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.

Legacy Medical Care Inc (NPI 1497181697)

Key Findings

Field	Value
Entity Type	Organization
Organization	Legacy Medical Care Inc
Address	3030 W Salt Creek Ln Ste 200
City	Arlington Heights
State	IL
ZIP	60005
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	September 19, 2013

Payer Source	Total Paid
Medicaid	$42.6M
Medicare	$0

This provider is effectively single‑payer in scale: Medicare shows none (no Medicare billing on file) while Medicaid lifetime revenue is $42.6M, indicating the organization’s billed activity and revenue are overwhelmingly Medicaid‑driven rather than split across traditional Medicare/Medicaid payer mixes. This concentration should be treated as the baseline when assessing payer risk and contracting exposure.

Revenue concentration is extreme: the precomputed top‑3 Medicaid codes account for 99.5% of this provider’s total Medicaid revenue, and a single code, T1015, accounts for $42.2M or 99.0% of Medicaid revenue. The remaining top revenue codes (90651 at $97.4K and 90734 at $86K) are orders of magnitude smaller, which means overall financial performance is almost entirely tied to the payment and utilization pattern of T1015.

The code mix and taxonomy point to an FQHC operational model: T1015 (Clinic visit/encounter, all‑inclusive) as the dominant revenue source is consistent with an all‑inclusive, encounter‑level reimbursement structure typical of Federally Qualified Health Centers. High volumes in pediatric and adolescent vaccine codes (90651, 90734, 90620 and others listed) further suggest a substantial preventive care and immunization workflow, implying the site functions as a community primary care and pediatric access point.

Competitive standing within the state is pronounced for key codes: T1015 ranks #12 of 846 providers in‑state (99th percentile; extreme outlier), indicating the provider is a top volume Medicaid clinic for bundled clinic visit payments. Multiple vaccine codes also score as state outliers—90651 ranks #5 of 773 (99th percentile; extreme outlier), 90734 ranks #3 of 849 (100th percentile; extreme outlier), and 90620 ranks #1 of 249 (100th percentile; extreme outlier)—demonstrating unusually high immunization activity relative to peers.

Several high‑count procedure lines report large claim volumes with $0 avg paid/claim (for example 99213: 132.3K claims, $0 avg paid/claim; 99212: 33.3K claims, $0 avg paid/claim; 96110: 31.9K claims, $0 avg paid/claim; 99393: 21.9K claims, $0 avg paid/claim). This pattern is consistent with encounter‑level bundling where separate CPT/HCPCS lines are submitted but payment is captured primarily via the T1015 all‑inclusive encounter code; analysts should interpret raw claim counts in light of bundled reimbursement rather than as independent revenue drivers.

The extreme revenue dependence on a single encounter code creates both operational strengths and concentration risk: as the facility is clearly a major Medicaid clinic (T1015 = $42.2M), it benefits from predictable encounter payments and high patient volume, but any policy or rate change affecting T1015 or FQHC encounter reimbursement could materially alter total Medicaid revenue given that the top three codes together make up 99.5% of Medicaid receipts. Payers and network planners should treat this provider as highly sensitive to encounter‑level reimbursement policy.

The provider’s NPI has been enumerated since 2013-09-19 (~13 years ago), indicating an established presence in the market; combined with FQHC taxonomy and the concentrated Medicaid revenue profile, this tenure supports the interpretation of an ongoing community clinic operation with sustained Medicaid contracting and high throughput in preventive services and vaccinations.

Medicaid: Complete Services Breakdown

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

74 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	285,220	$150	$42.2M
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,…	8,850	$10	$97.4K
90734	The provider administers a meningococcal conjugate vaccine in a diphtheria toxoid carrier (MenACWY–D) or CRM197 carrier (MenACWY–CRM) to protect the patient from four strains of meningococcal viruses…	9,560	$10	$86K
90620	This code represents a vaccine product administered into the muscle to protect against meningococcal disease caused by serogroup B. This vaccine uses recombinant proteins and outer membrane vesicles…	7,590	$10	$83.5K
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…	19,440	$1	$38.9K
90716	The provider administers a live vaccine subcutaneously to protect against varicella infection.	4,120	$10	$37.1K
90707	This code represents an MMR vaccine product administered beneath the skin to protect against measles, mumps, and rubella (German measles).	3,870	$10	$19.3K
90670	This code represents a pneumococcal vaccine product administered into the muscle to protect against 13 types of pneumococcal bacteria that can cause serious infections like pneumonia, meningitis, and…	9,140	$1	$18.3K
90696	This code represents a combination vaccine product administered into the muscle to protect young children (4 to 6 years of age) against diphtheria, tetanus, pertussis (whooping cough), and polio.	3,660	$1	$11K
90715	The provider uses this combination vaccine as a booster to help protect patients who are 7 years old or older from lockjaw, diphtheria, and whooping cough.	4,670	$1	$9.3K

Showing 1–10 of 74

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

Legacy Medical Care Inc — 12 of 17 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

74 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	12	850	7,490	$120	$3.9M
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…	324	14,680	300	$50	$48.7K
0502F	No Summary found for this code	12	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…	9	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…	12	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…	12	14,190	280	$20	$38.9K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	754	1,300	360	$20	$35.1K
76819	The provider performs a biophysical profile test to measure the health of the baby during pregnancy using only ultrasound and not a nonstress test.	68	140	190	$30	$33.7K
95004	The provider performs a percutaneous test with allergenic extracts to determine which substances (allergens) trigger an allergic reaction in the patient.	10	100	110	$70	$31.3K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	5	1,670	160	$40	$26.4K

Showing 1–10 of 74

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Universal Health Solutions Inc	IL	Clinical Medical Laboratory	$12.4M	$258.4K
A-z & Medical Supply Inc	IL	Durable Medical Equipment & Medical Supplies	$0	$9.3M
Village Of Arlington Heights A	IL	Land Ambulance	$1M	$7.4M
Clearbrook	IL	Case Management Agency	$0	$6.1M
Clarity Testing Services	IL	Clinical Medical Laboratory	$5.2M	$353.5K
Senad Osmanovic	IL	Ophthalmology Physician	$1.6M	$1.3M
Northwest Community Day Surgery Center Ii LLC	IL	Ambulatory Surgical Clinic/Center	$2.6M	$0
Richard Siegel	IL	Hematology & Oncology Physician	$1.4M	$0
Urszula Sobol	IL	Hematology & Oncology Physician	$1.2M	$12K
Randy Rich	IL	Hematology & Oncology Physician	$1.2M	$750

Legacy Medical 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

Nearby Providers

Frequently Asked Questions

References