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

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

Valley Family Health Care Inc (NPI 1407886484)

Field	Value
Entity Type	Organization
Organization	Valley Family Health Care Inc
Address	1441 Ne 10th Ave
City	Payette
State	ID
ZIP	83661
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	July 4, 2006

Payer Source	Total Paid
Medicaid	$13.9M
Medicare	$0

Key Findings

VALLEY FAMILY HEALTH CARE INC is effectively a single-payer Medicaid provider: there is no Medicare billing on file while total Medicaid revenue is reported as $13.9M. The absence of Medicare activity combined with material Medicaid revenue indicates the practice’s revenue and utilization profile are driven almost entirely by state Medicaid business.

Revenue is highly concentrated in a small set of codes: the precomputed top 3 Medicaid codes account for 89.5% of the provider’s total Medicaid revenue, with T1015 alone representing $9.2M (70.1% of Medicaid revenue). This concentration means a large share of the organization’s cash flow depends on encounter/clinic visit payments tied to a few high-volume codes.

The code mix and taxonomy (Federally Qualified Health Center) point to a clinic-centered primary care operation: heavy use of T1015 (Clinic visit/encounter, all-inclusive) and high volumes of 99213 and 99214 indicate routine, high-volume established patient visits and ambulatory primary care. These patterns are consistent with an FQHC delivering broad primary care services, with many shorter, lower-complexity encounters plus a material volume of moderate-complexity visits.

Several E/M codes show unusually large state-level volumes: 99213 is described as an "extreme outlier" and ranks #5 of 669 providers in-state (99th percentile), while 99214 ranks #14 of 618 providers (98th percentile; "notably above typical"). The provider therefore appears to be a dominant high-volume deliverer of established outpatient visits relative to most in-state peers.

T1015 is a dominant revenue driver but is characterized in the data as a "typical, unremarkable volume for this code" despite ranking #9 of 143 providers in-state (94th percentile), which suggests that large T1015 revenue is expected behavior for FQHC-style clinic billing and not necessarily an anomaly versus other clinic-based peers. In short, T1015 is the single largest revenue source but sits within the expected pattern for community health centers.

The provider offers a broad mix of services beyond standard adult E/M visits: listed codes include dental procedures (D7140 $107.5K; D1110 $75.5K; D2150 $52.9K; D4910 $46.8K), maternal/OB services and fetal ultrasound (59400 $85.8K; 76805 $60.5K; 76816 $97.2K), and vaccinations (90686 $64.5K). These discrete revenue lines indicate integrated primary care with dental, maternal–child, and preventive services commonly seen in community health centers.

A few non-E/M codes are also notable state outliers on volume and rank: D2150 ranks #2 of 15 providers in-state (93rd percentile; "notably above typical") and D4910 ranks #2 of 22 providers (95th percentile; "notably above typical"). These rankings signal that dental services—particularly multi-surface amalgam restorations and periodontal maintenance—are stronger here than at most in-state peers, representing a meaningful adjunct to the clinic’s Medicaid-driven primary care base.

The NPI tenure shows the organization has been active for an extended period: NPI enumerated 2006-07-04 (~20 years ago). Combined with $13.9M in Medicaid revenue and the code mix above, this tenure supports the interpretation of an established FQHC with sustained Medicaid-centered operations; however, the very high reliance on a few Medicaid encounter codes implies sensitivity to state Medicaid reimbursement or policy changes affecting those codes.

Medicaid: Complete Services Breakdown

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

173 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	45,590	$200	$9.2M
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…	95,090	$20	$1.7M
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…	24,720	$30	$840.5K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	1,710	$60	$107.5K
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…	3,930	$30	$106.2K
99203	The provider sees a new 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 provider…	1,380	$70	$97.7K
76816	The provider reexamines the fetus to follow up on a prior abnormal transabdominal ultrasound.	1,350	$70	$97.2K
59400	In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including…	40	$2,000	$85.8K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	1,940	$40	$75.5K
D0120	Periodic oral evaluation - established patient	3,090	$20	$71.1K

Showing 1–10 of 173

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Valley Family Health Care Inc — 5 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

173 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	9	140	5,470	$180	$2.6M
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	670	740	$40	$193.6K
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…	14	620	560	$60	$191.8K
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	410	740	$60	$174.3K
D7210	Extraction, 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…	36	40	220	$120	$173.7K
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…	16	80	450	$80	$171.3K
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…	14	80	380	$70	$151.1K
D1120	Prophylaxis–child	53	250	180	$60	$143K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	15	80	130	$80	$91.4K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	49	320	310	$80	$80.8K

Showing 1–10 of 173

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Valley Family Heatlh Care, Inc	ID	Federally Qualified Health Center (FQHC)	$0	$3M
Adam Baker	NV	Physician Assistant	$1.8M	$0
Valley Family Health Care, Inc	ID	Federally Qualified Health Center (FQHC)	$0	$340.9K
Aaron Dykstra	SD	Orthopaedic Hand Surgery Physician	$171.5K	$0
Christopher Malcom	ID	Diagnostic Radiology Physician	$99.6K	$0
Kelsey Ferrell	ID	Dermatology Physician	$70.8K	$0
John Gambino	OR	Diagnostic Radiology Physician	$25.3K	$0
Morris Smith	OR	Internal Medicine Physician	$2.3K	$0
Judith Norris	OR	Family Nurse Practitioner	$1.8K	$0
Jared Van Orman	OR	Internal Medicine Physician	$1.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Healthcare With Heart LLC	ID	Family Medicine Physician	$0	$1M
Insight Counseling & Therapy	ID	Clinical Social Worker	$0	$585.8K
Daniel Iwasa	ID	Optometrist	$97.8K	$0
Ben Barbot	ID	Nurse Practitioner	$29K	$0
Andrew Silsby	ID	Family Nurse Practitioner	$650	$0

Valley Family Health Care Inc — Billing Profile & Reimbursement Data

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Valley Family 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