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

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

Esperanza Health Centers (NPI 1124187125)

Field	Value
Entity Type	Organization
Organization	Esperanza Health Centers
Address	2001 S. California Ave
City	Chicago
State	IL
ZIP	60608
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	December 6, 2006

Payer Source	Total Paid
Medicaid	$40M
Medicare	$0

Key Findings

ESPERANZA HEALTH CENTERS is effectively a Medicaid-centric provider: Medicare revenue is listed as none while total Medicaid revenue is $40M, so its entire billed dataset here is driven by Medicaid. This makes the organization functionally single-payer in the available data and concentrates financial exposure on Medicaid policy and payment changes.

The provider has an established presence: its NPI was enumerated on 2006-12-06 (~20 years ago), indicating roughly two decades of operation under the current identifier and suggesting institutional maturity in the local market.

Revenue is extremely concentrated: the precomputed top 3 Medicaid codes account for 99.8% of the provider’s Medicaid revenue. In particular, T1015 accounts for $39.4M (98.7% of total Medicaid revenue), while T1040 accounts for $392K (1.0%) and J7307 accounts for $62.6K (0.2%), highlighting a heavy reliance on a single encounter-level code.

The code mix points to an FQHC primary care and community health delivery model supplemented by behavioral health and reproductive services. T1015 (Clinic visit/encounter, all-inclusive) as the dominant driver is consistent with an FQHC comprehensive encounter payment; T1040 (community behavioral health clinic per diem) indicates staffed behavioral health capacity; J7307 and J7298 show on-site contraceptive implant and IUD services as part of family planning offerings.

On competitive standing, the provider is a statewide leader for its primary encounter line: T1015 ranks #14 of 846 in-state (98th percentile; extreme outlier, far above typical state volume for this code), which characterizes the organization as a major billing entity for all-inclusive clinic encounters in Illinois. By contrast, the behavioral-health per diem T1040 ranks #11 of 191 (95th percentile; typical, unremarkable volume for this code) and contraceptive implant J7307 ranks #10 of 36 (74th percentile; typical, unremarkable volume), indicating dominance is concentrated in visit-based billing rather than evenly across specialty lines.

The center also runs a high-volume immunization and preventive program that contributes only modestly to revenue because vaccines have low average paid/claim. Examples include 90651 with 4K claims at $3 avg paid/claim for $12K revenue (98th percentile; notably above typical state volume) and 90656 with 946 claims at $1 avg paid/claim for $946 revenue (99th percentile; notably above typical state volume). These high claim counts but low paid amounts show substantial preventive service throughput that does not materially move the revenue needle.

From a business risk and operational perspective, the combination of single-payer reliance and extreme concentration in T1015 creates sensitivity to Medicaid rate changes or encounter-payment policy shifts. Because $39.4M of the $40M Medicaid revenue is tied to one all-inclusive clinic visit code, any change to how those encounters are defined or reimbursed would materially affect overall revenue and should be a core focus for payer contracting and compliance review.

Service-level implications for network and contracting: the dominance of T1015 suggests Esperanza bills primarily under an FQHC-like encounter methodology, which affects how payers and partners should model per-patient costs and capitation. The presence of T1040 behavioral-health per diem billing and onsite contraceptive insertion codes (J7307, J7298) implies bundled or programmatic service lines that could be leveraged in value-based agreements, while immunization volumes imply capacity for broad preventive outreach despite low per-claim revenue.

Medicaid: Complete Services Breakdown

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

112 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	264,520	$150	$39.4M
T1040	Medicaid certified community behavioral health clinic services, per diem	5,850	$70	$391.9K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	70	$940	$62.6K
J7298	Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg	10	$1,100	$13.2K
90651	This code represents a nonavalent human papillomavirus (HPV) vaccine product administered into the muscle to protect against HPV infection. The vaccine protects against nine HPV types (6, 11, 16, 18,…	3,990	$1	$12K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	3,780	$1	$7.6K
0011A	N/A	310	$20	$7.5K
91322	This code represents a SARS–CoV–2 vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 50 mcg/0.5 mL.	60	$120	$7.4K
0012A	N/A	150	$40	$6.3K
90734	The provider administers a meningococcal conjugate vaccine in a diphtheria toxoid carrier (MenACWY–D) or CRM197 carrier (MenACWY–CRM) to protect the patient from four strains of meningococcal viruses…	490	$10	$5.9K

Showing 1–10 of 112

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Illinois Distribution

Esperanza Health Centers — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. Illinois median

112 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	14	850	7,490	$120	$3.9M
J7298	Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg	8	10	120	$830	$372.2K
T1040	Medicaid certified community behavioral health clinic services, per diem	11	190	880	$70	$128.2K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	10	40	20	$630	$97.6K
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…	11	960	330	$30	$51K
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…	32	14,680	300	$50	$48.7K
0502F	No Summary found for this code	19	1,170	550	$30	$48.2K
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…	17	1,380	370	$40	$46.2K
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…	27	1,270	370	$40	$40.8K
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…	20	14,190	280	$20	$38.9K

Showing 1–10 of 112

Related Providers

Other providers that share a Tax Identification Number (TIN) with Esperanza Health Centers, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Esperanza Health Centers	IL	Federally Qualified Health Center (FQHC)	$0	$28.9M
Russell Fiorella	IL	Clinical Pathology/Laboratory Medicine Physician	$4K	$17.3M
Esperanza Health Centers	IL	Federally Qualified Health Center (FQHC)	$0	$16.5M
Michael Blair	IL	Retina Specialist (Ophthalmology) Physician	$3M	$2.6M
Michael Appiagyei	IL	Internal Medicine Physician	$52.7K	$5.1M
Esperanza Health Centers	IL	Federally Qualified Health Center (FQHC)	$0	$4.5M
Anuj Jain	IL	Family Medicine Physician	$140.8K	$3.9M
Manish Shukla	IL	Family Medicine Physician	$39.6K	$3.8M
James Diesfeld	IL	Interventional Pain Medicine Physician	$32.6K	$3.5M
Satwant Kingra	IL	Internal Medicine Physician	$442.5K	$1.4M

Nearby Providers

Other providers in the same ZIP code as Esperanza Health Centers, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pilsen Little Village Community Mental Health Center, Inc.	IL	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$110.7M
The Board Of Trustees Of The University Of Illinois	IL	Federally Qualified Health Center (FQHC)	$0	$72.7M
Mount Sinai Hospital Medical Center	IL	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$15.6M
Alivio Medical Center, Inc.	IL	Federally Qualified Health Center (FQHC)	$0	$12.3M
Alivio Medical Center, Inc.	IL	Federally Qualified Health Center (FQHC)	$0	$12M
Access Community Health Network	IL	Federally Qualified Health Center (FQHC)	$0	$11.7M
Easter Seals Metropolitan Chicago	IL	Case Management Agency	$0	$8.9M
Access Community Health Network	IL	Federally Qualified Health Center (FQHC)	$0	$7.6M
Catholic Charities Of The Archdiocese Of Chicago	IL	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.5M
Access Community Health Network	IL	Federally Qualified Health Center (FQHC)	$0	$6.3M

Esperanza Health Centers — Billing Profile & Reimbursement Data

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Esperanza Health Centers — 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