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.

Five-town Health Alliance, Inc (NPI 1871840843)

Field	Value
Entity Type	Organization
Organization	Five-town Health Alliance, Inc
Address	61 Pine St
City	Bristol
State	VT
ZIP	05443
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	August 9, 2012

Payer Source	Total Paid
Medicaid	$3.9M
Medicare	$0

Key Findings

FIVE-TOWN HEALTH ALLIANCE, INC reports no Medicare billing on file and $3.9M in lifetime Medicaid revenue, making its public claims footprint effectively single-payer Medicaid at present. The provider is registered as a Federally Qualified Health Center (FQHC) and its NPI was enumerated on 2012-08-09 (~14 years ago), indicating a long-standing operation in the Bristol, VT market.

Revenue is extremely concentrated: the precomputed top-3 Medicaid codes account for 99.4% of the provider's total Medicaid revenue, with a single code, T1015, representing $3.9M and 98.6% of Medicaid revenue. That concentration means the provider’s financial profile is driven overwhelmingly by one all-inclusive clinic encounter line item rather than a diversified CPT mix.

The code mix is consistent with core FQHC primary care operations: T1015 (Clinic visit/encounter, all-inclusive) dominates revenue, and the presence of G0467 alongside T1015 signals FQHC-style bundled encounter billing for face-to-face primary care services. A small but visible dental and preventive footprint appears in codes such as D7140 and D1110, indicating the center furnishes some oral health services in addition to medical primary care.

Despite the $3.9M revenue concentration in T1015, the provider’s volume position on that code is not dominant in-state: T1015 ranks #23 of 70 providers in-state (68th percentile; typical, unremarkable volume for this code). In other words, the high-dollar dependence on T1015 reflects payment structure more than an outsized share of visits compared with peers.

The provider does report higher-state standing on certain E/M codes in terms of rank: 99214 shows 12.4K claims and ranks #20 of 323 providers in-state (94th percentile; typical, unremarkable volume for this code), though that code represents only $24.9K (0.6% of total Medicaid revenue). This suggests FQHC billing is capturing many encounters under T1015 while some higher-complexity E/M activity is still reported separately at modest revenue impact.

Several frequently billed procedure and vaccine codes show substantial claim counts but $0 average paid/claim on file (examples include 80305 with 724 claims $0, 90686 with 430 claims $0, and 90834 with 104 claims $0). Given T1015’s all-inclusive nature and the provider’s FQHC taxonomy, these zero-paid entries are plausibly due to bundling, supplemental program payments, or separate reimbursement channels rather than large independent fee-for-service receipts.

Dental services generate only a small share of revenue: D7140 ($9.8K, 133 claims) and D1110 ($5.7K, 163 claims) together make up a fractional portion of total Medicaid revenue and rank modestly in-state (D7140 #36 of 45, 20th percentile; D1110 #116 of 150, 23rd percentile; both described as typical, unremarkable volume for these codes). These figures point to a modest dental offering relative to dedicated dental providers rather than a major dental clinic role.

The strong dependence on a single all-inclusive Medicaid code creates sensitivity to how FQHC encounter reimbursement is handled by payers and by state policy; because T1015 drives 98.6% of Medicaid revenue and the top three codes total 99.4% of Medicaid revenue, changes to encounter bundling or Medicaid payment methodology would materially affect reported Medicaid receipts. For payer or network analysts, this profile flags an entity to evaluate on encounter-level contract terms and FQHC-specific reimbursement arrangements rather than a diversified fee-for-service CPT portfolio.

Medicaid: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	22,160	$180	$3.9M
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…	12,440	$1	$24.9K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	130	$70	$9.8K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	160	$40	$5.7K
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…	260	$20	$4.3K
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…	4,140	$1	$4.1K
D0140	Limited oral evaluation – problem focused	70	$30	$2.4K
D0120	Periodic oral evaluation - established patient	130	$20	$2.3K
D0220	Intraoral - periapical first radiographic image	70	$10	$910
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	180	$10	$880

Showing 1–10 of 23

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

Five-town Health Alliance, Inc — 0 of 13 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

23 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	23	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…	20	320	680	$30	$146.1K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	36	50	400	$80	$101.1K
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…	70	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…	37	50	1,020	$20	$87.6K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	116	150	540	$50	$73.5K
D0120	Periodic oral evaluation - established patient	122	160	720	$30	$57.8K
D0140	Limited oral evaluation – problem focused	56	70	560	$40	$53.3K
99204	The provider sees a new 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 provider…	29	50	50	$80	$50K
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…	104	110	170	$70	$38.6K

Showing 1–10 of 23

Related Providers

Other providers that share a Tax Identification Number (TIN) with Five-town Health Alliance, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Five-town Health Alliance, Inc	VT	Dentist	$0	$229.9K
Jessica Lindert	VT	Psychiatric/Mental Health Nurse Practitioner	$64K	$0
Laura Weylman	VT	Family Medicine Physician	$31.2K	$0
Shauna Mckeon	VT	Adult Health Nurse Practitioner	$23K	$0
Kate Lamancuso	VT	Family Medicine Physician	$1.1K	$0

Nearby Providers

Other providers in the same ZIP code as Five-town Health Alliance, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bristol Park Dental Associates Plc	VT	General Practice Dentistry	$0	$968.2K
Bristol Rescue Squad, Inc.	VT	Land Ambulance	$165.6K	$241.8K
Ellen Repstad	VT	Clinical Social Worker	$0	$96.1K
Terri Thomsen	VT	Addiction (Substance Use Disorder) Counselor	$0	$93.7K
Carolyn Dundon	VT	Psychologist	$0	$67.1K
Body And Mind Physical Therapy, Plc	VT	Physical Therapist	$0	$65.6K
Chad Volk	VT	Physical Medicine & Rehabilitation Physician	$36.1K	$0

Five-town Health Alliance, Inc — Billing Profile & Reimbursement Data

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Five-town Health Alliance, 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