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

Why is the Medicaid comparison limited to Delaware 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. Delaware (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 Red Health Center Inc (NPI 1700832185)

Field	Value
Entity Type	Organization
Organization	La Red Health Center Inc
Address	21444 Carmean Way
City	Georgetown
State	DE
ZIP	19947
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	May 26, 2006

Payer Source	Total Paid
Medicaid	$7.3M
Medicare	$0

Key Findings

Provider is effectively single‑payer at present: there is no Medicare billing on file while Medicaid lifetime revenue is $7.3M, so Medicaid accounts for the entirety of recorded fee‑for‑service activity in the dataset. Analysts should treat this profile as Medicaid‑centric when assessing payer exposure and reimbursement sensitivity.

Revenue is highly concentrated: the top 3 Medicaid codes by revenue account for 79.8% of this provider's total Medicaid revenue, with G0467 alone driving the largest share. G0467 generates $5M revenue (68.5% of this provider's total Medicaid revenue), followed by G0468 ($535.7K, 7.3%) and D1120 ($291.1K, 4.0%), making the provider’s financial performance heavily dependent on a small set of FQHC and dental codes.

The code mix indicates an FQHC operating model with substantial on‑site dental and preventive services: high-volume FQHC visit codes (G0467, G0468, G0466) coexist with pediatric and preventive dental codes such as D1120 (7.5K claims, $291.1K), D1206 (9.1K claims, $208.6K) and D0120 (7.6K claims, $204.1K). This suggests the center operates as a comprehensive community health clinic that bundles medical/behavioral encounters under FQHC visit codes while maintaining robust dental prevention programs.

Competitive standing within the state is mixed by service line: for G0467 the provider ranks #2 of 15 in‑state (93th percentile; typical, unremarkable volume), indicating major but not singular leadership in established FQHC visits; for G0468 it ranks #1 of 4 (100th percentile; typical, unremarkable volume), showing top position for IPPE/AWV FQHC visits; dental prophylaxis D1120 ranks #15 of 116 (88th percentile; typical, unremarkable volume), reflecting strong dental volume relative to peers. These rank/percentile positions show the provider is a meaningful in‑state competitor on core FQHC visit types and dental prevention.

The provider has long tenure in the NPI registry, enumerated 2006-05-26 (~20 years ago), which supports interpretation of these patterns as established operational behavior rather than a short‑term program or startup artifact. Tenure combined with concentrated revenue sources suggests historical reliance on the FQHC visit reimbursement model.

Several high‑volume procedure lines report $0 average paid despite large claim counts—99177 shows 6.2K claims and $0 revenue (ranks #1 of 5 in‑state; notably above typical state volume) and 99213 shows 8.6K claims and $0 revenue (ranks #66 of 543; 88th percentile). These zero‑paid lines are consistent with substantial encounter and screening activity that may be recorded separately from per‑diem FQHC payments and should be investigated when reconciling encounter volumes versus paid revenue.

Operationally, reliance on G0467 for $5M (68.5% of Medicaid revenue) creates concentration exposure: changes to FQHC per‑visit rates, encounter definitions, or state policy for bundled payments would disproportionately affect this provider’s revenue base. Analysts evaluating contract negotiations or payment reform impact should model scenarios that adjust G0467 reimbursement.

Service delivery appears to emphasize preventive dental care across age groups: D1120 (Prophylaxis–child) has 7.5K claims ($291.1K), D1110 (Prophylaxis - adult) has 3K claims ($142.5K), and sealant and topical fluoride codes (D1351, D1206) also appear in the top code list. This pattern indicates active pediatric and adult preventive dental programs that are meaningful contributors to non‑visit Medicaid revenue streams.

Medicaid: Complete Services Breakdown

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

80 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	31,410	$160	$5M
G0468	Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle…	5,580	$100	$535.7K
D1120	Prophylaxis–child	7,460	$40	$291.1K
G0466	Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more…	2,110	$130	$278.5K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	9,070	$20	$208.6K
D0120	Periodic oral evaluation - established patient	7,560	$30	$204.1K
D2392	Post 2 surface resin‑based composite	950	$170	$165K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	2,970	$50	$142.5K
T1015	Clinic visit/encounter, all-inclusive	1,320	$90	$117.6K
D2391	Resin‑based composite – one surface, posterior	650	$160	$100.9K

Showing 1–10 of 80

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

La Red Health Center Inc — 1 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

80 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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	20	2,490	$170	$2.9M
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…	5	10	2,020	$160	$604.9K
G0466	Federally qualified health center (fqhc) visit, new patient; a medically-necessary, face-to-face encounter (one-on-one) between a new patient and a fqhc practitioner during which time one or more…	2	10	910	$170	$379.8K
D2392	Post 2 surface resin‑based composite	36	90	490	$220	$366.3K
T1015	Clinic visit/encounter, all-inclusive	26	50	1,490	$80	$340.7K
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…	194	500	1,130	$50	$235.1K
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…	19	50	1,070	$70	$226.6K
D1351	Sealant - per tooth	28	70	1,690	$40	$217.1K
D2391	Resin‑based composite – one surface, posterior	27	70	320	$180	$192K
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…	22	50	1,050	$60	$191.3K

Showing 1–10 of 80

Related Providers

Other providers that share a Tax Identification Number (TIN) with La Red Health Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
La Red Health Center Inc	DE	Federally Qualified Health Center (FQHC)	$0	$3.1M
La Red Health Center, Inc.	DE	Federally Qualified Health Center (FQHC)	$0	$2.7M
La Red Health Center, Inc.	DE	Federally Qualified Health Center (FQHC)	$0	$2.5M
La Red Health Center, Inc.	DE	Federally Qualified Health Center (FQHC)	$0	$241.6K
Fabricio Alarcon	DE	Internal Medicine Physician	$157K	$0
Ana Guerrero	DE	Psychiatric/Mental Health Nurse Practitioner	$60.9K	$50
Martha Valero	DE	Family Nurse Practitioner	$24.1K	$0
Ericka Taylor-daniel	DE	Psychiatric/Mental Health Nurse Practitioner	$17K	$0
Nadya Julien	DE	Nurse Practitioner	$15.7K	$0
Juliana Rossi	DE	Physician Assistant	$670	$0

Nearby Providers

Other providers in the same ZIP code as La Red Health Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Packd LLC	DE	In Home Supportive Care Agency	$0	$31M
Sea Care LLC	DE	Intellectual & Developmental Disabilities Psychologist	$0	$10.1M
Cheer, Inc.	DE	Home Health Agency	$0	$7.3M
Rainbow Pediatrics	DE	Pediatrics Physician	$0	$5.6M
Wilmington Orthodontic Center	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$3.8M
Horizon House Delaware Inc.	DE	Case Management Agency	$0	$3.3M
Fellowship Health Resources, Inc	DE	Community/Behavioral Health Agency	$0	$2.8M
Nutrihealth LLC	DE	Internal Medicine Physician	$0	$994.6K
Sussex Pain Relief Center LLC	DE	Pain Medicine Physician	$0	$948.5K
Georgetown Medical Associates, LLC	DE	Internal Medicine Physician	$0	$902.5K

La Red 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