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NPI 1487602736 · Tucson, AZ · Federally Qualified Health Center (FQHC)
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El Rio Santa Cruz Neighborhood Health Center, Inc is a federally qualified health center (fqhc) provider located in Tucson, Arizona. This profile covers 0 Medicare and 347 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 | El Rio Santa Cruz Neighborhood Health Center, Inc |
| Address | 839 W Congress St |
| City | Tucson |
| State | AZ |
| ZIP | 85745 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | May 5, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $360M |
| Medicare | $0 |
EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC reports $360M in lifetime Medicaid revenue and has no Medicare billing on file, making its billing footprint effectively single-payer (Medicaid) for the datasets shown. The provider’s NPI was enumerated on 2006-05-05 (~20 years ago), indicating long tenure in the market and an established claim history concentrated under Medicaid.
Revenue concentration is extremely high: the precomputed top three Medicaid codes together account for 99.5% of this provider’s total Medicaid revenue, and a single code, T1015, alone represents $357.5M (99.3% of Medicaid revenue). This indicates that nearly all Medicaid dollars flow through the all-inclusive clinic encounter code rather than a diversified mix of high-dollar procedures.
T1015 (Clinic visit/encounter, all-inclusive) dominates the payer relationship and signals an FQHC operating model focused on bundled clinic encounters and comprehensive visit payments; the volume tied to T1015 (1.2M claims at $288 avg paid/claim) is consistent with high-frequency, broad-access primary care and wraparound services typical of FQHCs. T1015 ranks #2 of 357 providers in-state (100th percentile) and is labeled an extreme outlier, underscoring that EL RIO bills this encounter code at volumes far above typical state peers.
The secondary top codes by revenue (99213: $406.4K and 99214: $398.8K) are minor revenue contributors relative to T1015 but are present in very large claim counts (406.4K and 398.8K claims respectively) and also rank at the highest percentiles in-state (both noted as extreme outliers). Their presence alongside a dominant T1015 pattern suggests the center bills both fee-for-service E/M codes and the all-inclusive clinic encounter, but Medicaid payments are overwhelmingly captured via the FQHC-style bundled encounter rather than standard outpatient E/M reimbursement.
Competitive standing within Arizona is strong for several codes beyond T1015: 90750 (vaccine injection) ranks #1 of 16 providers in-state (100th percentile; extreme outlier) and behavioral health codes such as 90837 rank in the 98th percentile (extreme outlier). These high ranks across immunization and behavioral health CPTs indicate the center is a major statewide provider for preventive and behavioral services in addition to its clinic-encounter dominance.
Service-line breadth is evident beyond primary clinic encounters: the top-25 list includes obstetrics/newborn codes (59409, 99460, 59514), inpatient follow-up codes (99231–99233, 99238–99239), case management and nutrition codes (T1016, 97803), and multiple behavioral health assessment and psychotherapy codes (H0031, 96156, 90792, ). This mix aligns with an FQHC that delivers primary care, maternity/newborn care, behavioral health, case management, and preventive services under a consolidated clinic model.
From a risk/revenue-management perspective, the extreme concentration in T1015 (99.3% of Medicaid revenue) creates a single-code dependency: any reimbursement policy change or audit focus on T1015 would disproportionately affect the center’s Medicaid revenue. Analysts and payers should treat EL RIO as highly exposed to changes in clinic encounter reimbursement given the preponderance of revenue tied to that one all-inclusive code.
Operationally, the combination of very high claim volumes (e.g., 1.2M claims for T1015) and top-state percentile rankings suggests EL RIO functions at scale for community-based primary and behavioral health services. For payer/provider strategy, this positions EL RIO as a dominant Medicaid provider in Arizona for bundled clinic encounters and selected preventive and behavioral services, while offering limited Medicare exposure due to no Medicare billing on file.
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.
347 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 1,241,180 | $290 | $357.5M |
| 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… | 406,360 | $1 | $406.4K |
| 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… | 398,770 | $1 | $398.8K |
| 99238 | The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends 30 minutes or less on the service on the… | 5,620 | $60 | $337.3K |
| 59409 | In this procedure, the provider provides admission to the hospital for delivery, labor management, including induction of labor, fetal monitoring, use of low forceps, and episiotomy, vaginal delivery… | 290 | $830 | $239.9K |
| 99460 | The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center. | 3,300 | $70 | $214.7K |
| T1016 | Case management, each 15 minutes | 16,660 | $10 | $200K |
| 99233 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 3,400 | $60 | $190.6K |
| 99231 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical… | 4,000 | $30 | $128K |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 2,640 | $40 | $103.1K |
Showing 1–10 of 347
How this provider's Medicaid billing volume and revenue compare to other Arizona providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Arizona median
347 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 2 | 360 | 3,640 | $230 | $7.7M |
| T1016 | Case management, each 15 minutes | 275 | 1,160 | 2,110 | $30 | $1.2M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 250 | 1,150 | 1,700 | $90 | $1M |
| 80081 | The lab analyst performs an obstetric panel; this panel must include tests for a complete blood count with differential, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens… | 3 | 10 | 17,850 | $30 | $995.7K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 11 | 30 | 470 | $20 | $761.9K |
| H2011 | Crisis intervention service, per 15 minutes | 87 | 140 | 330 | $210 | $659.5K |
| H0038 | Self‑help/peer services, per 15 minutes | 345 | 580 | 1,250 | $80 | $479.7K |
| 99233 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 146 | 540 | 900 | $60 | $475.8K |
| 97530 | The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity. | 161 | 510 | 1,320 | $60 | $454.9K |
| 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. | 227 | 400 | 200 | $120 | $403K |
Showing 1–10 of 347
Other providers in the same ZIP code as El Rio Santa Cruz Neighborhood Health Center, Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Smsj Tucson Holdings LLC | AZ | General Acute Care Hospital | $0 | $29.8M |
| Founders Healthcare, LLC | AZ | Durable Medical Equipment & Medical Supplies | $0 | $20.8M |
| Tucson Physician Group Holdings, LLC | AZ | Interventional Cardiology Physician | $0 | $11.5M |
| Behavioral Awareness Center, Inc | AZ | Methadone Clinic | $192.7K | $2.1M |
| Janakkumar Kansagra | AZ | Interventional Cardiology Physician | $798.6K | $0 |
| Afshin Emami | AZ | Otolaryngology Physician | $512.1K | $0 |
| Alexandre Benjo | AZ | Interventional Cardiology Physician | $352.6K | $0 |
| Susannah Cooper | AZ | Hematology & Oncology Physician | $342.4K | $0 |
| John Migliano | AZ | Hematology & Oncology Physician | $300.2K | $0 |
| Troy Virgil Taduran | AZ | Sports Medicine (Neuromusculoskeletal Medicine) Physician | $278.5K | $0 |
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