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NPI 1821341249 · Washington, DC · Federally Qualified Health Center (FQHC)
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Marys Center For Maternal And Child Care Inc is a federally qualified health center (fqhc) provider located in Washington, District of Columbia. This profile covers 0 Medicare and 122 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 | Marys Center For Maternal And Child Care Inc |
| Address | 3912 Georgia Ave. Nw |
| City | Washington |
| State | DC |
| ZIP | 20011 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | October 23, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $12.4M |
| Medicare | $0 |
This provider is effectively a Medicaid-focused FQHC: there is no Medicare billing on file and lifetime Medicaid revenue is $12.4M, indicating the organization operates almost entirely in the Medicaid market rather than as a dual-payer provider. Its NPI was enumerated on 2012-10-23 (~14 years ago), showing roughly 14 years of active enrollment during which this Medicaid-centric profile has been established.
Revenue is highly concentrated in a single encounter-type code: the top 3 Medicaid codes account for 90.9% of the provider's Medicaid revenue, with T1015 alone representing $10.4M or 84.5% of Medicaid revenue. This concentration means a very large share of earned Medicaid dollars flows through the all-inclusive clinic visit encounter rather than a wide mix of fee-for-service lines.
The code mix signals a bundled primary-care FQHC operating model combined with substantial dental services and case management: T1015 (clinic visit/encounter, all-inclusive) dominates the revenue base, while D0120 ($346.8K, 2.8%), D0274 ($220.1K, 1.8%), D1110 ($180.6K, 1.5%) and other dental codes appear throughout the top lines. T2022 (case management, per month) contributes $442K (3.6%), indicating an operational component around care coordination or social-services billing alongside clinical encounters.
State-level competitive standing is strong for the primary encounter and several dental services: T1015 ranks #3 of 97 providers in-state (98th percentile), and D0120 ranks #8 of 184 (96th percentile), with multiple dental codes at or above the 90th percentile. These ranks describe a provider that is a major statewide participant for bundled clinic encounters and a high-volume dental services provider relative to peers in DC.
There are multiple high-claim lines that report $0 average paid/claim, which is notable for operational and adjudication review: 99213 shows 51.3K claims at $0 paid (ranks #11 of 316, 97th percentile), 90471 shows 22.3K claims at $0 paid (ranks #2 of 72, 99th percentile, labeled an extreme outlier), and D0999 shows 16.7K claims at $0 paid (ranks #2 of 40, 97th percentile). These patterns suggest heavy encounter or service reporting where paid-dollar recognition is captured under other bundled codes (for example T1015) rather than as separate paid fee-for-service items.
The provider’s operational dependence on one dominant revenue stream creates potential policy and payment exposure: with 84.5% of Medicaid revenue coming from T1015 and the top 3 codes totaling 90.9%, changes to FQHC encounter reimbursement, encounter reporting rules, or eligibility for T1015-like bundles could materially affect total receipts. At the same time, the presence of robust dental preventive codes (D0120, D1208, D1110) indicates diversified service lines within the Medicaid program that may partially mitigate risk.
For payers and contracting teams, this profile identifies a prospective partner that functions largely as an FQHC encounter hub and a high-volume dental access point: negotiations or program design should account for the provider’s T1015-centric revenue model and significant dental throughput (multiple dental codes at 90th+ percentiles). Case management revenue (T2022 at $442K, 3.6%) further indicates potential value in care coordination arrangements or targeted payments for non-clinical supports.
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.
122 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 107,720 | $100 | $10.4M |
| T2022 | Case management, per month | 3,540 | $130 | $442K |
| D0120 | Periodic oral evaluation - established patient | 11,960 | $30 | $346.8K |
| D0274 | N/A | 6,470 | $30 | $220.1K |
| D1110 | Prophylaxis - adult; cleaning and polishing of the teeth | 3,010 | $60 | $180.6K |
| D1208 | Topical application of fluoride - excluding varnish | 7,530 | $20 | $173.2K |
| D1120 | Prophylaxis–child | 3,010 | $50 | $135.4K |
| D2392 | Post 2 surface resin‑based composite | 970 | $130 | $124.2K |
| D0230 | Intraoral - periapical each additional radiographic image | 5,710 | $10 | $57.1K |
| D0150 | Comprehensive oral evaluation – new or established patient | 1,180 | $50 | $53.2K |
Showing 1–10 of 122
How this provider's Medicaid billing volume and revenue compare to other District of Columbia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. District of Columbia median
122 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes | 54 | 60 | 82,090 | $90 | $13.9M |
| T1015 | Clinic visit/encounter, all-inclusive | 3 | 100 | 160 | $110 | $1.9M |
| 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… | 16 | 30 | 5,420 | $40 | $946K |
| T2022 | Case management, per month | 5 | 10 | 2,540 | $120 | $728.6K |
| T2023 | Targeted case management; per month | 7 | 10 | 1,230 | $180 | $599.4K |
| 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,… | 15 | 130 | 290 | $140 | $579.2K |
| 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… | 86 | 120 | 1,050 | $110 | $409.5K |
| 94640 | The provider administers oxygen under pressure or not under pressure to open obstructed air passages. He uses any of the listed devices to treat a patient with an acute obstruction of the airway that… | 15 | 20 | 80 | $210 | $398.8K |
| 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… | 4 | 30 | 350 | $110 | $345.1K |
| 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… | 53 | 310 | 750 | $70 | $321.6K |
Showing 1–10 of 122
Other providers in the same ZIP code as Marys Center For Maternal And Child Care Inc, ranked by combined Medicare and Medicaid revenue.
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