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NPI 1164840302 · Phoenix, AZ · Federally Qualified Health Center (FQHC)
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Maricopa County Special Health Care District is a federally qualified health center (fqhc) provider located in Phoenix, Arizona. This profile covers 0 Medicare and 206 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 | Maricopa County Special Health Care District |
| Address | 2525 E Roosevelt St |
| City | Phoenix |
| State | AZ |
| ZIP | 85008 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | April 4, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $56.5M |
| Medicare | $0 |
This provider is effectively single‑payer in the available claims data: Total Medicaid revenue is $56.5M and there is no Medicare billing on file. That concentration means Medicaid reimbursement policy and rate-setting will dominate the provider's financial picture.
Medicaid revenue is extremely concentrated in a single encounter code: T1015 accounts for $56.5M and 99.9% of the provider's Medicaid revenue, and the precomputed top 3 Medicaid codes by revenue account for 100.0% of lifetime Medicaid revenue. This level of concentration indicates that the provider’s financial performance is highly sensitive to changes in how T1015 is paid or defined.
The code mix and taxonomy are consistent with Federally Qualified Health Center operations: T1015 (Clinic visit/encounter, all‑inclusive) as the dominant revenue driver suggests an encounter‑based, all‑inclusive billing model that bundles many services into a single clinic visit payment. High volumes of vaccine and preventive codes (e.g., 90648, 90685, 90471, 90472, 99391) alongside T1015 are typical for FQHCs that provide broad primary care, immunization, and well‑child services.
Competitive standing on the primary revenue driver is strong but described as typical for the code: T1015 ranks #8 of 357 in‑state (98th percentile; typical, unremarkable volume for this code), indicating the provider is a high‑volume clinic for this encounter code without an unusual market share claim beyond being a top percentile performer. In short, it is a major in‑state participant for clinic encounters but not anomalously dominant relative to comparable FQHCs.
Several preventive and pediatric evaluation codes are state outliers in claim volume despite generating minimal standalone revenue: 99391 ranks #3 of 298 (99th percentile; extreme outlier) and 90685 ranks #2 of 121 (99th percentile; extreme outlier), yet each contributes only $42.2K and $2.8K respectively. These patterns suggest the provider delivers very high volumes of preventive visits and vaccinations that are likely captured within bundled encounter payments rather than producing large separately billed Medicaid dollars.
Many high‑volume CPT/HCPCS entries report $0 or near‑zero average paid/claim (examples include 99213: 102.7K claims $0, 99392: 26.5K claims $0, 90670: 12.4K claims $0, 99214: 72.1K claims $0). This supports the interpretation that Medicaid reimbursement is largely encounter‑based or bundled for this FQHC, with per‑service payments suppressed or incorporated into all‑inclusive encounter billing.
Beyond revenue patterns, clinical focus is evident: the presence of large counts for well‑child and well‑patient codes (99381/99382/99383/99391/99392/99393) and numerous vaccination codes signals a strong emphasis on primary care, pediatric preventive services, and immunization programs consistent with community health center missions. Operational planning and capacity for immunization clinics and pediatric preventive workflows are likely important drivers of throughput.
Provider tenure is established but not long‑standing by some systems' standards: NPI enumerated 2014‑04‑04 (~12 years ago), indicating roughly a decade of operation under this identifier. That tenure, combined with the concentrated encounter revenue model and high preventive/vaccine volumes, positions the organization as a mature FQHC clinic network with established Medicaid operational processes that would be sensitive to policy changes affecting T1015 or bundled encounter reimbursement.
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.
206 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 209,150 | $270 | $56.5M |
| 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… | 42,200 | $1 | $42.2K |
| 90648 | This code represents a Haemophilus influenzae type b (Hib) vaccine product administered into the muscle to protect against Hib disease. This formulation uses a PRP–T conjugate and follows a four–dose… | 7,370 | $1 | $7.4K |
| 99204 | The provider sees a new 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 provider… | 6,000 | $1 | $6K |
| 99203 | The provider sees a new 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 provider… | 4,860 | $1 | $4.9K |
| 76815 | The provider performs a limited examination of the fetus using ultrasound. The provider performs the examination of certain parameters for one or more fetuses. | 3,460 | $1 | $3.5K |
| 90685 | This code represents a quadrivalent flu vaccine given by injection into the muscle. It is a split–virus vaccine, preservative–free, and provided in a 0.25 mL dose. | 2,780 | $1 | $2.8K |
| 99383 | The provider performs a well–patient visit for a child who is between the ages of 5 and 11 who meets the definition of new patient. | 1,060 | $1 | $2.1K |
| T1016 | Case management, each 15 minutes | 90 | $20 | $1.7K |
| 99381 | The provider performs a well–baby visit for a child under the age of one. | 1,610 | $1 | $1.6K |
Showing 1–10 of 206
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
206 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 8 | 360 | 3,640 | $230 | $7.7M |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 96 | 110 | 960 | $70 | $1.7M |
| T1016 | Case management, each 15 minutes | 1,027 | 1,160 | 2,110 | $30 | $1.2M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 737 | 1,150 | 1,700 | $90 | $1M |
| 87801 | The lab analyst performs a test for multiple infectious agents using amplified nucleic acid probe technique. | 6 | 20 | 250 | $40 | $915.9K |
| H2027 | Psychoeducational service, per 15 minutes | 379 | 500 | 750 | $170 | $592.2K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 86 | 140 | 1,460 | $60 | $422.5K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 152 | 400 | 200 | $120 | $403K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 139 | 170 | 3,560 | $30 | $397.9K |
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 4 | 20 | 550 | $10 | $368.9K |
Showing 1–10 of 206
Other providers in the same ZIP code as Maricopa County Special Health Care District, ranked by combined Medicare and Medicaid revenue.
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