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

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

River Hills Community Health Center Inc. (NPI 1912952367)

Field	Value
Entity Type	Organization
Organization	River Hills Community Health Center Inc.
Address	201 S Market St
City	Ottumwa
State	IA
ZIP	52501
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	May 24, 2006

Payer Source	Total Paid
Medicaid	$77.5M
Medicare	$0

Key Findings

RIVER HILLS COMMUNITY HEALTH CENTER INC. is effectively a Medicaid-focused FQHC: there is no Medicare billing on file while total Medicaid revenue is $77.5M, indicating the organization's patient mix and reimbursement base are overwhelmingly driven by Medicaid rather than Medicare. Its NPI was enumerated on 2006-05-24 (~20 years ago), showing it has been established and operating long enough to build substantial Medicaid volume.

Revenue concentration is extremely high: the top three Medicaid codes (T1015, D9999, D0999) together account for 98.9% of the provider’s total Medicaid revenue, signaling that a very small set of service codes drives nearly all of the $77.5M in Medicaid receipts. This level of concentration implies that changes to reimbursement, policy, or utilization for these specific codes would disproportionately impact the center’s overall revenue.

T1015 (Clinic visit/encounter, all-inclusive) is the dominant revenue driver with $52.5M (67.8% of total Medicaid revenue) and 225.3K claims; the provider ranks #3 of 327 in-state and is characterized as a 99th percentile extreme outlier. This suggests the organization functions as a high-volume primary care clinic or encounter-based clinic where bundled clinic visit payments form the core of its clinical and financial operations.

D9999 and D0999 together comprise $24.1M (20.9% and 10.2% of Medicaid revenue respectively) with very large claim counts (69.1K and 30.9K) and top statewide ranks (D9999 ranks #1 of 41, D0999 ranks #2 of 31). Both codes are labeled as extreme or notably above typical state volume, indicating the center provides high volumes of services classified under these unspecified dental/ancillary codes and relies heavily on them as secondary revenue streams.

Across the broader procedure mix, several dental and behavioral health codes appear frequently at high in-state percentiles (e.g., D0120, D1120, D1206, D2392, D0150 and multiple psychotherapy codes like 90834/90837 and 90791). These patterns suggest a multi-service FQHC model that includes substantive dental and mental-health service lines in addition to general clinic visits, though none of these individual codes approach the revenue scale of T1015.

Competitive standing in-state is strong for multiple codes: the clinic ranks at or near the top percentile for many Medicaid codes (several 99–100th percentile ranks and multiple #1–#4 positions). That combination of rank and volume identifies RIVER HILLS as a leading Medicaid provider in its region for both bundled clinic visits and numerous dental and behavioral health services. This dominance increases market importance but also concentrates risk around Medicaid policy or payer changes affecting those high-volume codes.

Operational implications: because G0467 and G0470 (FQHC visit codes for established/general and mental-health encounters) appear but contribute negligible revenue relative to T1015 (G0467: $111.4K; G0470: $57.9K), the center appears to bill more heavily under state Medicaid clinic encounter codes than those FQHC-specific Medicare-equivalent visit codes. That suggests the provider’s billing strategy and service delivery are tailored to Medicaid program rules and reimbursement mechanisms rather than Medicare FQHC billing constructs.

Medicaid: Complete Services Breakdown

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

125 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	225,260	$230	$52.5M
D9999	N/A	69,130	$230	$16.2M
D0999	N/A	30,920	$260	$7.9M
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…	6,550	$20	$111.4K
D0120	Periodic oral evaluation - established patient	26,200	$1	$78.6K
D1120	Prophylaxis–child	16,280	$1	$65.1K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	31,820	$1	$63.6K
D2392	Post 2 surface resin‑based composite	10,400	$10	$62.4K
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…	3,410	$20	$57.9K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	18,400	$1	$55.2K

Showing 1–10 of 125

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

River Hills Community Health Center Inc. — 20 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

125 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	3	330	3,960	$170	$2.8M
D9999	N/A	1	40	6,850	$180	$2.7M
D0999	N/A	2	30	6,470	$210	$1.8M
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…	30	680	670	$70	$343.5K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	94	120	980	$50	$230.3K
D2930	N/A	60	80	850	$110	$217.2K
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…	36	40	310	$100	$162.7K
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…	14	1,060	480	$40	$154.5K
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…	15	1,310	760	$20	$153.1K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	9	140	210	$120	$152.1K

Showing 1–10 of 125

Nearby Providers

Other providers in the same ZIP code as River Hills Community Health Center Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
American Baptist Homes Of The Midwest	IA	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$22.7M
Southern Iowa Mental Health Center	IA	Mental Health Clinic/Center (Including Community Mental Health Center)	$650	$17.5M
Tenco, Industries, Inc.	IA	Community/Behavioral Health Agency	$0	$13.5M
Rchp Ottumwa LLC	IA	General Acute Care Hospital	$0	$9.6M
Ottumwa Community School District	IA	Local Education Agency (LEA)	$0	$8.5M
Pella Regional Health Center	IA	Rural Health Clinic/Center	$0	$5.3M
Milestones Area Agency On Aging	IA	Home Delivered Meals	$0	$3.2M
Southern Iowa Economic Development Assoc	IA	Addiction (Substance Use Disorder) Counselor	$0	$2.6M
Mercy Medical Center-centerville	IA	Multi-Specialty Clinic/Center	$0	$2.6M
Emergency Services Of Iowa LLC	IA	Emergency Medicine Physician	$0	$2.5M

River Hills Community Health Center Inc. — Billing Profile & Reimbursement Data

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River Hills 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

Nearby Providers

Frequently Asked Questions

References