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NPI 1780969345 · Rutland, VT · Pediatrics Physician
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Community Health Centers Of The Rutland Region, Inc. is a pediatrics physician provider located in Rutland, Vermont. This profile covers 0 Medicare and 50 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Community Health Centers Of The Rutland Region, Inc. |
| Address | 1 General Wing Rd |
| City | Rutland |
| State | VT |
| ZIP | 05701 |
| Taxonomy | Pediatrics Physician |
| NPI Enumerated | October 14, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $13.6M |
| Medicare | $0 |
This entity is effectively a single‑payer Medicaid practice: Total Medicare revenue is listed as none (no Medicare billing on file) while Total Medicaid revenue is $13.6M, so all measurable fee‑for‑service activity in the dataset stems from Medicaid. The NPI was enumerated 2011-10-14 (~15 years ago), indicating an established presence in the market long enough to develop stable Medicaid volume.
Revenue is extremely concentrated in a single code group: the provider’s top 3 Medicaid codes account for 99.0% of its total Medicaid revenue. T1015 alone generates $13M in revenue (95.8% of the provider’s Medicaid revenue), demonstrating that the clinic’s paid Medicaid activity is dominated by the all‑inclusive clinic visit/encounter code.
The code mix and taxonomic classification point to a pediatric primary‑care, high‑volume clinic model: this provider is registered as Pediatrics Physician and shows very large counts for visit and pediatric vaccine administration codes (for example, 90460 has 19.8K claims and 90461 has 6.8K claims). The dominance of T1015 plus high vaccine/well‑child claim counts suggests routine outpatient clinic throughput (well visits, immunizations, and bundled clinic encounters) is the core service line.
Competitive standing within Vermont for the dominant visit code is strong: T1015 ranks #4 of 70 providers in‑state and is in the 96th percentile (described as notably above typical state volume for this code). For ancillary services, 87637 (multiplex SARS‑CoV‑2/influenza/RSV NAAT) ranks #2 of 9 providers (88th percentile) and 90460 ranks #2 of 44 providers (98th percentile, described as an extreme outlier), indicating the clinic is a leading state provider for both multiplex respiratory testing and pediatric vaccine administration.
Several high‑volume codes report $0 average paid per claim in the Medicaid file despite substantial claim counts—examples include 99391 (6.2K claims, $0 avg paid/claim), 90686 (5.2K claims, $0 avg paid/claim), and 99213 (24.3K claims, $0 avg paid/claim). This pattern suggests many preventive and routine E/M services are present in encounter data but did not produce separate Medicaid paid claims in this extract (possible explanations include bundled payments, encounter reporting practices, or payer reporting conventions), and should be investigated before interpreting utilization strictly as unreimbursed work.
Immunization activity is a notable operational characteristic: 90460 (19.8K claims, $6 avg paid/claim, $119K revenue) and 90461 (6.8K claims, $2 avg paid/claim, $13.5K revenue) are high‑volume relative to peers (90460 in the 98th percentile, 90461 in the 97th percentile and both described as extreme outliers or notably above typical), indicating a large pediatric vaccination program that contributes meaningful visit volume even if payment per dose is low.
Testing and lab services are present but secondary to clinic visits: 87637 produced $312.8K (2.3% of total Medicaid revenue) from 2.8K claims and ranks #2 of 9 providers in‑state, while other lab codes (87804, 87880, 87635) show modest volumes and revenues. Overall the lab/testing revenue profile is much smaller than the visit/bundle revenue, reinforcing that around‑the‑clock clinic encounters (T1015) are the primary revenue engine.
Given the heavy reliance on T1015 (95.8% of Medicaid revenue) and the statement that top 3 codes comprise 99.0% of Medicaid revenue, the provider has pronounced revenue concentration risk: changes in Medicaid payment policy for bundled clinic encounter codes or payer reporting practices could materially affect reported revenue. Analysts evaluating contracting or reimbursement negotiations should treat this provider as high‑exposure to visit/encounter payment rules rather than diversified fee‑for‑service lines.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
50 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 80,870 | $160 | $13M |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 2,790 | $110 | $312.8K |
| 90460 | In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age. | 19,830 | $10 | $119K |
| T1023 | Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter | 1,090 | $30 | $35.8K |
| 87804 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings. | 2,040 | $20 | $30.6K |
| 87880 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab. | 1,500 | $10 | $21K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 210 | $90 | $18.7K |
| 90461 | In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the… | 6,770 | $1 | $13.5K |
| 0072A | N/A | 160 | $40 | $6.5K |
| 90480 | The provider administers the first or only component of a SARS–CoV–2 (COVID–19) vaccine by intramuscular injection to reduce the patient's risk of contracting COVID–19. | 330 | $20 | $4.9K |
Showing 1–10 of 50
How this provider's Medicaid billing volume and revenue compare to other Vermont providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Vermont median
50 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 4 | 70 | 11,650 | $150 | $3.3M |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 2 | 10 | 160 | $120 | $149.2K |
| 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… | 24 | 320 | 680 | $30 | $146.1K |
| 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… | 634 | 670 | 760 | $70 | $143.9K |
| 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… | 14 | 320 | 760 | $20 | $88.2K |
| 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… | 19 | 170 | 360 | $20 | $35.9K |
| 90460 | In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age. | 2 | 40 | 890 | $10 | $32.1K |
| 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… | 1 | 40 | 170 | $40 | $31.6K |
| 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… | 14 | 40 | 130 | $40 | $25.3K |
| 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… | 3 | 40 | 280 | $20 | $19.5K |
Showing 1–10 of 50
Other providers in the same ZIP code as Community Health Centers Of The Rutland Region, Inc., ranked by combined Medicare and Medicaid revenue.
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