083617823)

Key Findings

Field	Value
Entity Type	Organization
Organization	Shenandoah Valley Medical System, Inc.
Address	99 Tavern Rd
City	Martinsburg
State	WV
ZIP	25401
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	May 24, 2005

Payer Source	Total Paid
Medicaid	$61M
Medicare	$0

SHENANDOAH VALLEY MEDICAL SYSTEM, INC. reports $61M in lifetime Medicaid revenue and has no Medicare billing on file, making it effectively a Medicaid-centric provider. The organization is a Federally Qualified Health Center (FQHC) and its NPI was enumerated on 2005-05-24 (~21 years ago), indicating long-standing operational presence in the market.

Revenue is extremely concentrated in a handful of encounter-style codes: the precomputed top 3 Medicaid codes account for 95.4% of total Medicaid revenue, with one code overwhelmingly dominant. T1015 alone generates $55M (91.6% of the provider’s Medicaid revenue) from 379.6K claims at $145 avg paid/claim, underscoring that most revenue flows through bundled clinic/encounter payments rather than discrete procedure fees.

The code mix and volumes indicate a core primary-care and community-health operating model consistent with an FQHC. High-volume use of T1015 (clinic visit/encounter), paired with large counts for preventive visit codes (99395, 99393, 99391, 99392) and basic E/M codes (99213, 99214, 99212), suggests the organization delivers broad primary care, well visits, and ongoing chronic care management for Medicaid populations.

SHENANDOAH is a dominant statewide player on several measures: T1015 ranks #1 of 385 providers in-state (100th percentile; extreme outlier), 99213 ranks #5 of 1273 (100th percentile; extreme outlier), and 99214 ranks #8 of 1031 (99th percentile; extreme outlier). These high ranks and percentile placements indicate the provider operates at volumes far above typical state peers for core outpatient visit codes, reflecting market leadership in Medicaid primary-care encounters.

Behavioral health services appear integrated at scale: 90834 (psychotherapy) shows 44.5K claims and $444.8K revenue and ranks #1 of 214 providers in-state (100th percentile; extreme outlier), and group therapy 90853 also contributes material volume. The presence of substantial psychotherapy claims alongside primary-care encounter billing implies embedded mental-health capacity within the FQHC model.

Preventive pediatrics and point-of-care screening are major operational lines: codes such as 99395 ($94.9K; ranks #1 of 100, 100th percentile; extreme outlier), 99393 ($72.6K; ranks #1 of 186, 100th percentile; extreme outlier), 99173 (17.2K claims; $103.2K revenue; ranks #2 of 102, 99th percentile; extreme outlier), and 92551 (14.4K claims; $57.4K revenue; ranks #3 of 129, 98th percentile; extreme outlier) show elevated preventive and screening activity for children and young adults. This pattern points to substantial well-child and developmental screening throughput.

High-volume immunization and point-of-care testing activity is evident across multiple vaccine and testing codes: 90471 (35.8K claims, $322.3K revenue; ranks #2 of 425, 100th percentile; extreme outlier), 90686 (12.3K claims, $135.4K revenue; ranks #2 of 356, 100th percentile; extreme outlier), 90472 (18.9K claims, $132.4K revenue; ranks #2 of 196, 99th percentile; extreme outlier), and 81002 (23.5K claims, $70.4K revenue; ranks #1 of 144, 100th percentile; extreme outlier). These volumes are consistent with a large-scale vaccination program and routine in-clinic testing for the Medicaid population.

Because a single bundled encounter code (T1015) supplies the majority of Medicaid revenue, the provider’s financial performance and capacity to offer other services are closely tied to FQHC encounter payment policies and Medicaid volume. Any material changes to Medicaid encounter reimbursement, enrollment, or policy could have an outsized impact on revenue given the concentration in T1015, so analysts should treat Medicaid policy sensitivity as a key strategic exposure for this entity.

Medicaid: Complete Services Breakdown

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

120 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	379,570	$150	$55M
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…	145,780	$10	$1.6M
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…	77,650	$10	$698.9K
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…	44,480	$10	$444.8K
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…	580	$660	$380.6K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	35,810	$10	$322.3K
76817	The provider performs an ultrasound of the pregnant uterus to examine the fetus and the mother's organs using a transvaginal approach.	2,490	$60	$139.7K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	12,310	$10	$135.4K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	18,910	$10	$132.4K
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,…	12,350	$10	$111.2K

Showing 1–10 of 120

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Shenandoah Valley Medical System, Inc. — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

120 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	1	390	4,610	$130	$2.2M
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…	6	20	150	$700	$308.2K
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…	5	1,270	1,240	$30	$245K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	105	190	660	$40	$226.4K
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	1,030	890	$50	$221K
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…	41	310	740	$80	$178.2K
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…	9	10	100	$720	$168.5K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	31	50	730	$60	$126.6K
71046	In this diagnostic procedure, the provider performs a minimum of two radiological views of the chest. He performs this study for the assessment of conditions affecting the chest, its contents, and…	98	140	1,090	$20	$104.5K
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…	62	340	140	$90	$97.5K

Showing 1–10 of 120

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shenandoah Valley Medical System, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$5M
Shenandoah Valley Medical System,inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.8M
Courtney Struthers	WV	Internal Medicine Physician	$143.8K	$0
Hugh Labree	VA	Family Nurse Practitioner	$50.6K	$5.4K
Charlotte Lane	VA	Family Nurse Practitioner	$990	$0
Michael Li	VA	Internal Medicine Physician	$490	$0
Cheryl Taitano	WV	Family Medicine Physician	$250	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
City Hospital, Inc	WV	General Acute Care Hospital	$0	$41.1M
Eastern Panhandle Mental Health Center (waiver)	WV	Community/Behavioral Health Agency	$0	$28.8M
Stepping Stones Cottages, LLC	WV	Counseling Psychologist	$0	$26.6M
University Healthcare Physicians, Inc.	WV	Family Medicine Physician	$0	$17.5M
American Family Matters LLC	WV	Community/Behavioral Health Agency	$0	$16.9M
Berkeley County Emergency Ambulance Authority	WV	Land Ambulance	$864.6K	$5.6M
Eastern Panhandle Mental Health (rehab)	WV	Community/Behavioral Health Agency	$0	$5.7M
City Of Martinsburg	WV	Land Ambulance	$222.2K	$2.7M
Lance Pittman	WV	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$2.3M
Wv Pediatric Dentistry PLLC	WV	Pediatric Dentistry	$0	$2M

Shenandoah Valley Medical System, Inc. — Billing Profile & Reimbursement Data

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Shenandoah Valley Medical System, 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