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

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

Optimus Health Care (NPI 1992871875)

Key Findings

Field	Value
Entity Type	Organization
Organization	Optimus Health Care
Address	471 Barnum Ave
City	Bridgeport
State	CT
ZIP	06608
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	November 24, 2006

Payer Source	Total Paid
Medicaid	$33.1M
Medicare	$0

Payer mix is effectively single-payer Medicaid: this provider reports no Medicare revenue on file and $33.1M of lifetime Medicaid revenue, indicating its business is focused squarely on Medicaid-covered behavioral health services rather than Medicare populations. The absence of Medicare billing suggests limited engagement with fee‑for‑service Medicare beneficiaries or alternative Medicare arrangements.

Revenue is extremely concentrated in a small set of encounter codes: the precomputed top three Medicaid codes account for 99.9% of this provider's total Medicaid revenue, and T1015 alone generates $32.2M (97.3% of Medicaid revenue). That level of concentration creates material operational exposure to changes in clinic-encounter reimbursement policy or audit scrutiny of bundled payments.

The code mix and payments indicate the operation functions as an encounter-based mental health clinic: T1015 (Clinic visit/encounter, all-inclusive) dominates revenue, and FQHC/RHC-specific codes such as G0470 and G0467 appear on the file, consistent with bundled clinic visit reimbursement rather than isolated fee-for-service psychotherapy billing. Together with meaningful G2025 telehealth distant-site payments, the pattern is consistent with a community mental health clinic or FQHC-style service model that combines in-person and telehealth encounters.

Competitive standing by code is mixed: for its revenue-driving code T1015 the provider ranks #15 of 73 providers in-state (81th percentile; typical, unremarkable volume for this code), indicating a solid but not dominant position statewide for all-inclusive clinic visits. In contrast, the provider ranks #3 of 27 for G2025 (92th percentile; typical, unremarkable volume) and #3 of 25 for G0470 (92th percentile; typical, unremarkable volume), showing relatively high use of telehealth distant-site and FQHC mental-health visit codes among peers.

Many stand-alone psychotherapy and E/M codes show substantial claim volumes but $0 reported Medicaid payments (for example, 90832 has 123.7K claims with $0 avg paid/claim and 99213 has 41.9K claims with $0 avg paid/claim). This pattern strongly suggests those services are being documented on claims but are being reimbursed through the all‑inclusive clinic encounter (T1015) rather than paid separately, which affects how revenue and utilization should be interpreted for service-line analysis.

There are notable statistical outliers in volume that have little revenue impact: 90792 appears as an "extreme outlier, far above typical state volume for this code" (ranks #3 of 212 providers in-state, 99th percentile) but accounts for only $6K of Medicaid revenue (0.0% of total), while 90832 is "notably above typical state volume" (ranks #8 of 417, 98th percentile) with large claim counts yet $0 reported Medicaid payments. These discrepancies highlight that high clinical activity for specific psychiatric services may be subsumed under bundled encounter payments rather than reflected as distinct paid line items.

The provider shows long operational tenure: NPI enumerated 2006-11-24 (~20 years ago), indicating an established presence in the Bridgeport, CT mental health market. Combined with the FQHC/RHC-targeted codes and the large Medicaid revenue base, this tenure suggests sustained relationships with Medicaid payers and an operational model built around bundled clinic encounters and telehealth services.

From a business risk and opportunity perspective, the dominant role of T1015 and the presence of G2025 telehealth revenue indicate both vulnerability and optionality: vulnerability because $32.2M (97.3% of Medicaid revenue) is tied to a single all‑inclusive encounter code, and optionality because the provider is already capturing telehealth distant-site revenue ($666.8K, 2.0% of Medicaid revenue) and could potentially expand telehealth services within its existing FQHC/RHC billing framework. Strategic analysis should therefore focus on encounter reimbursement trends and telehealth policy changes that would materially affect this provider's Medicaid revenue stream.

Medicaid: Complete Services Breakdown

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

21 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	212,080	$150	$32.2M
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	12,120	$60	$666.8K
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…	11,740	$20	$176.1K
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…	2,530	$20	$37.9K
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…	6,000	$1	$6K
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…	30	$10	$200
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	5,820	$0	$0
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…	123,700	$0	$0
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…	6,600	$0	$0
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…	20	$0	$0

Showing 1–10 of 21

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Optimus Health Care — 1 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

21 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	15	70	830	$150	$24M
S9480	Intensive outpatient psychiatric services, per diem	51	60	5,640	$110	$1.3M
G0511	Rural health clinic or federally qualified health center (rhc or fqhc) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral…	17	20	6,040	$40	$952.7K
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…	323	1,590	740	$50	$331.8K
G2025	Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only	3	30	2,590	$60	$278.5K
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…	55	1,710	750	$30	$243.3K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	113	150	290	$80	$206.3K
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…	2,065	2,180	850	$90	$202.1K
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…	8	420	1,230	$20	$199.3K
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…	78	570	410	$50	$197.6K

Showing 1–10 of 21

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Optimus Health Care Inc	CT	Federally Qualified Health Center (FQHC)	$0	$100.4M
Optimus Health Care	CT	Dental Clinic/Center	$0	$8.4M
Deena Ebright	CT	Internal Medicine Physician	$85.4K	$0
Shakeilla Smithbey	TX	Family Medicine Physician	$84.9K	$0
Jennifer Gilbert	CT	Family Nurse Practitioner	$71.7K	$0
Joseph Feuerstein	CT	Family Medicine Physician	$66.9K	$0
Gustavo Herrera-brito	CT	Adult Health Nurse Practitioner	$54.9K	$0
Luis Rojas	CT	Family Nurse Practitioner	$35.2K	$0
Prajay Rathore	CT	Internal Medicine Physician	$33K	$150

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Skmp Enterprises, Inc.	CT	Land Ambulance	$2.3M	$4.7M
Chemical Abuse Services Agency, Inc.	CT	Community/Behavioral Health Agency	$0	$3.2M
Vicarah, LLC	CT	Home Health Agency	$0	$1.2M

Optimus Health Care — Billing Profile & Reimbursement Data

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Optimus Health Care — 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