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NPI 1952335630 · Kailua-kona, HI · Federally Qualified Health Center (FQHC)
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West Hawaii Community Health Center, Inc. is a federally qualified health center (fqhc) provider located in Kailua-kona, Hawaii. 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 | West Hawaii Community Health Center, Inc. |
| Address | 75-5751 Kuakini Hwy |
| City | Kailua-kona |
| State | HI |
| ZIP | 96740 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | July 10, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $46.8M |
| Medicare | $0 |
This provider is effectively single‑payer in scope: there is no Medicare billing on file while Medicaid revenue totals $46.8M, indicating the organization’s reimbursement and patient mix are overwhelmingly driven by Medicaid rather than Medicare. Analysts should treat Medicaid as the primary revenue source when evaluating operational and contracting strategies for this entity.
Revenue is highly concentrated in a very small set of procedures: the precomputed top‑3 Medicaid codes account for 74.2% of the provider’s total Medicaid revenue, with 99213 generating $15M (32.2%), D9999 $12.3M (26.4%), and 99214 $7.3M (15.6%). This concentration means shifts in utilization, reimbursement, or audit focus on these codes would materially impact overall revenue.
The code mix and volumes point to an FQHC operating as a high‑volume primary care hub: large counts and revenue for 99213 and 99214 combined with FQHC‑specific codes such as G0467 and G0470 indicate day‑to‑day delivery of outpatient evaluation and management bundled under the FQHC model. The presence of chronic care/general care management G0511 and telehealth payment G2025 further supports a clinic model oriented to ongoing primary and behavioral health management.
Competitive standing within the state is dominant for core E/M activity: 99213 ranks #5 of 707 providers in‑state (99th percentile; extreme outlier) and 99214 ranks #7 of 690 (99th percentile; extreme outlier), signaling unusually high volume of established‑patient office visits compared to peers and positioning the center as a major primary care access point on a statewide basis.
D9999 is a large, concentrated revenue driver but lacks a public description; it contributes $12.3M (26.4%) and ranks #1 of 20 providers in‑state (100th percentile; extreme outlier). Because D9999 is an unspecified/placeholder code, its outsized share and top state rank warrant attention from analysts seeking to understand what services or bundled charges are being reported under that code.
Dental and preventive services are a meaningful secondary service line: D0140 accounts for $4.1M (8.8%) and ranks #1 of 119 providers in‑state (100th percentile; extreme outlier), while pediatric preventive codes 99393, 99392, 99391 and immunization codes such as 90677 and 90670 appear across the top‑25 list at typical volumes. This pattern indicates the FQHC delivers integrated oral health and well‑child/preventive care alongside primary medical services.
Behavioral health and virtual care are represented but not dominant: psychotherapy codes 90832 ($3M, 6.3%, rank #3 of 74; 97th percentile; typical, unremarkable volume) and 90834 ($1.2M, 2.6%, rank #4 of 81; 96th percentile; notably above typical) show a substantive behavioral health footprint, and telehealth/virtual codes G2025 and G0071 appear in the mix—G0071 is reported as #1 of 1 providers in‑state (no peer comparison available), suggesting the clinic offers remote communication services consistent with FQHC virtual care capabilities.
The provider has longstanding presence in the market with an NPI enumerated on 2006-07-10 (~20 years ago), reinforcing its role as an established FQHC. Combined with the heavy Medicaid dependence and the extreme outlier rankings on several high‑revenue codes, the organization functions as a major safety‑net provider in Hawaii and should be prioritized in payer network and population‑health engagement discussions.
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 |
|---|---|---|---|---|
| 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… | 74,050 | $200 | $15M |
| D9999 | N/A | 35,600 | $350 | $12.3M |
| 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… | 36,130 | $200 | $7.3M |
| D0140 | Limited oral evaluation – problem focused | 11,340 | $360 | $4.1M |
| 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… | 16,040 | $180 | $3M |
| 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… | 5,890 | $210 | $1.2M |
| 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,… | 4,490 | $190 | $831.2K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 2,170 | $240 | $519.1K |
| 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… | 1,920 | $220 | $425.1K |
| 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… | 1,780 | $210 | $376.7K |
Showing 1–10 of 122
How this provider's Medicaid billing volume and revenue compare to other Hawaii providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Hawaii median
122 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| D9999 | N/A | 1 | 20 | 2,200 | $280 | $1.6M |
| 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… | 3 | 70 | 370 | $150 | $457.3K |
| 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… | 5 | 710 | 650 | $90 | $274.1K |
| 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… | 4 | 30 | 1,850 | $60 | $248.9K |
| 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… | 7 | 690 | 650 | $90 | $235.4K |
| 98967 | A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes… | 6 | 10 | 60 | $260 | $199.8K |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only | 5 | 20 | 310 | $130 | $184K |
| 98968 | A nonphysician qualified healthcare professional discusses, via telephone, a health issue and possible treatment or management with an established patient, parent, or guardian. This service includes… | 8 | 10 | 490 | $190 | $172.3K |
| D0140 | Limited oral evaluation – problem focused | 1 | 120 | 400 | $140 | $150.2K |
| 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,… | 10 | 190 | 190 | $100 | $122.8K |
Showing 1–10 of 122
Other providers in the same ZIP code as West Hawaii Community Health Center, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| S&g Labs Hawaii LLC | HI | Clinical Medical Laboratory | $292.7K | $15.1M |
| Full Life | HI | Developmentally Disabled Services Day Training Agency | $0 | $11M |
| Liberty Dialysis - Hawaii LLC | HI | End-Stage Renal Disease (ESRD) Treatment Clinic/Center | $0 | $9M |
| Mf Med Inc | HI | Pain Medicine (Anesthesiology) Physician | $0 | $4.3M |
| Transformation Health Network | HI | Urgent Care Clinic/Center | $0 | $1.7M |
| Access Capabilities, Inc | HI | Community/Behavioral Health Agency | $0 | $1.3M |
| Alii Health Center | HI | Multi-Specialty Clinic/Center | $0 | $799.9K |
| Edwin Herd | HI | Pediatrics Physician | $0 | $640.5K |
| David Kwon Jr Dds | HI | Dentist | $0 | $611.1K |
| Hawaii Life Flight, LLC | HI | Air Ambulance | $507.4K | $54.4K |
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