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

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

Esperanza Health Centers (NPI 1487124707)

Field	Value
Entity Type	Organization
Organization	Esperanza Health Centers
Address	4700 S California Ave
City	Chicago
State	IL
ZIP	60632
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	November 29, 2018

Payer Source	Total Paid
Medicaid	$28.9M
Medicare	$0

Key Findings

ESPERANZA HEALTH CENTERS is effectively a Medicaid-centric provider: there is no Medicare revenue on file while total Medicaid revenue is $28.9M, indicating the organization’s billed activity and reimbursement are driven almost entirely by Medicaid. This single-payer footprint should be treated as the primary lens for any financial or utilization analysis of the entity.

Revenue concentration is extremely high: the precomputed top-three Medicaid codes account for 99.3% of the provider’s Medicaid revenue, with T1015 alone contributing $28.4M (98.2% of Medicaid revenue). The remaining top-two codes are T1040 ($257.3K, 0.9%) and 99000 ($60.6K, 0.2%), showing that nearly all Medicaid dollars flow through a very narrow set of billing codes.

The code mix points to an FQHC operational model that relies on bundled encounter payments and community behavioral health per-diems: T1015 is labeled as a clinic visit/encounter, all-inclusive, while T1040 is per diem community behavioral health clinic services, and 99000 covers in-office specimen preparation/transport for labs. That combination suggests primary care and integrated behavioral health encounters plus basic lab routing are the core service lines driving reimbursement.

T1015 is a dominant in-state revenue driver and high-volume service for this provider: it represents 190.3K claims and ranks #23 of 846 providers in Illinois (97th percentile), placing ESPERANZA among the state’s higher-volume billers for the all-inclusive clinic encounter. This ranking signals a major role in delivering reimbursed ambulatory encounters relative to peers rather than a marginal participation.

T1040 and 99000 also show above-typical state participation: T1040 has 3.8K claims and ranks #23 of 191 providers (88th percentile), and 99000 has 2.6K claims and ranks #19 of 436 providers (96th percentile). These positions indicate meaningful delivery of behavioral health per-diem services and specimen-prep/lab support relative to in-state peers, supporting a multi-service outpatient clinical footprint.

Several individual codes are flagged as statistical outliers in state comparisons and warrant attention: 0011A is an extreme outlier with 2.3K claims, $55.1K revenue, and ranks #3 of 349 providers (99th percentile), and 90686 is another extreme outlier with 11.8K claims, $11.8K revenue, and ranks #15 of 2637 providers (99th percentile). These high-count outlier profiles (one for an unidentified A-series code and one for a flu vaccine product) point to unusually large volumes on specific services compared with typical state patterns.

From a contracting and operational perspective, the provider’s heavy reliance on T1015 encounter revenue makes reimbursements sensitive to changes in encounter rates, visit mix, or FQHC payment policy; diversification away from a single dominant revenue source appears limited. For payers and partners, the mix also highlights opportunities to target value-based arrangements that focus on primary care and integrated behavioral health, given the centrality of encounter-based and per-diem codes.

The provider’s NPI enumeration date is 2018-11-29 (~8 years ago), indicating a comparatively recent formal enrollment window relative to long-established institutions; combined with the absence of Medicare billing on file, analysts should consider tenure and payer participation when benchmarking utilization or network-leverage assumptions.

Medicaid: Complete Services Breakdown

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

116 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	190,280	$150	$28.4M
T1040	Medicaid certified community behavioral health clinic services, per diem	3,840	$70	$257.3K
99000	Use this code for the in office preparation of a specimen for lab analysis and or its transport from the office to the outside testing laboratory.	2,630	$20	$60.6K
0011A	N/A	2,300	$20	$55.1K
0012A	N/A	1,370	$40	$53.3K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	40	$860	$36.2K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	11,780	$1	$11.8K
0001A	N/A	240	$40	$9.9K
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,…	2,520	$1	$5K
0002A	N/A	110	$40	$4.6K

Showing 1–10 of 116

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Illinois Distribution

Esperanza Health Centers — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. Illinois median

116 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	23	850	7,490	$120	$3.9M
T1040	Medicaid certified community behavioral health clinic services, per diem	23	190	880	$70	$128.2K
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies	14	40	20	$630	$97.6K
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…	20	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…	136	14,680	300	$50	$48.7K
0502F	No Summary found for this code	24	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…	22	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…	24	1,270	370	$40	$40.8K
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…	36	14,190	280	$20	$38.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	23	1,670	160	$40	$26.4K

Showing 1–10 of 116

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Esperanza Health Centers	IL	Federally Qualified Health Center (FQHC)	$0	$40M
Russell Fiorella	IL	Clinical Pathology/Laboratory Medicine Physician	$4K	$17.3M
Esperanza Health Centers	IL	Federally Qualified Health Center (FQHC)	$0	$16.5M
Michael Blair	IL	Retina Specialist (Ophthalmology) Physician	$3M	$2.6M
Michael Appiagyei	IL	Internal Medicine Physician	$52.7K	$5.1M
Esperanza Health Centers	IL	Federally Qualified Health Center (FQHC)	$0	$4.5M
Anuj Jain	IL	Family Medicine Physician	$140.8K	$3.9M
Manish Shukla	IL	Family Medicine Physician	$39.6K	$3.8M
James Diesfeld	IL	Interventional Pain Medicine Physician	$32.6K	$3.5M
Satwant Kingra	IL	Internal Medicine Physician	$442.5K	$1.4M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Thresholds	IL	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$12.2M
Access Community Health Network	IL	Federally Qualified Health Center (FQHC)	$0	$8M
The Thresholds	IL	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$3.1M
Bohdan Fedirko	IL	Legal Medicine	$478.7K	$29.7K

Esperanza Health Centers — 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