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.

Gifford Health Care, Inc (NPI 1326478702)

Key Findings

Field	Value
Entity Type	Organization
Organization	Gifford Health Care, Inc
Address	44 S Main St Ste 2
City	Randolph
State	VT
ZIP	05060
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	November 20, 2013

Payer Source	Total Paid
Medicaid	$8.4M
Medicare	$0

This provider is effectively single‑payer in the dataset: there is no Medicare billing on file and all reported federal payor revenue is Medicaid, totaling $8.4M. The absence of Medicare activity means analyses of Medicare mix, Medicare‑based referral relationships, or fee‑for‑service senior volumes are not supported by this record.

Revenue is extremely concentrated in a single bundled clinic encounter: T1015 accounts for $8.3M and represents 99.0% of this provider's total Medicaid revenue, and the precomputed top three Medicaid codes together explain 99.8% of Medicaid revenue. That concentration indicates that most reimbursement flows through the FQHC all‑inclusive clinic encounter rather than discrete fee‑for‑service codes, which creates operational sensitivity to changes in T1015 policy or rates.

The code mix and dominant codes align with Federally Qualified Health Center operations: the prominence of T1015 and the presence of G0467 (2.5K claims, $37.6K revenue) reflect per‑encounter, bundled FQHC billing for primary and preventive care visits. This pattern is consistent with clinic‑based, team‑delivered primary care where many individual services are captured in a consolidated encounter code rather than paid separately.

Competitive standing on the top revenue code is solid but not uniquely dominant: T1015 ranks #11 of 70 providers in‑state (86th percentile) and is characterized in the data as having "typical, unremarkable volume for this code." In plain terms, GIFFORD HEALTH CARE is above many peers on the FQHC encounter metric but still one of a number of relatively high‑volume FQHCs statewide rather than the single market leader.

Evaluation and management coding shows high claim counts but minimal standalone revenue: 99214 appears with 11.8K claims and $23.7K revenue (0.3% of Medicaid revenue) and ranks #22 of 323 (93th percentile), while 99213 has 18.1K claims and $18.1K revenue and ranks #21 of 319 (94th percentile). These entries suggest frequent E/M activity is recorded but that payments are largely captured in bundled FQHC encounter rates rather than separate E/M reimbursements in the Medicaid data.

The provider shows substantial preventive, pediatric, and immunization activity that does not produce separate Medicaid revenue in this extract: examples include 90471 (5.8K claims), 90686 (1.7K claims), 99393 (1.1K claims) and 99391 (1.1K claims) — each listed with $0 avg paid/claim and $0 revenue. This pattern is consistent with services being delivered and billed under the FQHC bundle or with payer reporting conventions that do not attribute standalone payments to those codes in this dataset.

Behavioral health and allied services are present but are not revenue drivers in the Medicaid payments shown: psychotherapy codes such as 90837 (284 claims, $568 revenue) and 90834 (567 claims, $0 revenue) and psychiatric evaluation 90792 (31 claims, $155 revenue) appear with low dollar impact and are described as "typical, unremarkable volume for this code." This indicates integrated behavioral health capability at the clinic level without material separate Medicaid reimbursement for those specific CPT lines.

The provider has an established operational tenure: the NPI was enumerated on 2013-11-20 (~13 years ago), indicating over a decade of participation in federal programs. Combined with $8.4M in Medicaid lifetime revenue and the FQHC billing profile, this suggests a stable community clinic footprint rather than a newly formed practice or transient operation.

Medicaid: Complete Services Breakdown

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

31 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	52,090	$160	$8.3M
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…	2,510	$20	$37.6K
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…	11,830	$1	$23.7K
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…	18,080	$1	$18.1K
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…	950	$1	$950
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…	280	$1	$570
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…	60	$10	$360
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	30	$10	$160
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	80	$0	$0
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	5,800	$0	$0

Showing 1–10 of 31

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

Gifford Health Care, Inc — 0 of 8 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

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	11	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…	22	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…	469	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…	21	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…	15	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…	25	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…	73	170	360	$20	$35.9K
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…	13	40	170	$40	$31.6K
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…	11	40	280	$20	$19.5K
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…	86	110	260	$20	$19.5K

Showing 1–10 of 31

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gifford Health Care, Inc	VT	Federally Qualified Health Center (FQHC)	$0	$2M
Gifford Health Care, Inc	VT	Federally Qualified Health Center (FQHC)	$0	$1.8M
Gifford Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$935.6K
Gifford Health Care, Inc	VT	Federally Qualified Health Center (FQHC)	$0	$820.3K
Rebecca A Foulk Md PC	VT	Pediatrics Physician	$0	$753.2K
Suzanne Carlisle Stebenne	VT	Family Nurse Practitioner	$8.8K	$717.9K
Syed Akbar	IL	Diagnostic Radiology Physician	$280.8K	$223.7K
Alexander Harvin	IA	Diagnostic Radiology Physician	$353.1K	$0
Gifford Health Care, Inc	VT	Federally Qualified Health Center (FQHC)	$0	$344.4K
Peter Piampiano	TN	Diagnostic Radiology Physician	$254.4K	$20.1K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Clara Martin Center	VT	Community/Behavioral Health Agency	$0	$11.8M
Clara Martin Center	VT	Community/Behavioral Health Agency	$0	$807.8K
Jessica Heney	VT	Family Medicine Physician	$0	$273.6K
Gifford Health Care, Inc	VT	General Practice Physician	$0	$256.1K
Gifford Medical Center Inc.	VT	General Acute Care Hospital	$0	$218.4K
Shana Kotelchuck	VT	Clinical Social Worker	$0	$212.8K
Maxi Green Inc	VT	Community/Retail Pharmacy	$163.2K	$0
Resonant Medicine	VT	Naturopath	$0	$86.5K
Marjorie Crowe	VT	Clinical Social Worker	$27.7K	$51.2K
Soares Ocular Surgery	VT	Ophthalmologic Surgery Clinic/Center	$0	$63.9K

Gifford Health Care, Inc — Billing Profile & Reimbursement Data

Sign up for Gifford Health Care, Inc — Billing Profile & Reimbursement Data policy alerts

Gifford Health Care, Inc — Billing Profile & Reimbursement Data

Sign up for Gifford Health Care, Inc — Billing Profile & Reimbursement Data policy alerts

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