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

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

Rural Health, Inc. (NPI 1982666384)

Field	Value
Entity Type	Organization
Organization	Rural Health, Inc.
Address	513 N Main St
City	Anna
State	IL
ZIP	62906
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	April 3, 2006

Payer Source	Total Paid
Medicaid	$25.1M
Medicare	$0

Key Findings

This provider is effectively single-payer in the Medicare/Medicaid mix: there is no Medicare billing on file while total Medicaid revenue is $25.1M, indicating Medicaid is the sole recorded source of claims-based revenue in the dataset. The absence of Medicare activity suggests the organization operates primarily within Medicaid payment streams and state programs.

Revenue is highly concentrated in a very small set of encounter codes: the precomputed top-3 Medicaid codes account for 99.4% of the provider's Medicaid revenue, driven by T1015 ($21M, 83.5%), D0999 ($3.9M, 15.6%), and T1040 ($85.9K, 0.3%). This concentration indicates that a single encounter/clinic-rate code (T1015) is the dominant revenue driver, with a smaller but material contribution from D0999.

The code mix and volumes are consistent with an FQHC operating model: heavy use of T1015 (Clinic visit/encounter, all-inclusive) as the primary payment vehicle implies bundled encounter payments for primary care and related services, while the presence of T1040 (behavioral health per diem) and a broad set of dental codes indicates integrated behavioral health and dental service lines alongside primary care. In short, the center functions as a comprehensive community health clinic where encounter-based reimbursement captures the bulk of service revenue.

On competitive standing, the provider is a major in-state participant for its headline Medicaid codes: T1015 ranks #26 of 846 providers in-state (97th percentile; notably above typical state volume), and D0999 ranks #7 of 219 providers in-state (97th percentile; extreme outlier). These rank/percentile placements show the clinic is among the higher-volume providers statewide for its primary encounter billing and for the uncoded D0999 activity.

Dental services emerge as a distinct operational footprint beyond primary encounters: several dental CPT/HCPCS codes are unusually high in state ranking, including D7140 (rank #11 of 980, 99th percentile; extreme outlier), D2391 (rank #18 of 1129, 98th percentile; extreme outlier), and multiple prophylaxis and evaluation codes with ranks in the high percentiles. This pattern signals substantial dental throughput relative to peers and supports the view of an integrated dental platform within the FQHC.

Claim-level reporting patterns point to an encounter-centric reimbursement model rather than fee-for-service revenue for many visits: 99213 appears with 99.3K claims and $0 avg paid/claim ($0 revenue) and ranks #21 of 14191 providers in-state (100th percentile; extreme outlier). The combination of very high claim counts for 99213 with zero paid amounts is consistent with administrative submission of E&M visit codes alongside, or in place of, an encounter-rate payment such as T1015, and should be interpreted as a reporting characteristic of how services are billed and paid at this FQHC.

The provider has an established presence in its community: the NPI was enumerated 2006-04-03 (~20 years ago), indicating long tenure that supports operational continuity and likely mature billing workflows. That historical footprint aligns with the high aggregate Medicaid volume and the breadth of codes reported.

From a financial risk perspective, the business is highly dependent on encounter-rate reimbursement: with T1015 representing $21M (83.5%) of $25.1M in Medicaid revenue and the top three codes comprising 99.4% of revenue, changes to state Medicaid policies, encounter-rate calculations, or the treatment of D0999 could materially affect total revenue. Monitoring state policy on FQHC encounter payments and the treatment of uncoded dental/ancillary claims would be prudent for payers and analysts evaluating this provider.

Medicaid: Complete Services Breakdown

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

88 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	170,370	$120	$21M
D0999	N/A	36,550	$110	$3.9M
T1040	Medicaid certified community behavioral health clinic services, per diem	1,300	$70	$85.9K
D1120	Prophylaxis–child	5,650	$10	$33.9K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	7,760	$1	$15.5K
D0220	Intraoral - periapical first radiographic image	4,650	$1	$14K
D0330	N/A	5,520	$1	$11K
D0120	Periodic oral evaluation - established patient	5,390	$1	$10.8K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	2,540	$1	$10.2K
D2391	Resin‑based composite – one surface, posterior	3,270	$1	$9.8K

Showing 1–10 of 88

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Illinois Distribution

Rural Health, Inc. — 10 of 24 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. Illinois median

88 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	26	850	7,490	$120	$3.9M
D0999	N/A	7	220	1,090	$110	$610.1K
T1040	Medicaid certified community behavioral health clinic services, per diem	71	190	880	$70	$128.2K
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…	487	1,180	370	$90	$109.7K
D1120	Prophylaxis–child	244	2,140	960	$40	$89.1K
D1351	Sealant - per tooth	626	1,270	530	$60	$87.1K
D4341	Periodontal scaling and root planing - four or more teeth per quadrant	109	510	230	$160	$83.3K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	287	360	300	$50	$67.4K
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…	92	760	140	$110	$67.3K
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…	78	490	160	$100	$64.4K

Showing 1–10 of 88

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
John Cerny	IL	Family Medicine Physician	$251.8K	$190.2K
Lonzie Tripple	IL	Speech-Language Pathologist	$89.5K	$0
Karly Williard	IL	Speech-Language Pathologist	$33.8K	$0
H&s Pharmacies, LLC	IL	Community/Retail Pharmacy	$1	$0

Rural Health, Inc. — Billing Profile & Reimbursement Data

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Rural 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

Nearby Providers

Frequently Asked Questions

References