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

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

Esperanza Health Center, Inc. (NPI 1255726659)

Field	Value
Entity Type	Organization
Organization	Esperanza Health Center, Inc.
Address	4417 N 6th St
City	Philadelphia
State	PA
ZIP	19140
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	April 2, 2015

Payer Source	Total Paid
Medicaid	$40.8M
Medicare	$0

Key Findings

ESPERANZA HEALTH CENTER, INC. is classified as a Federally Qualified Health Center (FQHC) and its Medicaid coding mix is dominated by bundled clinic-visit payments: T1015 (Clinic visit/encounter, all-inclusive) accounts for $40.5M and 99.3% of the provider's total Medicaid revenue. The presence of G0467 (FQHC visit, established patient) and the FQHC taxonomy together support that this organization primarily delivers per‑visit, bundled primary care services typical of community health centers.

Revenue is extremely concentrated: the precomputed top-three Medicaid codes together account for 99.8% of the provider’s Medicaid revenue, with T1015 providing the overwhelming share and 0012A ($92.1K, 0.2%) and 0011A ($86K, 0.2%) contributing only marginally. This narrow revenue base indicates most reimbursement is captured through a single all‑inclusive visit code rather than diversified procedure-level billing.

On payer mix, ESPERANZA is effectively a single‑payer Medicaid provider: there is no Medicare billing on file while total Medicaid revenue is $40.8M. The absence of Medicare revenue means the organization’s financial performance and utilization patterns are centrally tied to Medicaid policy, rates, and patient enrollment.

Competitive standing for the chief Medicaid code is dominant within the state: T1015 ranks #5 of 1691 providers in-state and is described as an "extreme outlier, far above typical state volume for this code." Similarly, 0012A and 0011A each rank #1 in-state (100th percentile) and are labeled "extreme outlier," indicating the provider is a major outlier and a leading statewide reporter for these specific Medicaid codes.

Several commonly billed outpatient E/M and encounter codes appear with very large claim volumes but $0 reported revenue (notably 99213 with 59K claims, 99214 with 43.5K claims, and 3074F with 30K claims), each also flagged as extreme outliers in state claim volume. This pattern is consistent with encounter-level reporting or bundling of visit payments under T1015 in an FQHC reimbursement model, where procedure-level line items may be submitted but payment is captured in the all‑inclusive clinic visit code.

Service mix beyond the dominant visit code is present but low revenue: immunization codes (90677, 90688, 91322), G2025 (telehealth distant site) and J1050 (medroxyprogesterone injection) appear in the top-25 Medicaid list but together comprise a negligible share of revenue. These entries suggest the center offers preventive vaccines, some family‑planning injections, and telehealth encounters, yet none materially affect the overall Medicaid revenue picture.

Most other listed codes fall in mid-to-high state percentiles but contribute only small dollar amounts (examples include G0467 at $11.5K and several A-prefixed codes in the low‑teens of thousands), indicating that aside from the T1015 bundle the provider’s procedure-level billing pattern resembles a typical FQHC with routine ancillary services. In other words, operational breadth exists, but financial dependence remains concentrated on the bundled clinic-visit reimbursement.

The NPI was enumerated on 2015-04-02 (~11 years ago), indicating the provider has an established presence in the Philadelphia market. Given that longevity and the provider’s dominant standing for T1015 within the state, analysts should treat the center as a stable, Medicaid-focused FQHC whose performance will be highly sensitive to Medicaid rate changes and visit-volume dynamics.

Medicaid: Complete Services Breakdown

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

110 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	191,080	$210	$40.5M
0012A	N/A	2,420	$40	$92.1K
0011A	N/A	2,530	$30	$86K
0064A	N/A	680	$40	$26.6K
0071A	N/A	300	$40	$11.6K
0002A	N/A	290	$40	$11.6K
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…	550	$20	$11.5K
0001A	N/A	290	$40	$11.2K
0072A	N/A	250	$40	$9.8K
J1050	Injection, medroxyprogesterone acetate, 1 mg	70	$80	$6K

Showing 1–10 of 110

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Esperanza Health Center, Inc. — 4 of 22 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

110 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	5	1,690	760	$170	$1.2M
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…	78	820	230	$80	$71.7K
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…	16	8,160	210	$60	$68.4K
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…	86	660	180	$70	$63.7K
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…	17	8,870	240	$40	$56.1K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	194	710	230	$70	$49.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	60	870	160	$70	$48.2K
D2392	Post 2 surface resin‑based composite	204	960	190	$70	$35.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	76	730	90	$70	$31.5K
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…	613	1,410	60	$90	$30.5K

Showing 1–10 of 110

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Albert Fink	PA	Internal Medicine Physician	$200.8K	$0

Nearby Providers

Other providers in the same ZIP code as Esperanza Health Center, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Temple University Hospital, Inc	PA	General Acute Care Hospital	$0	$116.6M
All American Home Care LLC	PA	Home Health Agency	$0	$45M
Cognitive Behavioral Services, Inc.	PA	Community/Behavioral Health Agency	$0	$20.8M
Pan American Mental Health Services Inc	PA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$20.1M
Temple Faculty Practice Plan, Inc	PA	Emergency Medicine Physician	$0	$18.4M
Temple Faculty Practice Plan, Inc	PA	Diagnostic Radiology Physician	$0	$18M
Paulino Home Healthcare LLC	PA	In Home Supportive Care Agency	$0	$12.5M
Gaudenzia Inc	PA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$8.5M
Greater Philadelphia Health Action, Inc.	PA	Federally Qualified Health Center (FQHC)	$0	$5.5M
Michael Jaworski	PA	Internal Medicine Physician	$2.1M	$0

Esperanza Health Center, Inc. — Billing Profile & Reimbursement Data

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Esperanza 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