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    OpenPayerNPI Medicare & MedicaidSouthern Illinois Healthcare Foundation Inc
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    Southern Illinois Healthcare Foundation Inc — Billing Profile & Reimbursement Data

    NPI 1225556996 · O Fallon, IL · Federally Qualified Health Center (FQHC)

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    Southern Illinois Healthcare Foundation Inc is a federally qualified health center (fqhc) provider located in O Fallon, Illinois. This profile covers 0 Medicare and 53 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeOrganization
    OrganizationSouthern Illinois Healthcare Foundation Inc
    Address3 Saint Elizabeth Blvd Ste 4000
    CityO Fallon
    StateIL
    ZIP62269
    TaxonomyFederally Qualified Health Center (FQHC)
    NPI EnumeratedSeptember 1, 2017

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicaid$7.9M
    Medicare$0

    Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

    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

    Medicaid: Complete Services Breakdown

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

    53 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    T1015Clinic visit/encounter, all-inclusive62,960$120$7.8M
    T1040Medicaid certified community behavioral health clinic services, per diem900$70$66.5K
    90686This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…1,080$1$1.1K
    90688This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.510$1$510
    90651This code represents a nonavalent human papillomavirus (HPV) vaccine product administered into the muscle to protect against HPV infection. The vaccine protects against nine HPV types (6, 11, 16, 18,…160$1$480
    96372A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…250$1$250
    90734The provider administers a meningococcal conjugate vaccine in a diphtheria toxoid carrier (MenACWY–D) or CRM197 carrier (MenACWY–CRM) to protect the patient from four strains of meningococcal viruses…70$1$130
    0500FNo Summary found for this code30$0$0
    0502FNo Summary found for this code2,020$0$0
    1036FN/A2,440$0$0

    Showing 1–10 of 53

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. Illinois median

    53 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    T1015Clinic visit/encounter, all-inclusive1068507,490$120$3.9M
    T1040Medicaid certified community behavioral health clinic services, per diem95190880$70$128.2K
    90837In 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…3351,180370$90$109.7K
    90832In 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…219960330$30$51K
    99214The 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…26514,680300$50$48.7K
    0502FNo Summary found for this code2421,170550$30$48.2K
    99392Preventive 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…3941,380370$40$46.2K
    99391Preventive 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…2301,270370$40$40.8K
    99213The 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…9614,190280$20$38.9K
    99393The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.4951,670160$40$26.4K

    Showing 1–10 of 53

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Southern Illinois Healthcare Foundation Inc, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Southern Illinois Health Care Foundation, Inc.ILFederally Qualified Health Center (FQHC)$0$21.1M
    Southern Illinois Healthcare Foundation, IncILFederally Qualified Health Center (FQHC)$0$20.4M
    Southern Illinois Healthcare Foundation, Inc.ILFederally Qualified Health Center (FQHC)$0$20.4M
    Southern Illinois Healthcare Foundation IncILFederally Qualified Health Center (FQHC)$0$17.8M
    Southern Illinois Healthcare Foundation, IncILFederally Qualified Health Center (FQHC)$0$12.1M
    Southern Illinois Healthcare Foundation, IncILFederally Qualified Health Center (FQHC)$0$10.2M
    Southern Illinois Healthcare Foundation, Inc.ILFederally Qualified Health Center (FQHC)$0$9.8M
    Southern Illinois Healthcare Foundation, Inc.ILFederally Qualified Health Center (FQHC)$0$7.9M
    Southern Illinois Healthcare Foundation, Inc.ILFederally Qualified Health Center (FQHC)$0$6.3M
    Southern Illinois Healthcare Foundation, Inc.ILFederally Qualified Health Center (FQHC)$0$6.3M

    Nearby Providers

    Other providers in the same ZIP code as Southern Illinois Healthcare Foundation Inc, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Ssm Cardinal Glennon Childrens HospitalILPediatrics Physician$0$5.4M
    John ViscontiILMedical Oncology Physician$2.8M$149.1K
    Bassam MaaloufILHematology & Oncology Physician$1.8M$770.9K
    Brett HerzogILMedical Oncology Physician$1.9M$40.7K
    Justin FloydILMedical Oncology Physician$1.3M$336.2K
    Mark WalshauserILHematology & Oncology Physician$437.5K$395.5K
    O'fallon Surgical Center, LLCILAmbulatory Surgical Clinic/Center$793.7K$0
    Scott RoustioILEmergency Medicine Physician$83.8K$625.5K
    Michael StockILOphthalmology Physician$669.2K$0
    Raghav GovindarajanILNeuromuscular Medicine (Psychiatry & Neurology) Physician$377.7K$282.1K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicaid Revenue by Year vs. Illinois Providers
    7 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. Illinois Distribution
    Southern Illinois Healthcare Foundation Inc — 0 of 7 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Illinois