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

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

Healthnet, Inc. (NPI 1780634964)

Key Findings

Field	Value
Entity Type	Organization
Organization	Healthnet, Inc.
Address	2855 N Keystone Ave
City	Indianapolis
State	IN
ZIP	46218
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	May 11, 2006

Payer Source	Total Paid
Medicaid	$74M
Medicare	$0

HEALTHNET, INC. is effectively a Medicaid-focused Federally Qualified Health Center: it reports $74M in lifetime Medicaid revenue and has no Medicare billing on file, making its operating footprint single-payer in practice. The provider’s NPI was enumerated on 2006-05-11 (~20 years ago), indicating a long-tenured presence in the Indianapolis market and a sustained Medicaid billing relationship.

Revenue is highly concentrated in a small set of outpatient visit codes: the precomputed top 3 Medicaid codes account for 53.7% of this provider’s total Medicaid revenue. The single largest contributor is 99213 ($21.6M, 32.1% of Medicaid revenue, 431.9K claims) followed by T1015 ($10.5M, 15.6%, 581.6K claims) and 99214 ($4.1M, 6.1%, 57.2K claims), which together show the business is dominated by high-volume ambulatory encounters.

The code mix and volumes point to a primary-care and clinic-based operating model consistent with an FQHC: extremely high counts for T1015 (581.6K claims, ranks #1 of 404 in-state, 100th percentile, extreme outlier) indicate many all-inclusive clinic encounters, while large volumes of 99213 and 99214 (431.9K and 57.2K claims respectively) reflect heavy throughput of low-to-moderate complexity evaluation & management visits. This combination suggests the organization focuses on routine and chronic care management delivered in a community clinic setting rather than specialty or inpatient services.

Preventive, pediatric and maternal care are important service lines: several preventive E/M codes (99392, 99391, 99393, 99394, 99395) each generate multi‑million dollar revenue and rank at or near the top in-state (many at 99–100th percentile, often listed as extreme outlier). Maternal codes 59426 and 59425 also appear in the top contributors (42.6K claims and 30K claims respectively), demonstrating a sizable obstetric/antepartum component alongside well-child and adolescent preventive visits.

Behavioral health and dental services are notable complementary lines: psychotherapy 90832 (85.6K claims, $3.3M, ranks #6 of 428, 99th percentile) and psychiatric evaluation 90791 (12.9K claims, $989.5K, 95th percentile) indicate integrated mental health activity, while multiple dental codes (D0120, D1110, D1120, D1206, D2391, etc.) appear across the top-25 Medicaid codes and frequently rank at extreme outlier percentiles, signaling a broad primary-care-plus-dental model common to FQHCs.

Competitive standing in-state is dominant for many lines of business: 99213 is in the 100th percentile and noted as an extreme outlier (ranks #4 of 2377), T1015 is #1 of 404 at the 100th percentile (extreme outlier), and several preventive and pediatric codes rank #1 or in the top few providers statewide. Even codes that are not #1 often sit in the 95–100th percentile (for example 99214 at the 98th percentile, rank #51 of 2122), which collectively characterize HEALTHNET as a major, high‑volume Medicaid provider in Indiana.

The provider’s revenue concentration and code-level outlier status carry operational implications: reliance on very large volumes of low- to moderate-complexity visits (99213, T1015, 99214) means revenue is sensitive to visit mix, encounter coding rules, and clinic throughput. At the same time, the breadth of high-ranking procedural areas—preventive pediatrics, obstetrics, behavioral health, dental, and vision (92004)—suggests diversified Medicaid service lines within the outpatient/primary care setting, which can stabilize overall Medicaid revenue even though a small set of codes drives the majority share.

Statistical outlier labels across many codes reinforce the provider’s unusual scale in the state: multiple codes are explicitly described as extreme outlier or notably above typical state volume (e.g., 99213, T1015, 99392, 99391, 99393, D0330), and a few codes are characterized as typical or unremarkable (e.g., 98941). These descriptions confirm that HEALTHNET’s Medicaid pattern is exceptional for an FQHC in Indiana and should be interpreted as a high-volume statewide anchor for primary, preventive, maternal, behavioral health, dental, and vision services.

Medicaid: Complete Services Breakdown

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

170 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	431,940	$50	$21.6M
T1015	Clinic visit/encounter, all-inclusive	581,630	$20	$10.5M
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…	57,220	$70	$4.1M
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…	46,850	$80	$3.8M
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…	45,200	$80	$3.4M
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	42,740	$80	$3.3M
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…	85,620	$40	$3.3M
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	42,650	$70	$3.1M
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…	30,010	$70	$2.1M
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	24,630	$80	$1.9M

Showing 1–10 of 170

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Indiana Distribution

Healthnet, Inc. — 22 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

170 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	199	360	3,490	$110	$1.5M
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…	358	580	710	$60	$582.9K
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…	51	2,120	870	$60	$450.6K
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…	602	690	1,070	$80	$422.3K
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…	4	2,380	920	$50	$376.8K
D2930	N/A	135	170	1,180	$130	$370.2K
T1015	Clinic visit/encounter, all-inclusive	1	400	5,220	$20	$360.2K
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	2	160	1,390	$70	$294.8K
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…	3	280	880	$80	$267.2K
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…	4	190	1,680	$70	$264.2K

Showing 1–10 of 170

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Guy Crowder	IN	Family Medicine Physician	$59.7K	$0
Brandie Porter	NH	Advanced Practice Midwife	$31.5K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Seals Ambulance Service, Inc.	IN	Land Ambulance	$1.8M	$10.7M
Denise Moore	IN	Clinical Social Worker	$0	$5.6M
The Health And Hospital Corporation Of Marion County	IN	Federally Qualified Health Center (FQHC)	$0	$5M
City Optical Co., Inc.	IN	Optometrist	$0	$2.8M
Familia Dental Indianapolis Avondale, LLC	IN	Dental Clinic/Center	$0	$2.8M
Sherman Westend Dental LLC	IN	General Practice Dentistry	$0	$2.7M
East Campus Surgery Center LLC	IN	Ambulatory Surgical Clinic/Center	$663.1K	$683.4K
Ruth Human	IN	Family Nurse Practitioner	$49.4K	$0
Linda Fundenberger	IN	Ophthalmology Physician	$36.7K	$10.3K

Healthnet, 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