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

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

West Hawaii Community Health Center, Inc. (NPI 1225086887)

Key Findings

Field	Value
Entity Type	Organization
Organization	West Hawaii Community Health Center, Inc.
Address	1178 Kinoole St
City	Hilo
State	HI
ZIP	96720
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	May 5, 2006

Payer Source	Total Paid
Medicaid	$7.1M
Medicare	$0

WEST HAWAII COMMUNITY HEALTH CENTER, INC. is effectively a Medicaid-centric provider: lifetime Medicaid revenue is $7.1M and there is no Medicare billing on file, so Medicaid drives the provider's billed activity and revenue. The organization is listed as a Federally Qualified Health Center (FQHC) and its NPI was enumerated 2006-05-05 (~20 years ago), indicating an established, long-tenured community clinic presence.

Revenue for this provider is highly concentrated: the precomputed top 3 Medicaid codes (99213, 99214, 90832) account for 88.9% of this provider's total Medicaid revenue. Individually those top three are 99213 ($3.3M, 46.8%), 99214 ($2.3M, 31.7%), and 90832 ($739.1K, 10.3%), showing a heavy reliance on a very small set of services for the majority of Medicaid dollars.

The service mix indicates a primary-care–centric operation: the two largest revenue drivers are established-patient E&M codes 99213 (18.4K claims, $182 avg paid/claim, $3.3M) and 99214 (13.3K claims, $170 avg paid/claim, $2.3M). High claim volumes for these mid-level E&M codes suggest routine outpatient primary care visits are the clinic's operational backbone rather than specialty or procedure-based care.

Behavioral health is a meaningful secondary service line: psychotherapy code 90832 appears as the third-largest revenue source (4.1K claims, $182 avg paid/claim, $739.1K, 10.3%) and 90834 (1.3K claims, $174 avg paid/claim, $225.9K, 3.2%) plus 90791 and the FQHC mental-health bundle G0470 are also billed. This pattern indicates integrated behavioral health capacity within the FQHC model, with standalone psychotherapy sessions contributing materially to total Medicaid revenue.

FQHC-specific bundle and care-management codes are present but low-dollar relative to E&M: G0467 (3.4K claims, $33 avg paid/claim, $113.8K, 1.6%) and G0511 (440 claims, $114 avg paid/claim, $50.2K, 0.7%) appear in the mix. The modest revenue from these FQHC/bundled codes suggests the center predominantly bills conventional E&M codes for established patients rather than generating the majority of Medicaid revenue from per-diem FQHC bundles or chronic care management payments.

State-level competitive positioning on core primary-care codes is strong by rank/percentile: 99213 ranks #15 of 707 providers in-state (98th percentile) and 99214 ranks #20 of 690 (97th percentile), placing the clinic among the higher-volume Medicaid providers for those codes statewide. The underlying data labels these volumes as "typical, unremarkable volume for this code," so while the clinic ranks highly relative to peers, usage patterns for these codes align with standard primary-care practice rather than indicating atypical coding behavior.

Preventive and pediatric well-care appear as modest revenue contributors: G0101 (817 claims, $190 avg paid/claim, $155.2K, 2.2%) and well-patient codes such as 99394 ($34.4K, 0.5%) and 99393 ($27.7K, 0.4%) are reported but represent small shares of total Medicaid revenue. This suggests preventive and adolescent/child well visits are part of the service mix but are not the primary revenue drivers compared with routine established-patient visits and psychotherapy.

The clinic shows high throughput of low-reimbursement ancillary services: 90471 has 3K claims at $2 avg paid/claim for $6.1K (0.1%) and 81025 has 3.3K claims with $0 avg paid/claim and $0 revenue, demonstrating substantial vaccine and point-of-care testing activity that contributes little to overall Medicaid revenue. For payers and network planners, these volumes indicate operational capacity for immunizations and basic lab/testing despite minimal Medicaid reimbursement per procedure.

Medicaid: Complete Services Breakdown

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

36 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	18,370	$180	$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…	13,350	$170	$2.3M
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…	4,060	$180	$739.1K
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…	1,300	$170	$225.9K
G0101	Cervical or vaginal cancer screening; pelvic and clinical breast examination	820	$190	$155.2K
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…	3,450	$30	$113.8K
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…	440	$110	$50.2K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	320	$140	$45.2K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	170	$200	$34.4K
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…	170	$200	$33.7K

Showing 1–10 of 36

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

West Hawaii Community Health Center, Inc. — 3 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

36 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	11	70	370	$150	$457.3K
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…	15	710	650	$90	$274.1K
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…	13	30	1,850	$60	$248.9K
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…	20	690	650	$90	$235.4K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	70	190	190	$100	$122.8K
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…	23	80	320	$100	$119.2K
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…	70	100	210	$120	$116.7K
G0470	Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc…	11	10	610	$70	$111.5K
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…	73	100	210	$110	$101.4K
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…	6	10	490	$120	$89.6K

Showing 1–10 of 36

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Hilo Benioff Medical Center	HI	General Acute Care Hospital	$0	$51.2M
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$19.3M
Metropacific Group, Corp	HI	Developmentally Disabled Services Day Training Agency	$0	$13.3M
Triple Ace Venture Capital, Corp.	HI	In Home Supportive Care Agency	$0	$10.5M
Hilo Urgent Care Center, LLC	HI	Urgent Care Clinic/Center	$0	$6.5M
Alpha Care Hawaii LLC	HI	In Home Supportive Care Agency	$0	$5.9M
Mastercare Inc	HI	In Home Supportive Care Agency	$0	$5.4M
Americare Hawaii Incorporated	HI	In Home Supportive Care Agency	$0	$3.7M
Garret K. Uehara, Dds Inc. Dba	HI	General Practice Dentistry	$0	$3.6M
Hawaii Radiologic Associates, Ltd.	HI	Diagnostic Radiology Physician	$0	$3.5M

West Hawaii Community Health Center, Inc. — Billing Profile & Reimbursement Data

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West Hawaii Community Health Center, 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Whchc - Hawaii Island Community Health Center	HI	Federally Qualified Health Center (FQHC)	$0	$8.1M
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$2M
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$1.6M
Lanai Community Health Center	HI	Federally Qualified Health Center (FQHC)	$0	$1.4M
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$553.2K
West Hawaii Community Health Center, Inc.	HI	Federally Qualified Health Center (FQHC)	$0	$299.7K
Anil Punjabi	HI	Cardiovascular Disease Physician	$72.4K	$0
Irving Harper	HI	Internal Medicine Physician	$57.7K	$0
Michael Leong	HI	Optometrist	$49.4K	$0