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

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

Staywell Health Care, Inc. (NPI 1154342335)

Field	Value
Entity Type	Organization
Organization	Staywell Health Care, Inc.
Address	80 Phoenix Ave
City	Waterbury
State	CT
ZIP	06702
Taxonomy	Family Medicine Physician
NPI Enumerated	July 22, 2006

Payer Source	Total Paid
Medicaid	$76.8M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file while reported Medicaid revenue totals $76.8M, so Medicaid constitutes the entirety of documented lifetime revenue for STAYWELL HEALTH CARE, INC. in these records. That concentration should guide payer strategy and benchmarking toward Medicaid program rules and rates rather than Medicare comparisons.

Revenue is extremely concentrated in a small set of procedure codes: the top three Medicaid codes account for 98.2% of the provider's Medicaid revenue, with T1015 alone representing $70M (91.1% of total Medicaid revenue). The second and third top drivers are G0511 at $4.8M (6.2%) and 99213 at $705.8K (0.9%), underscoring a heavy dependence on a single clinic/encounter payment stream.

The mix of high‑revenue codes points to an RHC/FQHC‑style clinic operating model: T1015 (Clinic visit/encounter, all‑inclusive) is the dominant line, and FQHC/RHC‑specific codes such as G0511 (general care management for RH/ FQHC), G0467, G0470 and the RHC telehealth code G2025 also appear in the top code list. Together these codes indicate bundled, per‑visit and per‑month clinic payments and chronic care management services consistent with a high‑volume primary care clinic or federally qualified health center.

Competitive standing varies by code: the provider ranks #1 of 17 for G0511 (100th percentile) and is described as notably above typical state volume for that code, indicating statewide leadership in RH/FQHC general care management. For 99213 the practice ranks #25 of 1714 (99th percentile) and is also notably above typical state volume, showing very high-volume E/M billing; by contrast T1015 ranks #7 of 73 (92th percentile) and is labeled typical/unremarkable in volume despite its outsized revenue share.

Unit‑payment and throughput patterns show a high‑volume, low‑unit‑rate outpatient model: T1015 averaged $132 paid/claim across 529.9K claims to produce $70M, while common E/M codes such as 99213 averaged $6 paid/claim across 117.6K claims and 99214 averaged $10 across 25.7K claims. This combination of very large claim counts and low per‑claim payments is consistent with scaled clinic operations that rely on volume rather than high unit margins.

The provider exhibits several statistical outliers on secondary codes that suggest concentrated service offerings beyond core clinic visits: 95115 (allergy injection) is ranked #1 of 15 (100th percentile; extreme outlier, far above typical state volume), 99396 (adult well visit 40–64) is #2 of 136 (99th percentile; extreme outlier), and G0439 (annual wellness subsequent visit) is #1 of 38 (100th percentile; extreme outlier). These extreme percentile placements indicate unusually large activity in allergy services and preventive visit coding relative to in‑state peers.

Behavioral health and ancillary services are present but represent small shares of revenue: psychotherapy codes such as 90832 ($193.2K), 90834 ($88.7K) and 90837 ($13.4K) appear in the top codes and rank in mid‑to‑high percentiles statewide, suggesting integrated behavioral health capacity within the clinic model rather than primary revenue drivers. The presence of nutrition (97802/97803) and acupuncture (97810) codes further points to a broad, multidisciplinary service mix offered at scale.

The provider has long tenure in the NPI registry (enumerated 2006-07-22, approximately 20 years ago), which aligns with the scale of Medicaid billing observed and supports the interpretation that current patterns reflect established operational billing practices rather than a short‑term anomaly. For payers and analysts, that tenure combined with the concentrated revenue profile should focus audits, network contracting, and rate negotiations on the clinic/FQHC model and the high‑volume T1015 payment stream.

Medicaid: Complete Services Breakdown

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

177 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	529,930	$130	$70M
G0511	Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral…	91,400	$50	$4.8M
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…	117,630	$10	$705.8K
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…	25,740	$10	$257.4K
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…	24,150	$10	$193.2K
99442	N/A	13,130	$10	$105.1K
G0467	Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which…	8,000	$10	$96K
95115	The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives a single injection during the visit.	22,200	$1	$88.8K
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…	17,750	$10	$88.7K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	1,690	$50	$76K

Showing 1–10 of 177

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Staywell Health Care, Inc. — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

177 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	7	70	830	$150	$24M
G0511	Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral…	1	20	6,040	$40	$952.7K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	17	30	530	$320	$553.7K
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	1,590	740	$50	$331.8K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	17	30	2,590	$60	$278.5K
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…	25	1,710	750	$30	$243.3K
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…	8	170	850	$80	$203.5K
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…	424	2,180	850	$90	$202.1K
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…	33	420	1,230	$20	$199.3K
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…	35	570	410	$50	$197.6K

Showing 1–10 of 177

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Courtney Dowen	RI	Pediatric Nurse Practitioner	$0	$430.6K
Sandeep Tiyyagura	CT	Nephrology Physician	$170.3K	$0
Gustavo Herrera-brito	CT	Adult Health Nurse Practitioner	$54.9K	$0
Anita Salerno	CT	Nurse Practitioner	$9.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wellmore, Inc.	CT	Adolescent and Children Mental Health Clinic/Center	$0	$21.5M
City Of Waterbury Board Of Education	CT	Local Education Agency (LEA)	$0	$14.3M
Connecticut Renaissance, Inc.	CT	Substance Abuse Rehabilitation Facility	$0	$7.6M
Connecticut Junior Republic Association, Inc.	CT	Adolescent and Children Mental Health Clinic/Center	$0	$7.1M
Connecticut Renaissance, Inc	CT	Substance Abuse Rehabilitation Facility	$0	$5.5M
St. Francis Medical Equipment & Surgical Supply	CT	Durable Medical Equipment & Medical Supplies	$0	$4.1M
Wellmore, Inc	CT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$4.1M
Waterbury Eye Associates LLC	CT	Optometrist	$0	$3.6M
Waterbury Family Dental P.C.	CT	Dentist	$0	$2.5M
State Of Connecticut	CT	Adult Mental Health Clinic/Center	$0	$2.3M

Staywell Health Care, 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