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

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

North County Health Project Inc (NPI 1245246917)

Field	Value
Entity Type	Organization
Organization	North County Health Project Inc
Address	150 Valpreda Rd
City	San Marcos
State	CA
ZIP	92069
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	August 1, 2006

Payer Source	Total Paid
Medicaid	$125.9M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $125.9M in lifetime Medicaid revenue, making Medicaid effectively its sole payer exposure. The absence of any Medicare revenue suggests the organization operates primarily within Medicaid-funded programs and is highly dependent on state Medicaid policy and payments for its financial base.

Revenue is extremely concentrated in a small set of Medicaid codes: the precomputed top 3 Medicaid codes by revenue account for 97.5% of this provider's total Medicaid revenue. The three leading drivers are T1015 (547.5K claims, $189 avg paid/claim, $103.5M revenue), 00003 (75.7K claims, $241 avg paid/claim, $18.2M revenue), and 99213 (460.4K claims, $2 avg paid/claim, $920.8K revenue), which together dominate the revenue picture and create material concentration risk if reimbursement or program rules change.

The code mix—dominated by T1015 (Clinic visit/encounter, all-inclusive) and supplemented by FQHC/RHC-specific codes such as G0467 and G0511 as well as behavioral-health and case-management codes—is consistent with an FQHC-style, high-volume primary care and integrated services model. Specific codes supporting this interpretation include T1015 (103.5M revenue), G0467 (12.6K claims, $88.1K revenue), G0511 (8K claims, $24K revenue), and case-management/coordination codes such as G9008 and G9012.

Competitive standing in the state is pronounced for the key clinic-visit and E/M volumes: T1015 ranks #9 of 1550 in-state (99th percentile; extreme outlier, far above typical state volume) and 99213 ranks #15 of 14524 in-state (100th percentile; extreme outlier, far above typical state volume). Several other codes (90832 rank #2 of 1431; 98941 rank #2 of 494; G9920 rank #7 of 1571) are likewise labeled extreme outliers, indicating the provider is a major statewide outlier in utilization for multiple service lines.

There is a large volume-versus-revenue mismatch in conventional CPT E/M codes versus the FQHC encounter code: 99213 shows 460.4K claims but only $920.8K revenue ($2 avg paid/claim), and 99212 shows 176.4K claims and $176.4K revenue ($1 avg paid/claim). This pattern—very high claim counts but low per-claim payments for 9921x codes—underscores that T1015 and FQHC-specific billing are the principal revenue mechanisms rather than standalone CPT E/M reimbursements.

Behavioral health and mental-health services appear to be substantial parts of the service mix: 90832 (94.9K claims, $474.6K revenue) ranks #2 of 1431 in-state (100th percentile; extreme outlier), and 90791/90792 (7.5K and 5.6K claims respectively) are notably above typical state volume. The presence of multiple high-volume psychotherapy and psychiatric-evaluation codes indicates integrated behavioral-health capacity within the FQHC model.

Maternal and ancillary services are also present though much smaller revenue contributors: 59425 (3.8K claims, $204.7K revenue) and 76805 (1.6K claims, $81.3K revenue) show the provider delivers antepartum and obstetric imaging services. Complementary codes for care coordination (G9008, G9012) and telehealth (G2025) further suggest a broad clinical offering beyond routine primary care.

The NPI was enumerated on 2006-08-01 (~20 years ago), indicating an established presence in the market. Combined with FQHC taxonomy and the concentrated Medicaid revenue base, this tenure suggests long-standing operations focused on Medicaid populations; however, the reliance on a few high-revenue codes means reimbursement policy changes targeting those codes could have outsized financial impact.

Medicaid: Complete Services Breakdown

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

222 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	547,480	$190	$103.5M
00003	N/A	75,670	$240	$18.2M
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…	460,380	$1	$920.8K
G9920	Screening performed and negative	43,850	$10	$526.2K
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…	94,930	$10	$474.6K
G9008	Coordinated care fee, physician coordinated care oversight services	1,120	$400	$449K
98941	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in three to four spinal regions.	60,810	$10	$304K
G9012	Other specified case management service not elsewhere classified	700	$420	$288.4K
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	3,790	$50	$204.7K
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,…	176,420	$1	$176.4K

Showing 1–10 of 222

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

North County Health Project Inc — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

222 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	9	1,550	38,050	$190	$14.1M
00003	N/A	56	690	14,940	$260	$7.7M
G9012	Other specified case management service not elsewhere classified	416	720	1,110	$110	$651.3K
G9008	Coordinated care fee, physician coordinated care oversight services	207	490	660	$70	$396.7K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	38	390	250	$200	$220.4K
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…	65	1,030	1,050	$70	$219.7K
93005	The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to…	412	760	1,930	$20	$196K
59409	In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery…	384	410	130	$430	$193.6K
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…	138	1,950	500	$80	$179K
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…	113	13,300	640	$40	$169.6K

Showing 1–10 of 222

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
North County Health Project Inc	CA	Federally Qualified Health Center (FQHC)	$0	$57.5M
North County Health Project Inc	CA	Federally Qualified Health Center (FQHC)	$0	$29.4M
Mehran Moussavian	CA	Interventional Cardiology Physician	$3M	$67.3K
Steven Dickerson	CA	Foot & Ankle Surgery Podiatrist	$361.8K	$0
Emad Abu-khieran	CA	Internal Medicine Physician	$5.6K	$0

Nearby Providers

Other providers in the same ZIP code as North County Health Project Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Edward Mcclay	CA	Medical Oncology Physician	$3.4M	$0
San Diego Health Alliance	CA	Methadone Clinic	$113.9K	$543K
Arvin Mirow	CA	Psychiatry Physician	$189.3K	$0

North County Health Project 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