Clinic
Community Care of West Virginia, INC.
Community Care of West Virginia, INC. was paid $6.32M by Medicaid between Jan 2018 and Nov 2024, across 48 billing codes. Its largest line is T1015, a visit at a community health center or clinic (one all-in rate) — 89% of everything it billed.
33Billing provider infoCOMMUNITY CARE OF WEST VIRGINIA, INC.
BUCKHANNON, WV 26201
BUCKHANNON, WV 26201
33aNPI1255507810assigned 05/05/2008
33bProvider typeFederally Qualified Health Center (FQHC)
28Total paid$6.32M
24GClaims89,462
24DCodes billed48
24AFirst – last monthJan 2018 – Nov 2024
Compared with peers
Next to other Federally Qualified Health Center (FQHC) providers in West Virginia
Rank by total paid#25 of 205
Median peer was paid$521K
This provider vs. median12×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Auditor's notes
Automated statistical signals. Not evidence of fraud — how these are computed.
Entity ProliferationAuthorized official SIMON, RICHARD controls 11+ related entities in our dataset. Read more
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 11,118 | $798K | |
| 2019 | 6,738 | $476K | |
| 2020 | 13,341 | $693K | |
| 2021 | 15,075 | $857K | |
| 2022 | 27,717 | $1.95M | |
| 2023 | 9,428 | $888K | |
| 2024incomplete | 6,045 | $655K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| T1015 | A visit at a community health center or clinic (one all-in rate)Clinic visit/encounter, all-inclusive | 89% | 34,381 | 27,281 | $5.65M |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 4.4% | 20,783 | 17,056 | $276K |
| 87426 | Infectious agent antigen detection, SARS-CoV-2 (COVID-19) | 1.3% | 2,583 | 2,333 | $85K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 1.2% | 4,299 | 3,812 | $76K |
| 87428 | <1% | 1,658 | 1,517 | $54K | |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 1,851 | 1,650 | $32K |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 3,174 | 2,817 | $28K |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 1,919 | 1,629 | $13K |
| 99391 | Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) | <1% | 888 | 778 | $12K |
| 99392 | Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) | <1% | 1,474 | 1,296 | $12K |
| 81002 | <1% | 653 | 606 | $12K | |
| 90686 | <1% | 1,114 | 986 | $11K |
36 more codes
| 87804 | Infectious agent antigen detection by immunoassay; Influenza, each type | <1% | 873 | $8K |
| 90648 | <1% | 519 | $6K | |
| 90670 | <1% | 463 | $5K | |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | <1% | 1,340 | $5K |
| 96372 | Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular | <1% | 96 | $5K |
| 92551 | <1% | 2,121 | $4K | |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | <1% | 187 | $4K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 1,923 | $3K |
| 90723 | <1% | 230 | $3K | |
| 90680 | <1% | 160 | $2K | |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | <1% | 292 | $2K |
| 90474 | <1% | 134 | $2K | |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 80 | $2K |
| 90633 | <1% | 105 | $1K | |
| 81025 | <1% | 30 | $768.76 | |
| 90656 | <1% | 74 | $22.35 | |
| 3078F | 0% | 543 | $0.00 | |
| 90837 | Psychotherapy session, about an hour | 0% | 498 | $0.00 |
| 81003 | 0% | 191 | $0.00 | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 0% | 433 | $0.00 |
| 1160F | 0% | 679 | $0.00 | |
| 90672 | 0% | 32 | $0.00 | |
| 99173 | 0% | 66 | $0.00 | |
| 1159F | 0% | 679 | $0.00 | |
| 90710 | 0% | 30 | $0.00 | |
| 90473 | 0% | 33 | $0.00 | |
| 99000 | 0% | 1,555 | $0.00 | |
| 1036F | 0% | 338 | $0.00 | |
| 3074F | 0% | 616 | $0.00 | |
| 87807 | 0% | 214 | $0.00 | |
| 90677 | 0% | 38 | $0.00 | |
| 90651 | 0% | 16 | $0.00 | |
| 1034F | 0% | 17 | $0.00 | |
| 3079F | 0% | 38 | $0.00 | |
| 90696 | 0% | 30 | $0.00 | |
| 1035F | 0% | 12 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialSIMON, RICHARD (CEO)
Parent organizationCOMMUNITY CARE OF WEST VIRGINIA, INC.
| Provider | Location | Paid |
|---|---|---|
| Community Care of West Virginia, INC. | Buckhannon, WV | $606K |
| Community Care of West Virginia, INC. | Sutton, WV | $324K |
| Community Care of West Virginia, INC. | Sutton, WV | $156K |
| Community Care of West Virginia, INC. | Buckhannon, WV | $129K |
| Community Care of West Virginia, INC. | Green Bank, WV | $126K |
| Community Care of West Virginia, INC. | Dunmore, WV | $95K |
| Community Care of West Virginia, INC. | Green Bank, WV | $16K |
| Community Care of West Virginia, INC. | French Creek, WV | $13K |
| Community Care of West Virginia, INC. | Lost Creek, WV | $6K |
| Community Care of West Virginia, INC. | Marlinton, WV | $1K |
| Wolfe-Simon Medical Associates PA | Cherry Hill, NJ | $599.76 |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.