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NPI 1376589226 · Alton, IL · Federally Qualified Health Center (FQHC)
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Southern Illinois Health Care Foundation, Inc. is a federally qualified health center (fqhc) provider located in Alton, Illinois. This profile covers 0 Medicare and 88 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 | Southern Illinois Health Care Foundation, Inc. |
| Address | 4 Memorial Dr Ste 210 |
| City | Alton |
| State | IL |
| ZIP | 62002 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | June 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $21.1M |
| Medicare | $0 |
SOUTHERN ILLINOIS HEALTH CARE FOUNDATION, INC. is effectively a Medicaid-centric Federally Qualified Health Center: it has no Medicare billing on file and reports $21.1M in lifetime Medicaid revenue, indicating its operations and payer exposure are concentrated almost entirely in the Medicaid program rather than Medicare. This single-payer tilt suggests service lines, contracts, and financial performance will be driven by state Medicaid policy and local FQHC reimbursement structures.
Medicaid revenue is highly concentrated in a single code: T1015 accounts for $20.9M and represents 99.1% of the provider's total Medicaid revenue. This concentration indicates the organization bills predominantly all-inclusive clinic visit/encounter services, consistent with FQHC bundled visit reimbursement models, making overall revenue highly sensitive to changes in T1015 reimbursement.
The provider’s role in the state for T1015 is large by volume: it ranks #27 of 846 providers in-state (97th percentile) for this code and is described as notably above typical state volume. This positions the clinic as a major statewide provider of all-inclusive clinic visits and suggests it captures a sizable share of FQHC-style encounter billing among Illinois Medicaid providers.
Beyond T1015, the next two revenue-driving Medicaid codes (T1040 at $174.8K and 90651 at $4.2K) together make up the remaining 0.9% of Medicaid revenue, per the precomputed top-3 share. T1040 indicates a measurable component of community behavioral health per diem services, while 90651 shows vaccination activity; however, neither materially contributes to top-line Medicaid revenue compared with T1015.
Several codes show extremely high claim volumes but $0 or near-$0 average paid/claim in the file (for example 99212, 99213, 99214, 87880, 96127, and many lab and screening codes). These patterns suggest extensive use of procedure-level encounter reporting and ancillary screening or behavioral assessment services alongside T1015 billing; many of these codes are labeled as extreme outliers or notably above typical state volume, indicating heavy service throughput even if they do not drive revenue in the claims dataset.
Competitive standing across other Medicaid codes is mixed: while T1015 is a statewide strength (97th percentile), several preventive and screening codes (0503F, 0502F, 81003, 87880, 3008F, 90832) also rank in high percentiles (mostly mid-90s) indicating strong volume relative to peers, whereas basic E/M codes like 99211 and certain vaccine codes rank low or in modest percentiles, reflecting a service mix consistent with FQHC visit bundling rather than fee-for-service reliance.
The provider’s NPI has been enumerated since 2006-06-21 (~20 years ago), indicating long tenure in the market; this longevity, combined with the high T1015 volume, suggests established relationships with Medicaid managed care or fee-for-service networks and an entrenched role as an FQHC in its community.
From a business implication viewpoint, reliance on T1015 as the near-exclusive revenue driver implies limited revenue diversification: operational strategy likely emphasizes high visit volume and bundled primary care and behavioral health encounters. Any reimbursement policy changes to FQHC encounter rates or eligibility for T1015 could have outsized impact on the provider’s revenue given the 99.1% share tied to that 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
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
88 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 167,250 | $130 | $20.9M |
| T1040 | Medicaid certified community behavioral health clinic services, per diem | 2,360 | $70 | $174.8K |
| 90651 | This code represents a nonavalent human papillomavirus (HPV) vaccine product administered into the muscle to protect against HPV infection. The vaccine protects against nine HPV types (6, 11, 16, 18,… | 2,110 | $1 | $4.2K |
| 59430 | For this service, the provider or nonphysician healthcare professional provides care to the patient in the outpatient setting following the delivery. Routine postpartum care can involve one or more… | 200 | $20 | $3.3K |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 2,220 | $1 | $2.2K |
| 0503F | No Summary found for this code | 1,930 | $1 | $1.9K |
| 90734 | The provider administers a meningococcal conjugate vaccine in a diphtheria toxoid carrier (MenACWY–D) or CRM197 carrier (MenACWY–CRM) to protect the patient from four strains of meningococcal viruses… | 1,440 | $1 | $1.4K |
| 90620 | This code represents a vaccine product administered into the muscle to protect against meningococcal disease caused by serogroup B. This vaccine uses recombinant proteins and outer membrane vesicles… | 670 | $1 | $670 |
| 90732 | The provider intramuscularly or subcutaneously injects pneumococcal polysaccharide vaccine in an individual two years or older. This vaccine provides protection against meningitis and pneumonia that… | 30 | $1 | $120 |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 10 | $10 | $70 |
Showing 1–10 of 88
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
88 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 27 | 850 | 7,490 | $120 | $3.9M |
| T1040 | Medicaid certified community behavioral health clinic services, per diem | 42 | 190 | 880 | $70 | $128.2K |
| 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… | 160 | 1,180 | 370 | $90 | $109.7K |
| 90833 | In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the… | 113 | 360 | 300 | $50 | $67.4K |
| 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… | 115 | 760 | 140 | $110 | $67.3K |
| 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… | 29 | 960 | 330 | $30 | $51K |
| 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… | 67 | 14,680 | 300 | $50 | $48.7K |
| 0502F | No Summary found for this code | 31 | 1,170 | 550 | $30 | $48.2K |
| 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… | 80 | 1,380 | 370 | $40 | $46.2K |
| 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… | 68 | 1,270 | 370 | $40 | $40.8K |
Showing 1–10 of 88
Other providers in the same ZIP code as Southern Illinois Health Care Foundation, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Centerstone Of Illinois, Inc | IL | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $36.7M |
| Southeastern Emergency Physicians Of Memphis LLC | IL | Emergency Medicine Physician | $0 | $26.5M |
| Nu-crown, LLC | IL | Optometrist | $0 | $5.8M |
| Alton Memorial Hospital | IL | Ambulance | $0 | $4.1M |
| City Of Alton Ill | IL | Ambulance | $254.8K | $3.4M |
| Osf Healthcare System | IL | Home Health Agency | $0 | $3.4M |
| Centerstone Of Illinois, Inc | IL | Substance Use Disorder Rehabilitation Clinic/Center | $133.7K | $1.9M |
| Wynndel Buenger | IL | Pain Medicine Physician | $399.4K | $4.5K |
| Paolo Masetti | IL | Surgical Critical Care Physician | $94.1K | $182.7K |
| John Stirton | IL | Orthopaedic Surgery Physician | $202.4K | $20.2K |
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