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

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

The Lakes Community Health Center, Inc (NPI 1811178825)

Key Findings

Field	Value
Entity Type	Organization
Organization	The Lakes Community Health Center, Inc
Address	7665 Us Hwy 2
City	Iron River
State	WI
ZIP	54847
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	November 19, 2007

Payer Source	Total Paid
Medicaid	$44.5M
Medicare	$0

This provider is effectively a single‑payer Medicaid organization: reported Total Medicaid revenue is $44.5M and there is no Medicare billing on file. The absence of any Medicare revenue files means analyses of cross‑payer mix or Medicare-driven service lines are not applicable here and Medicaid policy and reimbursement changes will disproportionately affect the provider's financials.

Revenue is extremely concentrated in a small set of Medicaid codes: the precomputed top 3 Medicaid codes by revenue account for 96.2% of this provider's total Medicaid revenue. T1015 alone represents $41.4M (171.1K claims, $242 avg paid/claim) and is 93.2% of the provider's Medicaid revenue, with 90834 ($912.2K; 36.5K claims, $25 avg paid/claim) and 99214 ($388.4K; 18.5K claims, $21 avg paid/claim) making up the remainder of that top‑three share.

The code mix and taxonomy identify a classic FQHC operating model: T1015 (clinic visit/encounter, all‑inclusive) dominance plus the provider's listed taxonomy as a Federally Qualified Health Center indicate bundled, per‑encounter primary care delivery. Strong volumes on G0467 (12.3K claims, $296.4K revenue; ranks #1 of 35 providers in‑state, 100th percentile) and G0470 (4.6K claims, $124.1K revenue; ranks #1 of 15 providers in‑state, 100th percentile) further reinforce that the organization bills FQHC‑style encounter bundles and integrates medical and mental‑health FQHC visit types.

Behavioral health is a material secondary service line: psychotherapy code 90834 has 36.5K claims generating $912.2K (2.1% of Medicaid revenue) and ranks #9 of 789 in‑state (99th percentile; extreme outlier), and 90832/90837 and G0470 volumes add to that picture. The combined psychotherapy and FQHC mental‑health encounter codes suggest on‑site or co‑located behavioral‑health capacity and high per‑patient mental‑health encounter frequency compared with peers.

The provider shows unusually large dental and pediatric preventive throughput for an FQHC: D1206 (78.5K claims, $78.5K revenue) ranks #3 of 543 in‑state (100th percentile; extreme outlier) and D1120/D1110/D1351 and D0120 each appear at high state percentiles. These dental code volumes imply a significant school‑age/pediatric preventive dentistry program or high-volume dental clinic operating alongside medical and behavioral services.

Rehab and ancillary services are present at nontrivial volumes: 97530 (9.7K claims, $233.8K revenue), 97112 (3K claims, $47.7K revenue), and 92507 (4.9K claims, $83.9K revenue) indicate physical/occupational therapy and speech‑language services embedded in the site’s offerings. The mix of these therapy and lab/telehealth codes (e.g., G2025: 1.2K claims, $13.4K revenue; ranks #3 of 60, 97th percentile) suggests a multi‑disciplinary service footprint beyond basic primary care.

State competitive standing is dominant for several FQHC and dental codes: T1015 ranks #3 of 60 providers in‑state (97th percentile; extreme outlier), G0467 ranks #1 of 35 (100th percentile; extreme outlier), and D1206 ranks #3 of 543 (100th percentile; extreme outlier). For behavioral‑health psychotherapy 90834 the provider is also an outlier (rank #9 of 789, 99th percentile), indicating this entity is a major statewide player for bundled FQHC encounters and certain ancillary lines rather than a modest participant.

The provider has an established operating history (NPI enumerated 2007-11-19 (~19 years ago)), and that tenure plus heavy reliance on a single Medicaid revenue stream (T1015 dominated) highlights both operational stability and concentration risk. Analysts should account for the possibility that Medicaid payment policy changes to FQHC encounter payments or behavioral‑health reimbursement could have outsized impact on the provider's overall revenue given the reported concentration.

Medicaid: Complete Services Breakdown

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

78 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	171,060	$240	$41.4M
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…	36,490	$30	$912.2K
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…	18,490	$20	$388.4K
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…	23,710	$20	$355.6K
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…	12,350	$20	$296.4K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	9,740	$20	$233.8K
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…	4,600	$30	$124.1K
H0022	Alcohol and/or drug intervention service (planned facilitation)	8,340	$10	$91.8K
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…	4,300	$20	$85.9K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	4,940	$20	$83.9K

Showing 1–10 of 78

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

The Lakes Community Health Center, Inc — 12 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

78 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	3	60	4,880	$230	$4.9M
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…	70	1,630	270	$40	$205.3K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…	119	120	490	$100	$179.5K
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…	63	1,760	250	$40	$173.2K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	203	500	3,140	$20	$148.9K
H0022	Alcohol and/or drug intervention service (planned facilitation)	19	190	400	$30	$140.3K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	31	260	690	$40	$133.8K
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…	336	900	410	$70	$130.4K
D2392	Post 2 surface resin‑based composite	29	270	510	$60	$123.3K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	31	220	430	$50	$111.4K

Showing 1–10 of 78

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Lakes Community Health Center, Inc	WI	Federally Qualified Health Center (FQHC)	$0	$1.5M
Rena Christman	WI	Dentist	$0	$1.2M
Kennan Archer	IA	Physical Therapist	$44K	$0
Jason Klobucher	WI	Physical Therapist	$34.1K	$0

The Lakes Community Health Center, Inc — Billing Profile & Reimbursement Data

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The Lakes 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

Frequently Asked Questions

References