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.

South-west Community Health Center, Inc (NPI 1699703686)

Key Findings

Field	Value
Entity Type	Organization
Organization	South-west Community Health Center, Inc
Address	46 Albion St
City	Bridgeport
State	CT
ZIP	06605
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	June 29, 2006

Payer Source	Total Paid
Medicaid	$95M
Medicare	$0

Revenue is extremely concentrated in a very small set of Medicaid codes: the precomputed top three Medicaid codes account for 99.2% of this provider’s total Medicaid revenue. T1015 alone represents $92.8M (97.6% of Medicaid revenue) from 672.2K claims at $138 avg paid/claim, while G0511 ($1.2M, 37.4K claims, $32 avg paid/claim) and G2025 ($319.7K, 7.1K claims, $45 avg paid/claim) make up the remainder, leaving little revenue diversification beyond these encounter-focused payments.

The code mix and revenue profile point to an FQHC-style, clinic-centric delivery model with an emphasis on bundled clinic encounters and behavioral health integration. T1015 (Clinic visit/encounter, all-inclusive) is the dominant payment driver, and the presence of G0467, G0470, G0511, and psychotherapy codes (90834, 90832) indicates combined primary care and mental/behavioral health services delivered in a community health center setting.

This provider is effectively single-payer at scale: there is no Medicare billing on file while Medicaid revenue totals $95M, so financial performance and payer negotiations will be driven almost entirely by Medicaid policies and reimbursement structures. The lack of Medicare activity increases exposure to changes in state Medicaid rates and program rules.

Competitive standing for the primary revenue driver is strong within state peer sets but not uniquely dominant: T1015 ranks #4 of 73 providers in-state (96th percentile) — the dataset labels that position as "typical, unremarkable volume for this code," indicating high absolute revenue but expected concentration among similar community health centers. G0511 ranks #5 of 17 (75th percentile; typical, unremarkable volume) and G2025 ranks #7 of 27 (77th percentile; typical, unremarkable volume), suggesting these ancillary services are present at moderate levels compared with peers.

Several service codes are labeled as extreme outliers in claim volume relative to state peers, which signals unusual operational patterns even if they contribute little revenue. High-volume E/M and telephonic/virtual codes such as 99213 (147.9K claims, $147.9K revenue; ranks #16 of 1714, 99th percentile; extreme outlier), 99214 (92.7K claims, $92.7K revenue; ranks #18 of 1589, 99th percentile; extreme outlier), 90834 (59.9K claims, $59.9K revenue; ranks #6 of 571, 99th percentile; extreme outlier), 99442 (50.7K claims, $50.7K revenue; ranks #3 of 223, 99th percentile; extreme outlier) and 99212 (46.4K claims, $46.4K revenue; ranks #3 of 577, 100th percentile; extreme outlier) are reported at volumes far above typical state norms despite low per-claim payments.

A cluster of measure/quality codes appear with very high claim counts but $0 avg paid/claim and rank at or near #1 in-state (for example 3078F 61.3K claims, 1126F 60.8K claims, 3074F 68.8K claims, 1159F/1160F 93.3K claims, and 1036F 59.5K claims). These zero-revenue, high-count entries likely reflect systematic capture of clinical quality measures or EHR-driven reporting rather than direct revenue generation, signaling a mature documentation and quality-reporting workflow.

Per-claim payment patterns reinforce the bundled-revenue picture: T1015 pays at $138 avg paid/claim while many high-volume psychotherapy and E/M codes show $1 or $0 avg paid/claim (for example 90834 59.9K claims, $1 avg paid/claim; 99213 147.9K claims, $1 avg paid/claim). This contrast is consistent with a clinic model where the bulk of reimbursement is received via an all-inclusive encounter code and individual procedure codes are recorded for clinical tracking or encounter-level accounting rather than as primary revenue sources.

The provider has an established operating history with an NPI enumerated on 2006-06-29 (~20 years ago), which aligns with an embedded community health center presence producing $95M of Medicaid revenue. That tenure, combined with the FQHC-related code mix and heavy Medicaid concentration, suggests entrenched relationships with state Medicaid programs and a service footprint focused on community behavioral health and primary care integration.

Medicaid: Complete Services Breakdown

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

144 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	672,160	$140	$92.8M
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…	37,360	$30	$1.2M
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	7,110	$50	$319.7K
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…	17,770	$10	$213.3K
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…	147,890	$1	$147.9K
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…	92,700	$1	$92.7K
82962	Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained…	24,410	$1	$73.2K
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…	59,900	$1	$59.9K
99442	N/A	50,700	$1	$50.7K
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,…	46,390	$1	$46.4K

Showing 1–10 of 144

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

South-west Community Health Center, Inc — 7 of 18 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

144 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	4	70	830	$150	$24M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	32	70	3,710	$120	$1.6M
S9480	Intensive outpatient psychiatric services, per diem	10	60	5,640	$110	$1.3M
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…	5	20	6,040	$40	$952.7K
0241U	N/A	22	40	1,300	$110	$523.5K
87800	The lab analyst performs a test for multiple infectious organisms in one sample using direct nucleic acid probe technique.	3	10	2,270	$40	$387.6K
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…	18	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	7	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…	16	1,710	750	$30	$243.3K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	31	150	290	$80	$206.3K

Showing 1–10 of 144

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southwest Community Health Center	CT	Dental Clinic/Center	$0	$7.9M
Carmichael John	CT	Family Nurse Practitioner	$32.6K	$0
Brittany Herman	CT	Family Nurse Practitioner	$23K	$0
Bobbi Duffy-hidalgo	CT	Family Nurse Practitioner	$21.2K	$0
Sanjeev Rao	CT	Family Medicine Physician	$18.9K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lifebridge Community Services, Inc.	CT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$10.2M
Recovery Network Of Programs, Inc.	CT	Substance Abuse Rehabilitation Facility	$0	$3.9M
Cortney Katz	CT	Medical Physician Assistant	$63.8K	$0
Linton Kinlock	CT	Psychiatric/Mental Health Nurse Practitioner	$3.9K	$0

South-west Community Health Center, Inc — Billing Profile & Reimbursement Data

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South-west Community Health Center, 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