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

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

Kalihi Palama Health Center (NPI 1457304966)

Key Findings

Field	Value
Entity Type	Organization
Organization	Kalihi Palama Health Center
Address	915 N King St
City	Honolulu
State	HI
ZIP	96817
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	May 18, 2006

Payer Source	Total Paid
Medicaid	$38.9M
Medicare	$0

KALIHI PALAMA HEALTH CENTER is effectively a single-payer Medicaid provider: there is no Medicare billing on file while lifetime Medicaid revenue totals $38.9M. This indicates the organization’s patient mix and reimbursement reliance are concentrated in Medicaid populations rather than Medicare beneficiaries.

Medicaid revenue is highly concentrated in evaluation-and-management office visits: codes 99213, 99214, and 99212 together account for 69.5% of the provider’s total Medicaid revenue. This concentration implies routine primary care / established outpatient visits are the core service line driving the center’s financials.

99213 is the single largest revenue driver with $14.9M (39.0% of Medicaid revenue) across 80.5K claims, and the provider ranks #3 of 707 in-state at the 100th percentile; this establishes KALIHI PALAMA as an extreme outlier in volume for mid-level established patient visits within the state. High volumes here signal heavy panel management and recurring chronic care or primary care follow-up.

99214 ($6.4M, 16.8% of Medicaid revenue) and 99212 ($5.2M, 13.7% of Medicaid revenue) are also top contributors and both rank at or near the top of in-state peers (99214 at the 99th percentile, 99212 at the 100th percentile). Together these three E/M codes indicate a dominant focus on established-patient primary care across low-to-moderate complexity visit levels.

Behavioral health and preventive services are meaningful secondary lines: 90834 ($1.2M, 3.0% of Medicaid revenue) and 90832 ($653.7K, 1.7%) are high-volume relative to peers (90834 ranks #3 of 81, 90832 ranks high as well), while preventive medicine codes 99391/99392/99393/99396/99395 collectively appear across the top codes list and include multiple top-percentile rankings. This mix suggests integration of behavioral health and age-spanning preventive care into the FQHC model.

FQHC-specific and clinic management codes appear in the top list (G0467 and G0511), with G0467 generating $700.6K and ranking #2 in-state and G0511 ranking #1 in-state; these entries confirm the organization is billing typical FQHC encounter and care-management bundles and are consistent with Federally Qualified Health Center operations and reimbursement structures.

Several top codes are flagged as extreme outliers or notably above typical state volume (multiple 100th and high-90th percentile ranks across codes such as 99213, 99212, 99396, and 99395). These percentile placements indicate KALIHI PALAMA is a major statewide provider for routine primary care and many preventive services, far exceeding typical state volumes for those codes.

The NPI enumeration date of 2006-05-18 (~20 years ago) indicates long tenure in the market, supporting experience and established patient relationships that align with the high volumes of recurring E/M and preventive visit codes. Longstanding presence likely contributes to the large Medicaid panel reflected in the claims counts.

While the top three Medicaid codes account for 69.5% of Medicaid revenue, other services such as telehealth (G2025), ophthalmology codes (92012/92002/92014), and group psychotherapy (90853) appear further down the list with modest revenue shares. This suggests some service diversification beyond core primary care, but those lines are secondary to the dominant E/M-driven revenue base.

Medicaid: Complete Services Breakdown

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

82 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	80,450	$190	$14.9M
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…	36,340	$180	$6.4M
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,…	26,490	$200	$5.2M
D9999	N/A	6,980	$300	$2.1M
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…	5,680	$210	$1.2M
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…	6,620	$180	$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…	4,540	$210	$954K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	3,970	$210	$833.9K
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…	18,440	$40	$700.6K
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…	3,850	$170	$653.6K

Showing 1–10 of 82

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Kalihi Palama Health Center — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

82 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D9999	N/A	4	20	2,200	$280	$1.6M
H2015	Comprehensive community support services, per 15 minutes	13	30	2,300	$30	$634.2K
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…	12	70	370	$150	$457.3K
80061	The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood.	22	20	660	$20	$408.6K
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…	3	710	650	$90	$274.1K
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	30	1,850	$60	$248.9K
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…	6	690	650	$90	$235.4K
98967	A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes…	5	10	60	$260	$199.8K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	3	20	310	$130	$184K
98968	A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes…	5	10	490	$190	$172.3K

Showing 1–10 of 82

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Liberty Dialysis - Hawaii LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$42.8M
Careresource Hawaii	HI	Home Health Agency	$0	$12.8M
Lanakila Pacific	HI	Home Delivered Meals	$0	$11.7M
Usrc Aloha LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$11.1M
Kuakini Medical Center	HI	General Acute Care Hospital	$0	$10.9M
Usrc Honolulu, LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$8.1M
Dialysis Newco LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$6.3M
Ku Aloha Ola Mau	HI	Counselor	$220.5K	$5.8M
Dialysis Newco LLC	HI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$4.9M
Coastal Medical Supply, Inc.	HI	Durable Medical Equipment & Medical Supplies	$0	$4.7M

Kalihi Palama Health Center — Billing Profile & Reimbursement Data

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Kalihi Palama Health Center — 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

Nearby Providers

Frequently Asked Questions

References