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NPI 1154354744 · Princess Anne, MD · Federally Qualified Health Center (FQHC)
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Three Lower Counties Community Services, Inc. is a federally qualified health center (fqhc) provider located in Princess Anne, Maryland. This profile covers 0 Medicare and 122 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Three Lower Counties Community Services, Inc. |
| Address | 12145 Elm Street |
| City | Princess Anne |
| State | MD |
| ZIP | 21853 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | July 8, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $110.2M |
| Medicare | $0 |
This provider is effectively a Medicaid-focused FQHC: there is no Medicare billing on file and total Medicaid revenue is $110.2M, indicating the organization operates almost entirely within the Medicaid payer channel rather than a dual Medicare/Medicaid model. The NPI was enumerated on 2006-07-08 (~20 years ago), confirming a long tenure that aligns with an established community health center footprint.
Revenue is highly concentrated in a very small set of Medicaid codes: T1015, 99213, and 99214 together account for 84.1% of this provider's total Medicaid revenue (with T1015 generating $57.8M or 52.9% and 99213 generating $30.1M or 27.6%). This concentration implies that changes to reimbursement or utilization for these specific codes would materially affect the provider’s financial position.
The code mix and volumes point to a high-volume primary care and bundled clinic encounter model consistent with an FQHC: T1015 (Clinic visit/encounter, all-inclusive) is the single largest revenue driver at 342.2K claims and $57.8M revenue, and 99213 (established patient E/M, low complexity) is similarly large at 173.2K claims and $30.1M revenue. The prominence of an FQHC bundle plus high-volume E/M visits suggests routine chronic care management and frequent established-patient follow-ups are central to operations.
Preventive and well-patient services are also a clear service line emphasis: codes 99391, 99392, 99393, 99394, 99395, and 99396 together represent meaningful volumes (each in the thousands of claims) and several rank very highly in-state. Notably, 99395 ($1.8M, 10.3K claims) and 99396 ($1.1M, 6.5K claims) each rank #1 in-state (100th percentile), indicating a sizable preventive care practice spanning adolescents through adults.
The provider shows a dominant competitive standing in Maryland for several top codes: T1015 ranks #1 of 58 providers in-state at the 100th percentile (labeled an extreme outlier), 99213 ranks #3 of 3275 providers in-state at the 100th percentile (extreme outlier), and preventive codes such as 99395 and 99396 also rank #1 of their peer groups (100th percentile). These ranks indicate the provider is a major statewide player for bundled clinic encounters, routine E/M visits, and many preventive services.
There are multiple high-volume codes with limited public descriptions (3074F, 3078F, 3079F, 3075F) that nevertheless appear as extreme state outliers (each listed as rank #1 and 100th percentile) and together contribute nontrivial revenue (for example 3074F: 135.2K claims, $946.2K revenue). The presence of several high-volume, poorly documented codes suggests payers or analysts may want to review clinical mapping and coding definitions to understand service mix and reporting practices.
Obstetric imaging and maternal-fetal services are a material, secondary service line: ultrasound codes such as 76805 ($1.1M, 9.4K claims), 76818 ($579.9K), 76820 ($370.8K), and related CPTs rank at or above typical state volumes (96th–85th percentiles for several codes). This pattern points to on-site prenatal surveillance capacity that supplements the primary-care/well-visit volume rather than being the primary revenue driver.
Operational risk is concentrated: with T1015 and 99213 together responsible for the majority of Medicaid revenue, the organization is sensitive to policy, fee-schedule, or utilization shifts affecting FQHC encounter bundles and low-complexity E/M visits. Given the provider’s long tenure (~20 years) and its dominant in-state standing on several codes, strategic planning should prioritize maintaining access and coding stability for these core services while monitoring reimbursement trends for the high-concentration codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
122 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 342,190 | $170 | $57.8M |
| 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… | 173,240 | $170 | $30.1M |
| 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… | 24,370 | $170 | $4M |
| 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… | 12,540 | $180 | $2.3M |
| 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… | 12,140 | $180 | $2.2M |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 10,190 | $190 | $1.9M |
| 99395 | The provider performs an established well–patient visit for a patient who is between the ages of 18 and 39. | 10,340 | $170 | $1.8M |
| 99396 | The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64. | 6,550 | $170 | $1.1M |
| 99394 | The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17. | 6,070 | $190 | $1.1M |
| 76805 | In this procedure, the provider performs an ultrasound of a pregnant uterus for examination of the first or a single fetus and to examine the mother after the first trimester, or more than 14 weeks… | 9,350 | $120 | $1.1M |
Showing 1–10 of 122
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
122 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 1 | 60 | 380 | $170 | $4.1M |
| 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… | 901 | 2,200 | 890 | $110 | $596.1K |
| 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… | 61 | 3,670 | 680 | $90 | $310K |
| 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… | 3 | 3,280 | 610 | $80 | $296.1K |
| 76811 | The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic… | 12 | 30 | 670 | $130 | $291.4K |
| 76821 | The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the middle cerebral artery. This test determines the timing of labor induction and… | 10 | 10 | 1,680 | $50 | $242.7K |
| 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… | 7 | 330 | 800 | $110 | $228.7K |
| 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… | 7 | 290 | 730 | $100 | $212.2K |
| 76816 | The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound. | 22 | 60 | 370 | $70 | $195.6K |
| 76820 | The provider performs Doppler ultrasonography for fetal surveillance to determine the velocity of blood flow through the umbilical artery. This test determines the timing of labor induction and when… | 6 | 40 | 250 | $40 | $190.6K |
Showing 1–10 of 122
Other providers in the same ZIP code as Three Lower Counties Community Services, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Focus Point Solutions LLC | MD | Health Maintenance Organization | $0 | $6.1M |
| Go-getters, Inc. | MD | Community/Behavioral Health Agency | $0 | $5.5M |
| Charles Hofmann | MD | Internal Medicine Physician | $143.1K | $0 |
| Lionel Kum | MD | Medical Physician Assistant | $81.3K | $0 |
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