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

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

Primary Health Network (NPI 1417932609)

Field	Value
Entity Type	Organization
Organization	Primary Health Network
Address	63 Pitt St
City	Sharon
State	PA
ZIP	16146
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	December 9, 2005

Payer Source	Total Paid
Medicaid	$57.9M
Medicare	$0

Key Findings

PRIMARY HEALTH NETWORK is a Federally Qualified Health Center (FQHC) based in SHARON, PA with an NPI enumerated on 2005-12-09 (~21 years ago), indicating long-standing enrollment. Its billed activity is effectively single-payer: Total Medicare revenue is none (no Medicare billing on file) while Total Medicaid revenue is $57.9M, demonstrating near-exclusive reliance on Medicaid reimbursements.

Revenue is extremely concentrated in a single FQHC encounter code: T1015 accounts for $57.2M and 98.7% of the provider's Medicaid revenue, and the precomputed top 3 codes together account for 99.8% of total Medicaid revenue. This concentration indicates that nearly all topline Medicaid dollars flow through the bundled FQHC clinic visit payment rather than a mix of procedure or specialty codes.

The code mix — dominated by T1015 (Clinic visit/encounter, all-inclusive) and supported by high volumes of E/M visits such as 99213 and 99214 — signals an operation focused on high-volume primary care and bundled FQHC encounters rather than fee-for-service procedural care. With T1015 defined as an all-inclusive FQHC visit, the organization’s business model appears centered on ambulatory visit throughput and comprehensive encounter bundles typical of community health centers.

PRIMARY HEALTH NETWORK is a dominant statewide provider for the T1015 encounter: T1015 ranks #2 of 1691 providers in-state and is described as an extreme outlier at the 100th percentile, meaning its volume for the FQHC encounter is far above typical state peers. That rank and outlier status point to major market share for FQHC-style visits within Pennsylvania rather than marginal participation.

While 99213 and 99214 contribute only small shares of revenue ($406.5K or 0.7% from 99213 and $194.9K or 0.3% from 99214), their claim volumes are substantial — 33.9K claims for 99213 and 8.9K claims for 99214 — and 99213 is also labeled an extreme outlier (rank #44 of 8867, 100th percentile). This pattern indicates high-volume, lower-paid evaluation and management activity consistent with Medicaid primary care delivery, where revenue per visit is low (e.g., $12 avg paid/claim for 99213 and $22 avg paid/claim for 99214).

Several non-revenue or zero-paid codes appear at very high volumes, which reflects extensive quality reporting and preventive-service activity: G8510 has 8.7K claims ($0 revenue) and ranks #3 of 921 providers in-state (100th percentile; extreme outlier), and 3008F has 24K claims ($0 revenue) and ranks #6 of 1638 providers (100th percentile; extreme outlier). These figures suggest the provider files many measure- or reporting-related claims (screening, preventive measures, registry/reporting codes) that do not directly generate Medicaid dollars but document clinical processes at scale.

Competitively, the provider is a major statewide actor for FQHC encounter volume but shows limited payer diversification and revenue diversification. The absence of Medicare billing and the concentration of $57.9M in Medicaid tied to T1015 expose the organization to Medicaid policy or rate changes, even as its long tenure (NPI since 2005-12-09) implies organizational stability to potentially negotiate or expand service lines.

From an operational and payer-strategy perspective, PRIMARY HEALTH NETWORK’s profile suggests opportunities and risks: opportunity to leverage its dominant encounter volume in payer contracting or program participation, and risk from dependence on a single Medicaid encounter code (T1015) for 98.7% of revenue and on Medicaid overall given no Medicare activity. Analysts should treat the provider as a high-volume FQHC primary-care operator that would be sensitive to reimbursement changes affecting bundled FQHC visit payments and to shifts in state Medicaid policy.

Medicaid: Complete Services Breakdown

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

61 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	297,950	$190	$57.2M
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…	33,880	$10	$406.5K
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…	8,860	$20	$194.9K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	6,270	$10	$62.7K
0012A	N/A	710	$30	$24K
0011A	N/A	740	$30	$21.6K
0064A	N/A	170	$30	$5.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	60	$50	$2.9K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	230	$10	$2.7K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,240	$1	$2.5K

Showing 1–10 of 61

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Primary Health Network — 4 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

61 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	2	1,690	760	$170	$1.2M
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…	497	820	230	$80	$71.7K
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…	181	8,160	210	$60	$68.4K
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…	44	8,870	240	$40	$56.1K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	675	870	160	$70	$48.2K
D1351	Sealant - per tooth	323	600	480	$30	$46.6K
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…	419	1,210	100	$90	$45K
D2392	Post 2 surface resin‑based composite	729	960	190	$70	$35.1K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	433	730	90	$70	$31.5K
D1120	Prophylaxis–child	492	1,240	220	$30	$30.1K

Showing 1–10 of 61

Related Providers

Other providers that share a Tax Identification Number (TIN) with Primary Health Network, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Primary Health Network	PA	Federally Qualified Health Center (FQHC)	$0	$19.7M
Primary Health Network	PA	Federally Qualified Health Center (FQHC)	$0	$12.3M
Brittany Peebles	VA	Psychiatric/Mental Health Nurse Practitioner	$144.6K	$0
Zahid Akram	PA	Specialist	$118.3K	$0
Roberto Salcedo	PA	Specialist	$106.1K	$7.1K
Bruce Abbott	PA	Foot & Ankle Surgery Podiatrist	$54.9K	$56.8K
Robert Shellito	OH	Podiatrist	$30.5K	$30.8K
Rachel Lucullo	PA	Family Nurse Practitioner	$29.6K	$20.5K
John Scullin	PA	Orthopaedic Surgery Physician	$15.2K	$0
Nasim Shajihan	VI	Child & Adolescent Psychiatry Physician	$0	$5.9K

Nearby Providers

Other providers in the same ZIP code as Primary Health Network, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Comprehensive Children And Family Services	PA	Community/Behavioral Health Agency	$0	$20.1M
Associates In Counseling And Child Guidance Inc	PA	Mental Health Counselor	$0	$17.5M
Steward Sharon Regional Health System, Inc.	PA	Psychiatric Hospital Unit	$0	$6.8M
Steward Sharon Regional Health System, Inc.	PA	General Acute Care Hospital	$0	$5.8M
Rainbow Recovery Center, Inc.	PA	Methadone Clinic	$179.6K	$2.9M
Arthur Aronson	PA	Podiatrist	$53.5K	$19.6K
Emil Maurer	PA	Anesthesiology Physician	$37K	$0

Primary Health Network — Billing Profile & Reimbursement Data

Sign up for Primary Health Network — Billing Profile & Reimbursement Data policy alerts

Primary Health Network — Billing Profile & Reimbursement Data

Sign up for Primary Health Network — 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