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

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

Star Community Health, Inc (NPI 1942832720)

Field	Value
Entity Type	Organization
Organization	Star Community Health, Inc
Address	511 E 3rd St Ste 202
City	Bethlehem
State	PA
ZIP	18015
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	February 10, 2020

Payer Source	Total Paid
Medicaid	$45.6M
Medicare	$0

Key Findings

STAR COMMUNITY HEALTH, INC is effectively a Medicaid-focused FQHC: it has $45.6M in Medicaid revenue on file and no Medicare revenue reported, so the organization operates as a near–single-payer Medicaid provider rather than a mixed Medicare/Medicaid practice. The absence of any Medicare billing on file indicates either limited Medicare patient volume or no Medicare-billed services during the reporting period.

Revenue is highly concentrated in the FQHC all-inclusive encounter code T1015, which generates $45.3M and represents 99.3% of this provider’s total Medicaid revenue; the precomputed top-3 Medicaid codes together account for 99.9% of Medicaid revenue. This concentration signals that the encounter-based payment model is the dominant revenue driver rather than fee-for-service billing across many distinct high-dollar CPTs.

Operational/service-line implications: the dominance of T1015 (Clinic visit/encounter, all-inclusive) combined with very large counts of preventive and vaccine procedure lines (for example 90471: 30.2K claims, 90472: 14.2K claims, 99392: 10.7K claims, 99173: 20.7K claims) is consistent with a high-volume primary care and pediatric preventive services model typical of FQHCs, where many discrete services are bundled into an all-inclusive encounter payment. The code mix suggests routine well-child visits, immunizations, screenings, and brief behavioral assessments are central operational activities.

Competitive standing on Medicaid: STAR ranks as a statewide outlier on its top codes — T1015 ranks #3 of 1691 providers in-state (100th percentile; extreme outlier), 99499 ranks #2 of 245 providers in-state (100th percentile; extreme outlier), and 99213 ranks #9 of 8867 providers in-state (100th percentile; extreme outlier). These ranks indicate STAR is a major, high-volume participant in Pennsylvania for encounter-based and common outpatient evaluation services, substantially above typical state volumes.

Secondary codes contribute negligible revenue despite high claim volumes: 99499 produced $180.6K (0.4% of total Medicaid revenue) across 12K claims and 99213 produced $86K (0.2% of total Medicaid revenue) across 86K claims. This pattern — large claim counts but low per-claim payments — reinforces that the FQHC’s financial model is driven by bundled encounter reimbursement rather than itemized fee-for-service payments for these CPTs.

Service delivery implication from zero-paid CPT lines: multiple high-volume preventive and vaccine CPTs report $0 avg paid/claim and $0 revenue (for example 90686: 15.9K claims, 99393: 9.5K claims, 90471: 30.2K claims). In context of an FQHC taxonomy and the dominance of T1015, these $0 paid lines are plausibly included within the all-inclusive encounter rate rather than paid separately, which affects how payers should interpret claim-volume signals versus revenue impact.

Tenure and operational maturity: the NPI was enumerated on 2020-02-10 (~6 years ago), indicating the organization has been actively enrolled and billing Medicaid as an FQHC for a multi-year period. Given the large Medicaid revenue ($45.6M) and the extreme statewide ranks, STAR appears to have rapidly scaled Medicaid-facing primary care operations since enumeration.

Risk/analysis note for payer contracting and network planning: given STAR’s extreme concentration in T1015 (99.3% of Medicaid revenue) and its status as an outlier in statewide volume for several encounter and preventive-service codes, payers and analysts should treat STAR as a major Medicaid primary-care access point in Bethlehem, PA. Contracting approaches and encounter-rate negotiations should account for the bundled reimbursement structure and the high volumes of pediatric/preventive services that are reflected in claims counts but not in separate fee-for-service revenue lines.

Medicaid: Complete Services Breakdown

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

129 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	229,970	$200	$45.3M
99499	Use 99499 to report evaluation and management services for which there is no specific code available.	12,040	$20	$180.6K
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…	86,000	$1	$86K
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…	30,420	$1	$30.4K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	5,960	$1	$6K
3078F	No Summary found for this code	1,290	$1	$2.6K
3074F	No Summary found for this code	1,820	$1	$1.8K
3077F	No Summary found for this code	710	$1	$1.4K
3079F	No Summary found for this code	1,410	$1	$1.4K
3080F	No Summary found for this code	350	$1	$700

Showing 1–10 of 129

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Star Community Health, Inc — 6 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

129 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	3	1,690	760	$170	$1.2M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	485	980	310	$50	$136.6K
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…	11	820	230	$80	$71.7K
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…	28	8,160	210	$60	$68.4K
99391	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…	13	660	180	$70	$63.7K
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…	9	8,870	240	$40	$56.1K
99244	The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a moderate level of medical decision making or the provider…	274	310	70	$160	$53.9K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	89	710	230	$70	$49.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	8	870	160	$70	$48.2K
D1351	Sealant - per tooth	89	600	480	$30	$46.6K

Showing 1–10 of 129

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Joseph Zaladonis	PA	Specialist	$1.4M	$0
Ryan Johnson	NJ	MOHS-Micrographic Surgery Physician	$284.1K	$0
Sara Choudhry	PA	Endocrinology, Diabetes & Metabolism Physician	$260.9K	$0
Adam Teichman	PA	Foot & Ankle Surgery Podiatrist	$250.4K	$0
Brian Murphy	PA	Urology Physician	$249.2K	$0
Diane Schmidt	PA	Endocrinology, Diabetes & Metabolism Physician	$240K	$0
Daniel Verges	PA	Urology Physician	$183.8K	$0
Zachariah Goldsmith	PA	Urology Physician	$180.6K	$0
Jarrod Rosenthal	PA	Urology Physician	$159.3K	$0
Ahmad Abualsoud	PA	Otolaryngology Physician	$153.1K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St. Luke's Physician Group, Inc.	PA	Emergency Medicine Physician	$0	$28.8M
St Lukes Hospital	PA	General Acute Care Hospital	$0	$20.8M
White Deer Run, LLC	PA	Community/Behavioral Health Agency	$0	$9.4M
Kidspeace Children's Hospital, Inc.	PA	Adolescent and Children Mental Health Clinic/Center	$0	$8.9M
Life Guidance, LLC	PA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$5.7M
Roman Pravak	PA	Ophthalmology Physician	$680.5K	$0
Bassam Al-mamoori	PA	Diagnostic Radiology Physician	$566.6K	$0
Patrick Brogle	PA	Orthopaedic Surgery Physician	$469.1K	$0
Karen Dacey	PA	Ophthalmology Physician	$321.2K	$0
Manuel Jimenez-serrano	PA	Pulmonary Disease Physician	$258K	$0

Star Community Health, 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