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

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

Little Rivers Health Care, Inc. (NPI 1316165129)

Field	Value
Entity Type	Organization
Organization	Little Rivers Health Care, Inc.
Address	437 South Main Street
City	Bradford
State	VT
ZIP	05033
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	April 24, 2007

Payer Source	Total Paid
Medicaid	$12.1M
Medicare	$0

Key Findings

This provider is effectively single-payer at the claim level: there is no Medicare billing on file and all reported federal payments are from Medicaid, with total Medicaid revenue of $12.1M. The absence of Medicare revenue indicates Medicaid is the operational and financial driver for this entity rather than a balanced Medicare/Medicaid mix.

Revenue is extremely concentrated: the precomputed top three Medicaid codes account for 100.0% of this provider’s Medicaid revenue, led by T1015 which alone represents $12M (99.4% of Medicaid revenue). The other two top codes are G0467 ($56.1K, 0.5%) and 99214 ($12.5K, 0.1%), confirming that nearly all dollars flow through a very small set of codes.

The code mix and taxonomy align with a Federally Qualified Health Center operating model: T1015 (Clinic visit/encounter, all-inclusive) dominates revenue, which suggests the organization bills comprehensive, bundled FQHC encounters rather than relying on fee-for-service reimbursement for individual E/M or procedure codes. The presence of G0467 (FQHC visit) further reinforces that payments are largely FQHC-specific bundled or per‑visit arrangements.

Operationally there is a high volume of individual E/M and behavioral-health claims that generate little or no separate Medicaid payment, implying those services are often covered within the T1015 bundle. Examples include 99214 (12.5K claims, $1 avg paid/claim, $12.5K revenue), 99213 (12.7K claims, $0 revenue), 90834 (11.5K claims, $0 revenue) and 90832 (5.4K claims, $0 revenue); these counts show substantial service delivery even when payments are captured under an all-inclusive clinic code.

Competitive standing on the revenue-driving code is modest-to-strong but not dominant: T1015 ranks #7 of 70 in-state (91th percentile) and is labeled typical, unremarkable volume for that code. In other words, the provider is an established FQHC peer in Vermont for the primary clinic-bundle service but is not the largest payer-receiving FQHC in the state.

Behavioral health appears to be a meaningful service line in encounter volume even though it contributes almost no standalone Medicaid revenue: 90832 ranks #3 of 107 in-state (98th percentile, described as notably above typical) and 90834 ranks #6 of 165 (97th percentile, also notably above typical). This pattern indicates a substantial behavioral-health caseload that is likely reimbursed within bundled FQHC encounters rather than as separate Medicaid fee-for-service payments.

G0467 and other FQHC-specific codes provide small, additional paid revenue outside the dominant T1015 line: G0467 shows 2.7K claims at $21 avg paid/claim for $56.1K in revenue and ranks #13 of 49 in-state (75th percentile). The presence of these smaller paid codes — plus many preventive and vaccine codes with claims but $0 paid — is consistent with a billing environment where some visits or services are itemized while most reimbursement is concentrated in the FQHC all-inclusive code.

The provider is long‑tenured on the NPI file (enumerated 2007-04-24, ~19 years ago), which supports the interpretation of an established FQHC practice with standing Medicaid arrangements; tenure combined with the heavy reliance on T1015 suggests operational stability within the Medicaid payment model rather than recent entry or experimental billing patterns.

Medicaid: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	63,910	$190	$12M
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…	2,670	$20	$56.1K
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…	12,540	$1	$12.5K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	210	$10	$1.1K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	80	$10	$1K
36416	In this procedure, the provider pricks the patient’s finger, heel, or ear with a pointed instrument and collects specimen of droplets of blood by pressing the pricking site.	10	$0	$0
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.	340	$0	$0
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	30	$0	$0
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	80	$0	$0
90686	This 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…	310	$0	$0

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Little Rivers Health Care, Inc. — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	7	70	11,650	$150	$3.3M
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…	19	320	680	$30	$146.1K
90837	In 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…	226	670	760	$70	$143.9K
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…	34	320	760	$20	$88.2K
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…	13	50	1,020	$20	$87.6K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	52	110	170	$70	$38.6K
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…	6	170	360	$20	$35.9K
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.	28	40	890	$10	$32.1K
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…	34	40	170	$40	$31.6K
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…	3	110	260	$20	$19.5K

Showing 1–10 of 28

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Little Rivers Health Care, Inc.	VT	Primary Care Clinic/Center	$0	$114.7K
Sarah Metz	VT	Clinical Social Worker	$0	$110.4K
Little Rivers Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$69.5K
Maureen Boardman	VT	Nurse Practitioner	$2.3K	$0
Patricia Pratt	VT	Internal Medicine Physician	$750	$0
Rachel Morse	VT	Family Nurse Practitioner	$460	$0

Nearby Providers

Other providers in the same ZIP code as Little Rivers Health Care, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Oas, LLC	VT	Children's Substance Abuse Rehabilitation Facility	$0	$30.6M
Upper Valley Pediatrics, PLLC	VT	Pediatric Adolescent Medicine Physician	$0	$1.8M
Heidi Nostrant	VT	Clinical Psychologist	$0	$215.1K
Robert Munson	VT	General Practice Dentistry	$0	$189.9K
Sinclair Chiropractic Clinic PC	VT	Chiropractor	$0	$96.1K
Barry Waterson	VT	Clinical Psychologist	$71.3K	$0
Kph Healthcare Services, Inc.	VT	Community/Retail Pharmacy	$68.1K	$0
Visionary Eye Associates LLC	VT	Optometrist	$0	$61.7K
Martins Foods Of South Burlington LLC	VT	Community/Retail Pharmacy	$56.9K	$0
Bradford Optical, Plc	VT	Optometrist	$0	$55.9K

Little Rivers Health Care, Inc. — Billing Profile & Reimbursement Data

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Little Rivers Health Care, 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