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

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

La Maestra Family Clinic, Inc. (NPI 1609849074)

Field	Value
Entity Type	Organization
Organization	La Maestra Family Clinic, Inc.
Address	4060 Fairmount Ave
City	San Diego
State	CA
ZIP	92105
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	February 8, 2006

Payer Source	Total Paid
Medicaid	$202.1M
Medicare	$0

Key Findings

This organization reports $202.1M in lifetime Medicaid revenue and has no Medicare billing on file, making it effectively a Medicaid-focused operator rather than a dual-payer provider. Its NPI was enumerated 2006-02-08 (~20 years ago), indicating long-tenure presence in the market and time to establish Medicaid patient panels and billing workflows. The provider is also listed as a Federally Qualified Health Center (FQHC), which aligns with the observed code mix and billing patterns.

Revenue is extremely concentrated in a small set of encounter-level codes: the precomputed top 3 Medicaid codes account for 97.2% of the provider’s total Medicaid revenue, meaning most of the $202.1M is driven by a narrow set of services rather than a broad, evenly distributed portfolio. This concentration creates operational dependence on a few service lines and reimbursement streams, which will be important for payer contracting and risk assessment.

T1015 ($134.3M revenue; 66.8% of this provider's total Medicaid revenue) dominates the revenue picture and reflects the FQHC-style, all-inclusive clinic visit/encounter billing model the provider uses. T1015 ranks #3 of 1550 providers in-state (100th percentile) and is explicitly labeled an extreme outlier, far above typical state volume for this code; this confirms the clinic visit bundle is the core business model and primary revenue driver.

The second-largest revenue source is 00003 ($56.9M revenue; 28.3% of this provider's total Medicaid revenue), which also represents a very large share of Medicaid receipts and ranks #6 of 688 providers in-state (99th percentile), described as notably above typical state volume for this code. Together with T1015, 00003 accounts for the bulk of the center’s billed activity and suggests specialized encounter or program-level billing that pairs with the FQHC encounter model.

G9012 ($4.3M revenue; 2.2% of this provider's total Medicaid revenue) is the third top code and ranks #27 of 718 providers in-state (96th percentile) with the plain-language label of typical, unremarkable volume; this indicates that while case management services are present, they are a much smaller component of overall revenue compared to encounter/bundle billing. The mix (high encounter bundle plus modest case management) suggests primary care, care coordination, and population-health management typical of community health centers.

Beyond the top three codes, the provider shows multiple high-volume, low-paid claim lines that signal broad service delivery but limited standalone reimbursement: examples include 99213 (352.8K claims, $3 avg paid/claim, $1.1M revenue) and 99212 (109.9K claims, $1 avg paid/claim, $109.9K revenue), both ranked in the 100th percentile for volume and labeled extreme outliers. These patterns are consistent with FQHC billing where many traditional E/M codes appear with high claim counts but contribute modestly to revenue because the encounter bundle (T1015) captures the revenue value.

Service-line breadth is evident despite revenue concentration: the claim mix includes behavioral health (90832, 90834, 90791), obstetrics and prenatal imaging (59425, 76801, 76805, H1001), vision and hearing services (92081, 92014, 92551), chiropractic care (98940), and immunizations (90686). Many of these codes rank highly in-state (for example ranks #1 of 556 providers and is flagged an extreme outlier, and ranks #42 of 3766 providers as an extreme outlier), showing the clinic delivers a wide set of primary and allied health services even though those services contribute far less to total Medicaid revenue than the encounter codes.

From a competitive and payer-relationship perspective, the provider is a dominant statewide player for its principal encounter codes: T1015’s #3 ranking at the 100th percentile and 00003’s #6 ranking at the 99th percentile indicate market leadership in high-volume clinic-encounter billing within California. For payers evaluating network adequacy or negotiating FQHC arrangements, this provider represents a major Medicaid-facing delivery site with unusually high encounter-bundle volume and long tenure in the market.

Medicaid: Complete Services Breakdown

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

299 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	703,130	$190	$134.3M
00003	N/A	212,230	$270	$56.9M
G9012	Other specified case management service not elsewhere classified	34,620	$130	$4.3M
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…	352,800	$1	$1.1M
98940	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in one to two spinal regions.	63,150	$10	$694.6K
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…	133,180	$10	$665.9K
G9008	Coordinated care fee, physician coordinated care oversight services	2,920	$200	$577.2K
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	10,250	$50	$502.2K
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…	36,720	$10	$440.7K
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…	6,660	$30	$193.1K

Showing 1–10 of 299

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

La Maestra Family Clinic, Inc. — 17 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

299 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
81420	The lab analyst performs a genomic sequence analysis panel to evaluate circulating cell free fetal DNA in maternal blood for genetic sequences of at least the genes on chromosomes 13, 18, and 21,…	16	30	300	$260	$18M
T1015	Clinic visit/encounter, all-inclusive	3	1,550	38,050	$190	$14.1M
00003	N/A	6	690	14,940	$260	$7.7M
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	91	110	190	$140	$1.6M
81329	The lab analyst performs the technical lab test to detect deletions in the survival of motor neuron 1 (SMN1), telomeric, gene and may also analyze the survival of motor neuron 2 (SMN2), centromeric,…	53	60	400	$40	$748.5K
H0043	Supported housing, per diem	156	230	580	$250	$665.6K
G9012	Other specified case management service not elsewhere classified	27	720	1,110	$110	$651.3K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	473	660	1,490	$30	$417.2K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	1,595	4,290	780	$140	$400.1K
G9008	Coordinated care fee, physician coordinated care oversight services	140	490	660	$70	$396.7K

Showing 1–10 of 299

Nearby Providers

Other providers in the same ZIP code as La Maestra Family Clinic, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jennifer Hauser	CA	Clinical Psychologist	$66.8K	$0

La Maestra Family Clinic, Inc. — Billing Profile & Reimbursement Data

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La Maestra Family 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