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    v1.0.28
    OpenPayerNPI Medicare & MedicaidShenandoah Valley Medical System, Inc.
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    Shenandoah Valley Medical System, Inc. — Billing Profile & Reimbursement Data

    NPI 1295062719 · Martinsburg, WV · Federally Qualified Health Center (FQHC)

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    Shenandoah Valley Medical System, Inc. is a federally qualified health center (fqhc) provider located in Martinsburg, West Virginia. This profile covers 0 Medicare and 34 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
    OrganizationShenandoah Valley Medical System, Inc.
    Address58 Warm Springs Ave
    CityMartinsburg
    StateWV
    ZIP25404
    TaxonomyFederally Qualified Health Center (FQHC)
    NPI EnumeratedNovember 4, 2009

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

    Payer SourceTotal Paid
    Medicaid$5M
    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.

    34 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    D0999N/A25,900$140$3.6M
    T1015Clinic visit/encounter, all-inclusive26,380$10$369.4K
    D9999N/A770$180$134.8K
    D1120Prophylaxis–child11,230$10$112.3K
    D1208Topical application of fluoride - excluding varnish16,420$10$98.5K
    D1110Prophylaxis - adult; cleaning and polishing of the teeth6,300$20$94.5K
    D0120Periodic oral evaluation - established patient13,420$10$93.9K
    D2392Post 2 surface resin‑based composite3,490$20$76.8K
    D0330N/A4,450$20$66.7K
    D7140Extraction, erupted tooth or exposed root (elevation and/or forceps removal)4,010$20$64.1K

    Showing 1–10 of 34

    Medicaid: Competitive Analysis & Benchmarks

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

    Full comparison — all codes billed, vs. West Virginia median

    34 rows

    CPT/HCPCS CodeDescriptionRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    T1015Clinic visit/encounter, all-inclusive843904,610$130$2.2M
    D0999N/A120500$140$317.9K
    D2930N/A1320410$110$238.5K
    D7210Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…4440470$110$188.1K
    D2392Post 2 surface resin‑based composite9130170$100$93.1K
    D7140Extraction, erupted tooth or exposed root (elevation and/or forceps removal)8110330$60$90.5K
    D1351Sealant - per tooth31100490$30$89.6K
    D2391Resin‑based composite – one surface, posterior8120220$80$70.7K
    D9230N/A780280$40$52.6K
    D1120Prophylaxis–child6270290$30$49.1K

    Showing 1–10 of 34

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Shenandoah Valley Medical System, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Shenandoah Valley Medical System, Inc.WVFederally Qualified Health Center (FQHC)$0$61M
    Shenandoah Valley Medical System,inc.WVFederally Qualified Health Center (FQHC)$0$1.8M
    Courtney StruthersWVInternal Medicine Physician$143.8K$0
    Hugh LabreeVAFamily Nurse Practitioner$50.6K$5.4K
    Charlotte LaneVAFamily Nurse Practitioner$990$0
    Michael LiVAInternal Medicine Physician$490$0
    Cheryl TaitanoWVFamily Medicine Physician$250$0

    Nearby Providers

    Other providers in the same ZIP code as Shenandoah Valley Medical System, Inc., ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Martinsburg Institute IncWVMethadone Clinic$155.3K$11.4M
    Stonebrook Community Services LLCWVDevelopmentally Disabled Services Day Training Agency$0$11.1M
    Board Of Child Care, WvWVEmotionally Disturbed Childrens' Residential Treatment Facility$0$5.3M
    Berkeley Co Comm On AgingWVHomemaker$0$2.1M
    Benjamin KreppsWVPain Medicine (Anesthesiology) Physician$174K$0
    Carrie ChaseWVFamily Nurse Practitioner$162.7K$0
    Joseph JurandWVPsychiatry Physician$128.8K$0
    Miranda AlbaughWVFamily Medicine Physician$125.5K$0
    West Virginia Cvs Pharmacy LLCWVPharmacy$100.8K$0
    Johny AlencherryWVInternal Medicine Physician$77.3K$0

    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. West Virginia Providers
    0 of 7 years billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Claims Volume vs. West Virginia Distribution
    Shenandoah Valley Medical System, Inc. — 14 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — West Virginia