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.

Springfield Medical Care Systems Inc (NPI 1992073191)

Key Findings

Field	Value
Entity Type	Organization
Organization	Springfield Medical Care Systems Inc
Address	100 River St
City	Springfield
State	VT
ZIP	05156
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	December 2, 2011

Payer Source	Total Paid
Medicaid	$13.3M
Medicare	$0

SPRINGFIELD MEDICAL CARE SYSTEMS INC is an FQHC whose Medicaid billing dominates its public-payer footprint: the provider reports $13.3M in total Medicaid revenue and has no Medicare billing on file, making it effectively a single-payer (Medicaid) operation in the available dataset. The practice was enumerated on 2011-12-02 (~15 years ago), indicating an established presence in the state FQHC market.

Revenue is highly concentrated in a single encounter code: T1015 accounts for $13.1M in revenue and 98.3% of the provider’s total Medicaid revenue, and the precomputed top 3 Medicaid codes together account for 99.7% of Medicaid revenue. This concentration indicates that the FQHC encounter/bundled visit reimbursement is the primary revenue driver rather than separately reimbursed fee-for-service procedures.

The provider’s code mix and payment profile are consistent with a clinic that bills primarily under bundled FQHC visit rates: T1015 (Clinic visit/encounter, all-inclusive) dominates revenue, and G0467 (FQHC visit, established patient) also appears on file with $166.8K revenue (1.3% of total Medicaid revenue). The presence of these FQHC-specific encounter codes suggests operational focus on high-volume, per-encounter primary care and wraparound services typical of community health centers.

Competitive standing for its top encounter code is strong statewide: T1015 ranks #5 of 70 providers in-state and sits in the 94th percentile, marking the organization as a major in-state provider of billed FQHC encounters. Secondary encounter codes like G0467 rank #5 of 49 (around the 92nd percentile) and 99213 ranks #10 of 319 (97th percentile), further indicating higher-than-typical volumes on several commonly billed outpatient encounter/E&M codes relative to peers.

There is a notable mismatch between claim volume and paid amounts across many codes: several high-volume services show $0 avg paid/claim despite large claim counts — for example 90832 (12.6K claims, $0 avg paid/claim), 3008F (7.1K claims, $0 avg paid/claim), and 3074F/3078F (6.5K and 6.1K claims, $0 avg paid/claim respectively). This pattern suggests many services are captured in encounter-level payments (T1015/G0467) or are submitted in a manner that does not generate separate paid line-item revenue in the Medicaid extract.

Behavioral health and preventive pediatrics are prominent in utilization even when they do not drive separate revenue: 90832 (psychotherapy) is an extreme outlier by volume, ranking #1 of 107 providers in-state (100th percentile) with 12.6K claims, and pediatric vaccine/preventive codes such as 90460, 99173, 99393, and 90461 also show high claim counts but $0 avg paid/claim. These tallies indicate substantial mental health and child preventive service activity that likely falls under bundled FQHC reimbursements or alternative payment treatments.

Although E/M codes 99213 (27.6K claims, $27.6K revenue) and 99214 (17.8K claims, $17.8K revenue) contribute only small absolute revenue shares (0.2% and 0.1% of Medicaid revenue respectively), their claim volumes are notable — 99213 ranks #10 of 319 (97th percentile) and 99214 ranks #13 of 323 (96th percentile) — implying the center sees high visit counts per standard ambulatory E/M metrics even if most reimbursement is captured under FQHC encounter codes.

Smaller specialty or facility codes (e.g., G0470 mental-health FQHC visit with $14.4K revenue, 627 claims) make up only fractional shares of Medicaid revenue but demonstrate that the site provides a mix of primary care and targeted services. Overall, the provider’s financial profile and code distribution characterize it as a high-volume, encounter-driven FQHC with most Medicaid dollars flowing through bundled visit codes rather than discrete fee-for-service procedures.

Medicaid: Complete Services Breakdown

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

52 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	77,920	$170	$13.1M
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…	7,580	$20	$166.8K
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…	27,570	$1	$27.6K
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…	17,770	$1	$17.8K
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…	630	$20	$14.4K
99310	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the provider spends…	90	$20	$1.8K
99309	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider…	170	$10	$1.5K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	540	$1	$1.1K
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…	50	$10	$490
36416	In this procedure, the provider pricks the patient’s finger, heel, or ear with a pointed instrument and collects specimen of droplets of blood by pressing the pricking site.	90	$1	$90

Showing 1–10 of 52

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

Springfield Medical Care Systems Inc — 2 of 11 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

52 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	5	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…	13	320	680	$30	$146.1K
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…	10	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…	5	50	1,020	$20	$87.6K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	7	10	60	$40	$45.1K
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…	82	110	170	$70	$38.6K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	8	40	890	$10	$32.1K
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…	16	40	170	$40	$31.6K
90838	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…	8	10	230	$60	$20.4K
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…	14	40	280	$20	$19.5K

Showing 1–10 of 52

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Springfield Hospital	VT	Critical Access Hospital Clinic/Center	$0	$960.1K
Crissy Webster	VT	Mental Health Counselor	$0	$850.4K
Town Of Springfield	VT	Ambulance	$249.4K	$482K
Twin State Psychological Services	VT	Psychologist	$0	$519.6K
Kathy-jo Merlau	VT	Mental Health Counselor	$0	$512K
Crissy Webster Counseling Services LLC	VT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$242.6K
Vincent Buckholz	VT	Clinical Social Worker	$0	$202.6K
Maxi Green Inc	VT	Community/Retail Pharmacy	$198K	$0
Aman U Syed Plc	VT	Dentist	$0	$189.2K
Afterimage Inc.	VT	Optometrist	$0	$146.6K

Springfield Medical Care Systems Inc — Billing Profile & Reimbursement Data

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Springfield Medical Care Systems 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Springfield Medical Care Systems Inc	VT	Federally Qualified Health Center (FQHC)	$0	$7.8M
Springfield Medical Care Systems Inc	VT	Federally Qualified Health Center (FQHC)	$0	$3.6M
Springfield Medical Care Systems Inc	NH	Federally Qualified Health Center (FQHC)	$0	$3.1M
Springfield Medical Care Systems Inc	VT	Federally Qualified Health Center (FQHC)	$0	$1.8M
Springfield Medical Care Systems Inc	VT	Federally Qualified Health Center (FQHC)	$0	$1.8M
Springfield Medical Care Systems Inc	VT	Federally Qualified Health Center (FQHC)	$0	$683.8K
Springfield Medical Care Systems Inc.	VT	Federally Qualified Health Center (FQHC)	$0	$365.8K
Springfield Medical Care Systems Inc	VT	Federally Qualified Health Center (FQHC)	$0	$204.8K
Springfield Medical Care Systems Inc	VT	Federally Qualified Health Center (FQHC)	$0	$142.8K
Springfield Medical Care Systems Inc	VT	Federally Qualified Health Center (FQHC)	$0	$135.6K