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.

La Frontera Center, Inc. (NPI 1093810889)

Field	Value
Entity Type	Organization
Organization	La Frontera Center, Inc.
Address	502 W 29th St
City	Tucson
State	AZ
ZIP	85713
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	September 14, 2006

Payer Source	Total Paid
Medicaid	$136.5M
Medicare	$0

Key Findings

LA FRONTERA CENTER, INC. is effectively a single-payer provider: it has no Medicare billing on file and $136.5M in lifetime Medicaid revenue, and its NPI was enumerated on 2006-09-14 (~20 years ago), indicating long tenure in the market. The absence of Medicare activity combined with substantial Medicaid volume suggests the organization’s referral, contracting, and reimbursement exposure is concentrated in state Medicaid programs rather than Medicare payers.

Revenue is highly concentrated in a few service lines: the precomputed top-3 Medicaid codes account for 66.3% of total Medicaid revenue, with T1016 generating $36.1M (26.6%), H0018 generating $32.8M (24.1%), and H0004 generating $21.1M (15.6%). This level of concentration implies that changes to reimbursement, utilization management, or clinical authorization for those specific codes would materially affect overall revenue.

The code mix points to a behavioral-health–centric operation with large-scale case management, residential treatment, and high-volume counseling services. High revenue from T1016 (case management, per 15 minutes), H0018 (short-term residential, per diem, without room and board), and H0004 (behavioral health counseling and therapy, per 15 minutes) indicates integrated outpatient and non-room-and-board residential programming rather than a primarily medical or inpatient hospital model.

On competitive standing within Arizona Medicaid, LA FRONTERA ranks as a dominant outlier for multiple codes: T1016 ranks #5 of 1157 providers (100th percentile; extreme outlier), H0018 ranks #3 of 360 providers (99th percentile; extreme outlier), and H0004 ranks #3 of 1147 providers (100th percentile; extreme outlier). These rankings indicate the provider operates at a scale far above typical state peers for its core behavioral-health services, suggesting market leadership in case management, residential services, and counseling.

Beyond the top three, the provider shows leadership in several adjunct behavioral services that broaden its service footprint: H0031 (mental health assessment) accounts for $10.9M (8.0%) and ranks #3 of 812 providers (100th percentile; extreme outlier), while H2019 (therapeutic behavioral services) contributes $8.2M (6.0%) and ranks #1 of 43 providers (100th percentile; extreme outlier). The presence of H2010 (comprehensive medication services) at $4.7M (3.4%) — ranked #10 of 78 (88th percentile; typical, unremarkable) — signals that medication management is part of but not the dominant driver in the organization’s mix.

Operationally, a few high-frequency, low-unit-value lines also appear: H0020 (methadone administration) shows 567.4K claims for $1.7M (1.3%) and ranks #2 of 71 providers (99th percentile; notably above typical state volume), indicating a high-volume dosing/service model where volume drives throughput but per-claim revenue is low. Similarly, H0023 (behavioral health outreach) ranks #1 of 92 providers (100th percentile; extreme outlier) and H2019 ranks #1, which together point to both intensive community outreach and in-program therapeutic services.

Clinical and financial risk is concentrated because the organization derives two-thirds of Medicaid revenue from the top three codes and has essentially no Medicare diversification. That concentration creates sensitivity to Medicaid policy changes, prior authorization rules, or state-level shifts in payment for case management, residential per-diem services, or counseling, and it heightens the importance of maintaining authorization and utilization for those specific codes.

The provider also maintains substantial outpatient E/M activity alongside behavioral services: 99214 accounts for $4.3M (3.2%) with 62.3K claims (rank #59 of 3041, 98th percentile; notably above typical) and 99213 accounts for $3.6M (2.6%) with 74.5K claims (rank #34 of 2775, 99th percentile; notably above typical). These volumes suggest LA FRONTERA supports ongoing medical evaluation and management activity for established patients, complementing its behavioral-health programming and indicating integrated outpatient clinical workflows rather than exclusively non-medical social services.

Medicaid: Complete Services Breakdown

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

63 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1016	Case management, each 15 minutes	1,002,550	$40	$36.1M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	137,270	$240	$32.8M
H0004	Behavioral health counseling and therapy, per 15 minutes	364,490	$60	$21.1M
H0031	Mental health assessment, by non-physician	77,410	$140	$10.9M
H2019	Therapeutic behavioral services, per 15 minutes	89,950	$90	$8.2M
H2010	Comprehensive medication services, per 15 minutes	423,450	$10	$4.7M
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…	62,300	$70	$4.3M
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…	74,530	$50	$3.6M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	17,260	$160	$2.7M
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	19,000	$140	$2.7M

Showing 1–10 of 63

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

La Frontera Center, Inc. — 15 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

63 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	3	360	430	$320	$2.3M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	18	280	1,040	$460	$2.2M
H2010	Comprehensive medication services, per 15 minutes	10	80	71,620	$10	$1.7M
T1016	Case management, each 15 minutes	5	1,160	2,110	$30	$1.2M
S0215	Non-emergency transportation; mileage, per mile	184	510	4,610	$40	$1.2M
H0004	Behavioral health counseling and therapy, per 15 minutes	3	1,150	1,700	$90	$1M
H2014	Skills training and development, per 15 minutes	95	780	1,610	$100	$868.2K
H2027	Psychoeducational service, per 15 minutes	3	500	750	$170	$592.2K
H0038	Self‑help/peer services, per 15 minutes	29	580	1,250	$80	$479.7K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	101	540	900	$60	$475.8K

Showing 1–10 of 63

Nearby Providers

Other providers in the same ZIP code as La Frontera Center, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Banner - University Medical Center South Campus LLC	AZ	General Acute Care Hospital	$0	$82.4M
El Rio Santa Cruz Neighborhood Health Center, Inc	AZ	Federally Qualified Health Center (FQHC)	$0	$11.9M
Marana Health Center, Inc	AZ	Federally Qualified Health Center (FQHC)	$0	$11.4M
Community Medical Services Arizona-private, LLC	AZ	Methadone Clinic	$86.1K	$10.7M
Javier R Rios Md A Medical Professional Corporation	AZ	Family Medicine Physician	$0	$6.6M
Edward Oh	AZ	Diagnostic Radiology Physician	$440.8K	$0
Satinder Singh	AZ	Cardiovascular Disease Physician	$180.5K	$0
Corbin Ballam	AZ	Internal Medicine Physician	$175.5K	$0
Richard Rhoads	AZ	Psychiatry Physician	$2.5K	$125.6K
Guyve Shalileh	AZ	Emergency Medicine Physician	$87.7K	$0

La Frontera Center, Inc. — Billing Profile & Reimbursement Data

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La Frontera 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

Nearby Providers

Frequently Asked Questions

References