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

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

Lamoille Health Partners, Inc (NPI 1124436332)

Field	Value
Entity Type	Organization
Organization	Lamoille Health Partners, Inc
Address	609 Washington Hwy
City	Morrisville
State	VT
ZIP	05661
Taxonomy	Pediatrics Physician
NPI Enumerated	July 31, 2014

Payer Source	Total Paid
Medicaid	$4.6M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-only billing entity in the dataset: Total Medicare revenue is none and total Medicaid revenue is $4.6M, so all reported payer dollars in this file come from Medicaid. That concentration makes Medicaid reimbursement rules and state payment practices the primary revenue driver for the practice.

Medicaid revenue is highly concentrated in a very small set of codes: the precomputed top 3 Medicaid codes account for 99.0% of this provider's total Medicaid revenue, with T1015 alone representing $4.4M (96.1% of Medicaid revenue). This indicates the clinic’s financial picture in this dataset is dominated by a single all-inclusive clinic encounter code.

The code mix and volumes point to a clinic-based pediatric practice that emphasizes bundled clinic encounters and routine immunizations. T1015 (Clinic visit/encounter, all-inclusive) is the dominant revenue source, while vaccine administration codes 90471 ($88.7K, 1.9% of Medicaid revenue) and 90472 ($44.8K, 1.0% of Medicaid revenue) reflect substantial immunization throughput during visits.

Competitive standing is mixed across services: for the primary revenue code T1015 the provider ranks #20 of 70 in-state (72th percentile; typical, unremarkable volume), indicating a mid-tier position among peers for that clinic-encounter billing. By contrast, 90471 ranks #7 of 88 (93th percentile; notably above typical state volume), signaling unusually high vaccine-administration activity relative to state peers.

Claims mix shows many standard E/M and preventive codes with high claim counts but $0 avg paid/claim, which suggests those services are being reimbursed through bundled encounter billing rather than paid separately in these Medicaid records. Examples include 99213 (10.1K claims, $0 avg paid/claim), 99214 (4.1K claims, $0 avg paid/claim), and 99392 (1.8K claims, $0 avg paid/claim), underscoring the centrality of the all-inclusive T1015 payment in the dataset.

Operationally, the provider reports nontrivial point-of-care testing and vaccine-related lab activity that complements its clinic visits: 87880 (472 claims, $7.6K revenue) and multiple vaccine product codes (e.g., 90686 with 2K claims reported, $0 avg paid/claim). These volumes are consistent with a pediatric primary-care workflow that combines preventive visits, on-site immunizations, and some rapid testing.

Reliance on a single revenue-bearing encounter code creates concentration risk: because T1015 accounts for 96.1% of Medicaid revenue and the top three codes combine for 99.0%, any Medicaid policy, coding, or reimbursement change affecting T1015 or bundled clinic payments could materially alter the provider’s reported revenue. Analysts and payers should flag this as a vulnerability when modeling contract rates or forecasting revenue sensitivity.

The NPI was enumerated 2014-07-31 (~12 years ago), indicating the practice has an established presence in the provider registry. That tenure, combined with consistent vaccine-administration rankings and steady clinic-encounter volume, suggests an operationally stable pediatric clinic focused on preventive and routine pediatric services.

Medicaid: Complete Services Breakdown

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

46 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	25,680	$170	$4.4M
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	7,390	$10	$88.7K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	3,730	$10	$44.8K
G9001	Coordinated care fee, initial rate	660	$40	$25K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	270	$30	$8.9K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	470	$20	$7.6K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	100	$10	$1.4K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	70	$20	$1.1K
85018	The lab analyst measures the hemoglobin in a whole blood sample. Hemoglobin is the red pigmented iron compound contained in the red blood cell that combines with oxygen needed by the body tissue.	460	$1	$910
83655	The lab analyst performs a test to measure the amount of lead in the patient specimen. A typical aim of the test is to check for lead exposure.	50	$10	$730

Showing 1–10 of 46

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Lamoille Health Partners, Inc — 0 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

46 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	20	70	11,650	$150	$3.3M
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…	67	320	680	$30	$146.1K
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…	39	320	760	$20	$88.2K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	57	110	170	$70	$38.6K
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…	10	40	170	$40	$31.6K
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…	10	40	280	$20	$19.5K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	15	20	170	$10	$17.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	13	40	290	$20	$16K
G9001	Coordinated care fee, initial rate	8	20	230	$20	$15.6K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	17	40	210	$30	$13.7K

Showing 1–10 of 46

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lamoille Health Partners, Inc	VT	Cognitive & Behavioral Psychologist	$0	$10.5M
Lamoille Health Partners, Inc	VT	Federally Qualified Health Center (FQHC)	$0	$5.4M
Lamoille Health Partners, Inc	VT	Federally Qualified Health Center (FQHC)	$0	$4.9M
Lamoille Health Partners, Inc	VT	Dentist	$0	$1.7M
Heather Jones	VT	Mental Health Counselor	$0	$231.3K
Katherine Wilde	VT	Adult Psychiatric/Mental Health Clinical Nurse Specialist	$6.9K	$186.8K
Hayley Hamilton	VT	Clinical Social Worker	$0	$183.7K
Lamoille Health Partners Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$163.2K
Lauren Johnson	VT	Clinical Child & Adolescent Psychologist	$0	$162K
Lamoille Health Partners, Inc	VT	Neurology Physician	$0	$135.8K

Nearby Providers

Other providers in the same ZIP code as Lamoille Health Partners, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lamoille County Health Mental Health Services	VT	Community/Behavioral Health Agency	$0	$42.7M
Green Mountain Support Services Inc.	VT	Case Manager/Care Coordinator	$0	$25.9M
Lamoille County Mental Health Services	VT	Community/Behavioral Health Agency	$0	$22.2M
Lamoille Family Center Inc	VT	Public Health or Welfare Agency	$0	$5.2M
Maple Leaf Family Dentistry	VT	General Practice Dentistry	$0	$1.2M
Tamarack Family Medicine	VT	Clinic/Center	$0	$1.1M
Copley Hospital, Inc.	VT	Critical Access Hospital	$0	$525.5K
Melissa Mason	VT	Mental Health Counselor	$0	$488.6K
Experiential Counseling LLC	VT	Mental Health Counselor	$0	$440.7K
Carol Lehmann	VT	Occupational Therapist	$0	$412.1K

Lamoille Health Partners, 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