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

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

Upper Valley Community Health Services Inc (NPI 1124403258)

Field	Value
Entity Type	Organization
Organization	Upper Valley Community Health Services Inc
Address	72 S 1st E Ste 101
City	Rexburg
State	ID
ZIP	83440
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	July 30, 2015

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

Key Findings

This provider is effectively single‑payer in the available data: there is no Medicare billing on file while Medicaid revenue totals $7.6M, indicating Medicaid is by far the material payer relationship to analyze for revenues and service mix. The NPI was enumerated on 2015-07-30 (~11 years ago), so the organization has an established presence in the claims data for nearly a decade.

Revenue is extremely concentrated in a very small set of Medicaid codes: the precomputed top 3 codes account for 99.8% of the provider’s total Medicaid revenue, led by D0999 at $4.2M (55.0%) and T1015 at $3.4M (44.7%), with 99213 contributing $11.3K (0.1%). This concentration means payer-level shifts for those specific codes would materially affect overall revenue.

The provider’s taxonomy as a Federally Qualified Health Center (FQHC) combined with heavy billing for T1015 (T1015 – Clinic visit/encounter, all-inclusive) suggests it operates as a bundled‑encounter community clinic model where an all‑inclusive clinic visit code captures a large slice of outpatient activity. At the same time, D0999 dominates dollar revenue, indicating a substantial dental service component or a high‑level dental billing category that drives Medicaid payments.

D0999 shows notable competitive strength in the state: it ranks #5 of 32 providers in-state (87th percentile; notably above typical state volume for this code), which positions the provider as a relatively large state player for that dental code. By contrast, T1015 ranks #34 of 143 providers in-state (77th percentile; typical, unremarkable volume), indicating the clinic‑encounter business line is mid‑size relative to Medicaid peers rather than dominant.

Several utilization patterns point to low per‑claim Medicaid payments for common office codes: 99213 has 11.3K claims but reports $1 avg paid/claim and only $11.3K in Medicaid revenue, so high encounter volumes for evaluation & management services are not translating into high fee‑for‑service dollars. This suggests either that many visits are reimbursed at very low per‑claim rates in the dataset or that encounter payments are being captured elsewhere (for example under T1015 or other bundled/dental codes).

A number of dental procedure codes show large claim counts but $0 avg paid/claim and $0 reported revenue (for example D1110: 3.7K claims $0, D0120: 3.4K claims $0, D0230: 11.1K claims $0), which implies that dental clinical activity is high but that reimbursements for those specific line items are either zero in this extract or are being funneled through aggregate/bundled codes such as D0999 or T1015. Analysts should treat line‑item dollars and claim counts separately when modeling service capacity versus cash flow.

The provider offers ancillary services consistent with a broad primary care/dental safety‑net operation, but these services contribute only modest revenue relative to dental and bundled clinic encounter codes: examples include 90471 (823 claims, $3.3K revenue), 80053 (943 claims, $943 revenue), and G0008 (158 claims, $790 revenue). These items demonstrate clinical breadth (vaccination, basic labs) but they are not material revenue drivers compared with D0999 and T1015.

Medicaid: Complete Services Breakdown

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

45 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
D0999	N/A	16,280	$260	$4.2M
T1015	Clinic visit/encounter, all-inclusive	18,480	$190	$3.4M
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…	11,270	$1	$11.3K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	820	$1	$3.3K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,310	$1	$1.3K
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…	270	$1	$1.1K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	490	$1	$970
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	940	$1	$940
99238	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the…	20	$60	$890
G0008	Administration of influenza virus vaccine	160	$10	$790

Showing 1–10 of 45

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Upper Valley Community Health Services Inc — 0 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

45 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	34	140	5,470	$180	$2.6M
D0999	N/A	5	30	3,960	$250	$1.5M
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…	53	670	740	$40	$193.6K
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…	174	620	560	$60	$191.8K
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…	42	80	450	$80	$171.3K
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…	33	80	380	$70	$151.1K
D1120	Prophylaxis–child	207	250	180	$60	$143K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	23	320	310	$80	$80.8K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	30	80	460	$30	$77.7K
D2392	Post 2 surface resin‑based composite	26	190	280	$60	$72.9K

Showing 1–10 of 45

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Upper Valley Community Health Services Inc	ID	Federally Qualified Health Center (FQHC)	$0	$4.9M
Kelly Davis	ID	Clinical Psychologist	$2.5K	$0
Ryan Willmore	ID	Physician Assistant	$530	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of Madison School District 321	ID	Local Education Agency (LEA)	$0	$17.1M
Valley Help At Home Senior Care LLC	ID	In Home Supportive Care Agency	$0	$7.9M
Mhd Therapies, PLLC	ID	Physical Therapist	$0	$7.4M
Upper Valley Options, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$3.7M
Madison Co Memorial Hospital	ID	Obstetrics & Gynecology Physician	$0	$2.6M
Teton Medical Group PLLC	ID	Family Medicine Physician	$0	$2.1M
Clubhouse Pediatric Dentistry Of Madison	ID	Pediatric Dentistry	$0	$1.9M
Seasons Medical, PLLC	ID	Obstetrics & Gynecology Physician	$0	$1.8M
Fall River Medical, PLLC	ID	Primary Care Clinic/Center	$0	$1.7M
Complete Family Care PLLC	ID	Family Medicine Physician	$0	$1.7M

Upper Valley Community Health Services Inc — Billing Profile & Reimbursement Data

Sign up for Upper Valley Community Health Services Inc — Billing Profile & Reimbursement Data policy alerts

Upper Valley Community Health Services Inc — Billing Profile & Reimbursement Data

Sign up for Upper Valley Community Health Services Inc — Billing Profile & Reimbursement Data policy alerts

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