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.

Optimus Health Care Inc (NPI 1669445946)

Key Findings

Field	Value
Entity Type	Organization
Organization	Optimus Health Care Inc
Address	471 Barnum Ave
City	Bridgeport
State	CT
ZIP	06608
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	February 8, 2006

Payer Source	Total Paid
Medicaid	$100.4M
Medicare	$0

This provider has no Medicare billing on file and reports Total Medicaid revenue of $100.4M, making its commercial footprint effectively single-payer Medicaid for the billing data on record. Analysts should treat Medicaid as the primary and material revenue source when modeling patient mix, utilization, or contracting risk for OPTIMUS HEALTH CARE INC.

Revenue is extremely concentrated: the precomputed top 3 Medicaid codes together account for 99.6% of the provider’s total Medicaid revenue. T1015 alone represents 97.7% of Medicaid dollars, with G0511 and G0467 contributing 1.5% and 0.4% respectively, so movements in reimbursement or utilization for those codes would disproportionately affect overall revenue.

The code mix and taxonomy (Federally Qualified Health Center) indicate an FQHC operational model driven by bundled clinic-encounter payments: T1015 (Clinic visit/encounter, all-inclusive) and G0467 (FQHC visit, established patient) dominate revenue, while G0511 activity points to substantial chronic care management or behavioral health integration handled at the clinic level. This pattern is consistent with an FQHC that bills per-encounter bundles rather than relying on fee-for-service for most discrete procedures.

Despite the dominant revenue share of T1015, the provider ranks highly in-state on that code: T1015 ranks #3 of 73 providers in-state (97th percentile), indicating a strong state-level position on the core FQHC clinic encounter. The dataset’s descriptive label calls the T1015 volume “typical, unremarkable volume for this code,” so the high rank should be interpreted as market-leading within the state context rather than evidence of an unusual billing pattern.

G0511 (general care management/BHI, per calendar month) is a secondary revenue contributor and shows above-typical activity relative to peers: it produced $1.5M from 74.8K claims and ranks #2 of 17 in-state (94th percentile; notably above typical state volume). This suggests a deliberate operational emphasis on monthly chronic care management or behavioral health integration services within the FQHC model.

Several CPT/HCPCS show very high claim volumes with $0 recorded Medicaid revenue (examples include 99213: 342.6K claims, $0 revenue; 99442: 47.3K claims, $0 revenue; 90460: 45.4K claims, $0 revenue; 92551: 35.5K claims, $0 revenue). This pattern is consistent with encounter-level reporting and bundled reimbursement practices typical for FQHCs, where many individual procedure codes are reported but not separately paid outside the primary bundled encounter code.

Telehealth and preventive services appear in the mix but represent small shares of revenue: G2025 (telehealth distant site) generated $272.7K (4.2K claims), and vaccine/administration codes appear with very high claim counts but $0 revenue in the file (for example 90460: 45.4K claims, $0 revenue). These signals point to a material operational use of telehealth and high-volume preventive outreach, even if those activities are absorbed into broader encounter payments.

The provider’s NPI tenure is long-standing: enumerated on 2006-02-08 (~20 years ago). That duration, together with dominant in-state rankings on core FQHC encounter codes, supports an interpretation of OPTIMUS HEALTH CARE INC as an established, mission-driven community clinic with concentrated Medicaid-facing revenue streams rather than a diversified payer mix.

Medicaid: Complete Services Breakdown

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

191 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	721,060	$140	$98.1M
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…	74,770	$20	$1.5M
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…	28,980	$10	$405.7K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	4,200	$70	$272.7K
82947	The lab analyst performs a test to measure the amount of glucose in a patient's blood using a method other than a reagent strip.	10,790	$1	$43.2K
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…	34,350	$1	$34.4K
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…	1,520	$20	$30.5K
99223	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	160	$70	$11.3K
98940	The provider applies manipulation to influence joint and neurophysiological function by a variety of techniques and modalities in one to two spinal regions.	8,200	$1	$8.2K
G0470	Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health encounter (one-on-one) between an established patient and a fqhc…	2,780	$1	$5.6K

Showing 1–10 of 191

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

Optimus Health Care Inc — 2 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

191 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	3	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…	2	20	6,040	$40	$952.7K
0241U	N/A	30	40	1,300	$110	$523.5K
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…	47	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	9	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…	3	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…	5	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…	197	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…	4	30	6,140	$20	$180.2K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	33	120	1,140	$10	$178.2K

Showing 1–10 of 191

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Optimus Health Care	CT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$33.1M
Optimus Health Care	CT	Dental Clinic/Center	$0	$8.4M
Deena Ebright	CT	Internal Medicine Physician	$85.4K	$0
Shakeilla Smithbey	TX	Family Medicine Physician	$84.9K	$0
Jennifer Gilbert	CT	Family Nurse Practitioner	$71.7K	$0
Joseph Feuerstein	CT	Family Medicine Physician	$66.9K	$0
Gustavo Herrera-brito	CT	Adult Health Nurse Practitioner	$54.9K	$0
Luis Rojas	CT	Family Nurse Practitioner	$35.2K	$0
Prajay Rathore	CT	Internal Medicine Physician	$33K	$150

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Skmp Enterprises, Inc.	CT	Land Ambulance	$2.3M	$4.7M
Chemical Abuse Services Agency, Inc.	CT	Community/Behavioral Health Agency	$0	$3.2M
Vicarah, LLC	CT	Home Health Agency	$0	$1.2M

Optimus Health Care Inc — Billing Profile & Reimbursement Data

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Optimus Health 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

Related Providers

Nearby Providers

Frequently Asked Questions

References