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

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

Waimanalo Health Center (NPI 1780738005)

Key Findings

Field	Value
Entity Type	Organization
Organization	Waimanalo Health Center
Address	41-1347 Kalanianaole Hwy
City	Waimanalo
State	HI
ZIP	96795
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	January 23, 2007

Payer Source	Total Paid
Medicaid	$11.3M
Medicare	$0

WAIMANALO HEALTH CENTER is functionally a Medicaid-focused provider: it reports no Medicare billing on file and $11.3M in lifetime Medicaid revenue, making Medicaid the sole visible public-payer revenue stream for this entity. This single-payer footprint likely shapes contracting and service priorities toward Medicaid populations rather than Medicare beneficiaries.

Revenue is highly concentrated in a small set of outpatient E/M and behavioral-health codes: the top three Medicaid codes (99214, 99213, 90834) together account for 76.1% of this provider's total Medicaid revenue. That concentration indicates the clinic's financial performance is heavily dependent on established primary care visits at moderate complexity and a relatively large psychotherapy program.

The code mix points to an integrated primary care plus behavioral health model consistent with its Federally Qualified Health Center (FQHC) taxonomy. High revenue from 99214 ($4.8M) and 99213 ($2M) indicates substantial established-patient primary care volume, while major revenue from psychotherapy code 90834 ($1.8M) and supporting codes 90832 and 90837 show a robust mental-health service line embedded in ambulatory care.

WAIMANALO is a notable statewide player on several high-volume Medicaid codes. It ranks #12 of 690 in the state for 99214 (98th percentile) and is described as "notably above typical state volume" for that code, and it is an extreme outlier for 90834, ranking #1 of 81 (100th percentile), which signals market leadership in outpatient psychotherapy services within Hawaii.

Despite dominance on a few codes, many other billed services are modest or typical for the state. For example, G0467 and G0470 (FQHC visit bundles) show typical, unremarkable volumes (78th and 62th percentiles respectively), and several preventive and pediatric E/M codes (99391/99392/99393) sit near the middle of statewide ranks, indicating routine primary care throughput beyond the prominent behavioral-health activity.

Operational detail: the provider has been NPI-enumerated since 2007-01-23 (~19 years ago), which implies long-standing presence in the community and an established payer-provider relationship network that supports sustained Medicaid volume over time.

Specific service-line signals: exceptionally high psychotherapy volume (90834 as the #1 statewide reporter) together with meaningful counts for 90832 and 90837 suggests the clinic offers a full spectrum of individual psychotherapy session lengths and likely staffs dedicated behavioral-health clinicians. This pattern aligns with integrated behavioral-health models commonly found in FQHCs.

Other notable but smaller service contributions include dental problem-focused evaluations (D0140, $139.2K), immunizations (90471, 3.7K claims and $11.1K revenue, ranked #6 of 231 at the 98th percentile by claim count), and chronic-care/behavioral health integration billing (G0511), which suggests ancillary preventive and population-health functions that complement the dominant primary care and behavioral-health lines.

Medicaid: Complete Services Breakdown

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

82 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	23,420	$210	$4.8M
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…	8,780	$230	$2M
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…	8,330	$210	$1.8M
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…	4,790	$190	$899.8K
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…	5,020	$80	$421.7K
D9999	N/A	1,600	$230	$367.1K
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…	870	$200	$174.9K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	770	$190	$146.9K
D0140	Limited oral evaluation – problem focused	610	$230	$139.2K
97803	The provider reassesses the dietary needs of a patient and uses specific diet therapy to treat medical conditions and related symptoms by interacting individually with the patient. This code…	730	$80	$61.2K

Showing 1–10 of 82

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Waimanalo Health Center — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

82 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
D9999	N/A	12	20	2,200	$280	$1.6M
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…	10	70	370	$150	$457.3K
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…	49	710	650	$90	$274.1K
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…	8	30	1,850	$60	$248.9K
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…	12	690	650	$90	$235.4K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	15	20	310	$130	$184K
98968	A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes…	14	10	490	$190	$172.3K
D0140	Limited oral evaluation – problem focused	50	120	400	$140	$150.2K
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,…	88	190	190	$100	$122.8K
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…	1	80	320	$100	$119.2K

Showing 1–10 of 82

Waimanalo Health Center — Billing Profile & Reimbursement Data

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Waimanalo Health Center — 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

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Waimanalo Health Center	HI	Federally Qualified Health Center (FQHC)	$0	$2.3M
Robert Aki	HI	Podiatrist	$58.9K	$960.1K