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

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

Northern Counties Health Care, Inc. (NPI 1851418230)

Field	Value
Entity Type	Organization
Organization	Northern Counties Health Care, Inc.
Address	185 Sherman Drive
City	St Johnsbury
State	VT
ZIP	05819
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	March 23, 2007

Payer Source	Total Paid
Medicaid	$3.4M
Medicare	$0

Key Findings

NORTHERN COUNTIES HEALTH CARE, INC. shows no Medicare billing on file and reports $3.4M in lifetime Medicaid revenue, making it effectively a Medicaid‑dependent billing entity rather than a dual‑payer operation. Its NPI was enumerated on 2007-03-23 (~19 years ago), indicating a long‑standing FQHC presence in the ST JOHNSBURY, VT market.

Revenue is extremely concentrated: the precomputed top 3 Medicaid codes account for 99.8% of this provider's total Medicaid revenue, with T1015 alone accounting for the vast majority. T1015 appears as 20.7K claims, $162 avg paid/claim, $3.4M revenue (98.1% of this provider's total Medicaid revenue), while the next two codes are much smaller contributors (G0467: 2K claims, $27 avg paid/claim, $52.8K revenue (1.5%); 80305: 457 claims, $12 avg paid/claim, $5.5K revenue (0.2%)).

The code mix and top revenue drivers point to a classic FQHC ambulatory model: T1015 (clinic visit/encounter, all-inclusive) and G0467 (FQHC visit, established patient) are visit‑level, bundled encounter codes, suggesting most reimbursement is captured as per‑encounter bundled payments rather than fee‑for‑service E/M fees. The presence of these FQHC encounter codes aligns with the provider taxonomy (FQHC) and implies the organization’s operations are centered on high-volume primary care and bundled clinic encounters.

Operational billing behavior is reinforced by the high counts of common E/M codes with $0 avg paid (for example, 99213: 9.6K claims, $0 avg paid/claim and 99214: 7.5K claims, $0 avg paid/claim). This pattern is consistent with encounter‑level payment rules for FQHCs where standard E/M CPTs are often recorded but not separately reimbursed by Medicaid, indicating documentation of E/M activity while revenue is concentrated in encounter codes like T1015 and G0467.

State competitive standing for the top codes is modest: T1015 ranks #25 of 70 providers in-state (65th percentile; typical, unremarkable volume for this code), G0467 ranks #19 of 49 providers in-state (63th percentile; typical, unremarkable volume for this code), and 80305 ranks #19 of 29 providers in-state (36th percentile; typical, unremarkable volume for this code). These rank/percentile positions describe a steady, locally significant FQHC rather than a dominant statewide player for these service lines.

Ancillary services and preventive items (vaccines, point‑of‑care labs, blood draws) appear on the roster but contribute trivial revenue relative to visits: examples include 36415: 1.3K claims, $3 avg paid/claim, $3.9K revenue (0.1%) and various vaccine codes (90688, 91320, 90480) each contributing under $1K. This suggests that while the clinic delivers routine immunizations and basic lab work, these lines are operational complements to the visit‑based business model rather than primary revenue drivers.

The combination of long tenure (~19 years), the FQHC taxonomy, and extreme revenue concentration in bundled visit codes creates a stable, mission‑oriented profile: the provider fills an ambulatory primary‑care role in its community with predictable Medicaid revenue exposure. That same concentration also means reimbursement risk is concentrated in Medicaid policy and rates for FQHC encounter codes, since there is no Medicare revenue to diversify payer risk.

Medicaid: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	20,740	$160	$3.4M
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…	1,960	$30	$52.8K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	460	$10	$5.5K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	1,280	$1	$3.9K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	980	$1	$2.9K
90688	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose.	40	$20	$680
91320	This code represents a SARS–CoV–2 vaccine product (tris–sucrose formulation) administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage is 30 mcg/0.3 mL.	20	$30	$400
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.	70	$1	$270
0064A	N/A	10	$1	$40
90656	This code represents a preservative–free trivalent influenza vaccine product containing split virus components. It is administered into the muscle in a 0.5 mL dosage.	20	$1	$40

Showing 1–10 of 19

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Northern Counties Health Care, Inc. — 0 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

19 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	25	70	11,650	$150	$3.3M
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…	41	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…	577	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…	43	320	760	$20	$88.2K
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…	19	50	1,020	$20	$87.6K
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…	107	110	170	$70	$38.6K
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…	72	170	360	$20	$35.9K
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…	61	110	260	$20	$19.5K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	19	30	720	$10	$14.5K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	29	90	330	$10	$10K

Showing 1–10 of 19

Related Providers

Other providers that share a Tax Identification Number (TIN) with Northern Counties Health Care, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northern Counties Health Care, Inc.	VT	Dental Clinic/Center	$0	$4.5M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$4.4M
Northeastern Vermont Regional Hospital, Inc	VT	Primary Care Clinic/Center	$0	$2.8M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$2.5M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$2.1M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$1.8M
Northeastern Vermont Regional Hospital, Inc	VT	Rural Health Clinic/Center	$0	$1.3M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$1.3M
Northern Counties Health Care, Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$1.2M
Northeastern Vermont Regional Hospital Inc.	VT	Primary Care Clinic/Center	$0	$821.4K

Nearby Providers

Other providers in the same ZIP code as Northern Counties Health Care, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Darren Boles Dds PLLC	VT	Dental Clinic/Center	$0	$5.2M
Baart Behavioral Health Services, Inc.	VT	Substance Use Disorder Rehabilitation Clinic/Center	$559K	$3.5M
Caledonia-essex Area Ambulance Service, Inc.	VT	Land Ambulance	$406.4K	$1.6M
Jason Parks	VT	Radiation Oncology Physician	$1.2M	$0
Shippee Family Eye Care PC	VT	Optometrist	$0	$1M
St Johnsbury Psychology Associates, PLLC	VT	Clinical Psychologist	$0	$807.7K
Vermont Radiologists	VT	Diagnostic Radiology Physician	$0	$795.5K
Northeastern Vermont Regional Hospital Inc	VT	Rural Health Clinic/Center	$0	$703.3K
Cairn Counseling Center Plc	VT	Mental Health Counselor	$0	$510.7K
Northeastern Vermont Regional Hospital, Inc.	VT	Critical Access Hospital	$0	$442K

Northern Counties Health Care, Inc. — Billing Profile & Reimbursement Data

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Northern Counties Health Care, 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