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NPI 1275810160 · Riverton, WY · Federally Qualified Health Center (FQHC)
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Community Health Center Of Central Wyoming Inc is a federally qualified health center (fqhc) provider located in Riverton, Wyoming. This profile covers 0 Medicare and 23 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 | Community Health Center Of Central Wyoming Inc |
| Address | 1035 Rose Lane |
| City | Riverton |
| State | WY |
| ZIP | 82501 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | November 7, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $4.3M |
| Medicare | $0 |
This provider is effectively single‑payer in scope: there is no Medicare billing on file and all reported lifetime revenue is Medicaid‑based ($4.3M). The absence of Medicare claims removes the provider from Medicare competitive comparisons and suggests its payer footprint and contracting efforts are tightly focused on Medicaid populations and managed Medicaid plans in Wyoming.
Revenue is highly concentrated across a very small set of codes: the precomputed top three Medicaid codes account for 100.0% of this provider's total Medicaid revenue. T1015 alone represents $4.2M (98.9% of Medicaid revenue), while S0281 and 99213 contribute $42K (1.0%) and $5.8K (0.1%) respectively, indicating dependence on a single encounter billing mechanism for the bulk of Medicaid dollars.
The code mix and the provider's FQHC taxonomy align: T1015 (Clinic visit/encounter, all‑inclusive) dominating revenue is consistent with Federally Qualified Health Center encounter‑based payment models that bundle many services into a single per‑visit payment. This pattern suggests the center operates as a comprehensive primary‑care safety‑net clinic where most clinical and ancillary services are captured under the FQHC encounter rate rather than being billed individually.
Operational nuance: 99213 shows high claim volume (5.8K claims) and ranks #22 of 257 providers in‑state (92th percentile) but contributes only $5.8K in revenue (0.1% of Medicaid revenue). That disparity—substantial claim counts with minimal per‑claim payment—is consistent with evaluation/management services being recorded but financially subsumed within the T1015 encounter payment, producing low standalone revenue for traditional E/M CPTs.
Competitive standing on the principal revenue driver is solid but not dominant: T1015 ranks #9 of 53 providers in‑state (85th percentile) and is characterized in the source data as "typical, unremarkable volume for this code." This places the center above many peers on FQHC encounter billing statewide, indicating a meaningful presence in the Medicaid FQHC market without being a single dominant provider.
Behavioral‑health activity appears substantial in terms of service volume even when it does not generate discrete Medicaid line‑item revenue: 90834 (psychotherapy) shows 2.5K claims and ranks #4 of 36 providers in‑state (91th percentile), described in the data as "notably above typical state volume for this code." That suggests an operational emphasis or capacity for psychotherapy and behavioral‑health visits that may be covered under the encounter methodology rather than as separate paid line items.
Several common ancillary and preventive codes (vaccines, lab tests, well visits) show claims but report $0 average paid/claim in the supplied Medicaid dataset, which is consistent with encounter‑rate reimbursement. Analysts should interpret low or zero per‑code Medicaid payments in this profile as likely reflecting bundled FQHC payments rather than an absence of those services in the clinic's care mix.
The provider has an established operating history: NPI enumeration date is 2011‑11‑07 (~15 years ago). That tenure supports the interpretation that the billing patterns observed—heavy reliance on T1015 and bundling of services—are stable operational practices rather than a transient billing artifact.
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.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 14,380 | $290 | $4.2M |
| S0281 | Medical home program, comprehensive care coordination and planning, maintenance of plan | 8,390 | $10 | $42K |
| 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… | 5,800 | $1 | $5.8K |
| 87428 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2… | 290 | $1 | $290 |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 10 | $0 | $0 |
| 81003 | The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will… | 30 | $0 | $0 |
| 86328 | The lab analyst performs a single–step immunoassay to qualitatively or semiquantitatively evaluate the patient’s specimen for antibodies to the severe acute respiratory syndrome coronavirus 2… | 40 | $0 | $0 |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 20 | $0 | $0 |
| 87804 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings. | 100 | $0 | $0 |
| 87807 | The lab analyst performs the technical lab test to analyze for the presence of respiratory syncytial virus (RSV) in a specimen by immunoassay using direct optical, meaning visual, observation. | 10 | $0 | $0 |
Showing 1–10 of 23
How this provider's Medicaid billing volume and revenue compare to other Wyoming providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wyoming median
23 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 9 | 50 | 1,690 | $360 | $3.3M |
| S0281 | Medical home program, comprehensive care coordination and planning, maintenance of plan | 11 | 20 | 13,160 | $10 | $190.1K |
| 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… | 43 | 220 | 400 | $50 | $79.3K |
| 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… | 22 | 260 | 420 | $30 | $67.2K |
| 90460 | In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age. | 32 | 70 | 490 | $40 | $42.9K |
| 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 | 10 | 680 | $20 | $36.7K |
| 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… | 4 | 40 | 360 | $50 | $34.6K |
| 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… | 31 | 40 | 170 | $70 | $34.1K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 21 | 30 | 100 | $60 | $17.8K |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 19 | 20 | 330 | $30 | $16.8K |
Showing 1–10 of 23
Other providers in the same ZIP code as Community Health Center Of Central Wyoming Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Community Entry Services | WY | Developmentally Disabled Services Day Training Agency | $0 | $50.2M |
| Frontier Ambulance LLC | WY | Ambulance | $737.8K | $785.4K |
| Guardian Flight LLC | WY | Air Ambulance | $934.9K | $0 |
| Reach Foundation | WY | Case Management Agency | $0 | $927.5K |
| Lincare Inc. | WY | Durable Medical Equipment & Medical Supplies | $0 | $788K |
| Debra Stone | WY | Developmentally Disabled Services Day Training Agency | $0 | $709.2K |
| Kinisha Pullen-shelsta | WY | Case Manager/Care Coordinator | $0 | $661.2K |
| Riverton Vision Center P.C. | WY | Optometrist | $0 | $606.2K |
| Wyoming Counseling Services PC | WY | Professional Counselor | $0 | $595.8K |
| Teton Therapy, P.C. | WY | Physical Therapy Clinic/Center | $0 | $518K |
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