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

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

Wheeler Clinic Inc. (NPI 1548760119)

Key Findings

Field	Value
Entity Type	Organization
Organization	Wheeler Clinic Inc.
Address	10 N Main St
City	Bristol
State	CT
ZIP	06010
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	February 20, 2018

Payer Source	Total Paid
Medicaid	$21.8M
Medicare	$0

WHEELER CLINIC INC. is effectively a single-payer Medicaid provider: there is no Medicare billing on file while lifetime Medicaid revenue is $21.8M. The absence of Medicare activity indicates the clinic’s revenue and payer risk are concentrated in Medicaid rather than distributed across both programs.

Revenue is extremely concentrated in a single bundled FQHC clinic encounter: T1015 accounts for $21.6M in revenue (98.7% of the provider’s total Medicaid revenue) and, together with two other top codes, the precomputed top-3 codes account for 99.4% of total Medicaid revenue. This concentration is consistent with an FQHC delivering per-encounter all-inclusive visits rather than relying on numerous separately reimbursed procedures.

The provider’s code mix and taxonomy align with an FQHC delivery model: heavy reliance on T1015 (Clinic visit/encounter, all-inclusive) plus presence of FQHC-specific codes like G0467 and G0511 indicate most services are captured in bundled visit payments. Numerous high-volume preventive and behavioral codes with low or $0 separate payments (for example, 36.4K claims for 96127 with $0 avg paid/claim and 29.3K claims for H0049 with $0 avg paid/claim) suggest those services are frequently provided but reimbursed within the bundled encounter.

Operational profile: high-volume, low-per-claim billing patterns for standard E/M codes (99213: 53.7K claims, $2 avg paid/claim; 99214: 28.6K claims, $2 avg paid/claim) show many routine visits are recorded outside the T1015 bundle or as adjunct codes with minimal separate payment. 99213 ranks #43 of 1714 in-state at the 98th percentile, indicating unusually high volume activity for that E/M code relative to peers despite low separate reimbursement.

Competitive standing for the revenue driver is modest statewide: T1015 ranks #18 of 73 providers in-state (76th percentile), which the data notes as typical/unremarkable volume for this code — the provider is not a dominant statewide payer of T1015 despite its dependence on that code for nearly all revenue. Conversely, the provider is an outlier on several non-revenue-driving measures: 96127 (36.4K claims) ranks #6 of 288 (98th percentile) and 99406 (15.3K claims) ranks #2 of 67 (98th percentile, labeled an extreme outlier), indicating above-typical state activity in brief behavioral assessments and tobacco cessation counseling.

Specialty/service implications: the presence of 98940 (12.6K claims, $3 avg paid/claim; ranks #3 of 25, 92th percentile) and substantial counts for physical-therapy–adjacent codes like 97110 (12.7K claims) imply the clinic provides hands-on musculoskeletal or rehabilitative services alongside primary care. At the same time, vaccination-related codes (90460, 90471, 90461) and pediatric vision/screening codes (99173) appear at meaningful volumes, reinforcing a broad primary-care and preventive-services footprint typical of FQHCs.

Financial mechanics: multiple high-volume codes show $0 or very low avg paid/claim (examples include 96127, 99442, 90460 and many vaccination and counseling codes), which combined with the dominance of T1015 suggests that Medicaid payments are primarily delivered through the bundled clinic-visit payment rather than discrete fee-for-service reimbursements. Analysts should treat many recorded service counts as operational activity rather than separate revenue streams.

Tenure and administrative footprint: the NPI was enumerated on 2018-02-20 (~8 years ago), indicating the clinic has had several years to establish workflows under the FQHC model and to build the high-volume, bundle-centric billing profile observed in the Medicaid data. This medium-term tenure aligns with the presence of both primary care and integrated behavioral-health screening volumes evident in the claims mix.

Medicaid: Complete Services Breakdown

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

103 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	172,460	$130	$21.6M
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…	53,680	$1	$107.3K
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…	28,590	$1	$57.2K
98940	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in one to two spinal regions.	12,580	$1	$37.7K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	620	$50	$29.8K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	6,010	$1	$18K
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.	4,980	$1	$14.9K
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…	2,370	$1	$9.5K
G0511	Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral…	290	$20	$5.2K
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,…	3,710	$1	$3.7K

Showing 1–10 of 103

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Wheeler Clinic Inc. — 3 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

103 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	18	70	830	$150	$24M
G0511	Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral…	16	20	6,040	$40	$952.7K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	51	350	1,820	$40	$537.3K
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…	61	1,590	740	$50	$331.8K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	23	30	2,590	$60	$278.5K
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…	43	1,710	750	$30	$243.3K
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…	54	170	850	$80	$203.5K
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…	379	420	1,230	$20	$199.3K
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…	20	30	6,140	$20	$180.2K
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…	58	160	680	$70	$166.1K

Showing 1–10 of 103

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bristol Hospital Ems, LLC	CT	Land Ambulance	$1M	$7.1M
Hartford County Oral Maxillofacial & Implant Surgery PC	CT	Oral and Maxillofacial Surgery (Dentist)	$0	$7.9M
The Pediatric Care Center, LLC	CT	Pediatrics Physician	$0	$7.8M
Bristol Hospital Multi Specialty Group, Inc	CT	General Practice Physician	$0	$7.5M
City Of Bristol	CT	Local Education Agency (LEA)	$0	$6M
Kids Dental Care, LLC	CT	Pediatric Dentistry	$0	$5.9M
Usacs Of Connecticut, LLC	CT	Emergency Medicine Physician	$0	$3.7M
Pediatric Associates, LLC	CT	Primary Care Clinic/Center	$0	$3.7M
Bristol Oral Surgery & Implant Center	CT	Oral and Maxillofacial Surgery (Dentist)	$0	$2.8M
Tiny Teeth General Dentistry LLC	CT	Pediatric Dentistry	$0	$2.5M

Wheeler Clinic 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