Clinic
Lake Superior Community Health Center
Lake Superior Community Health Center was paid $4.86M by Medicaid between Jan 2018 and Apr 2022, across 47 billing codes. Its largest line is T1015, a visit at a community health center or clinic (one all-in rate) — 86% of everything it billed.
33Billing provider infoLAKE SUPERIOR COMMUNITY HEALTH CENTER
SUPERIOR, WI 54880
SUPERIOR, WI 54880
33aNPI1578781639assigned 04/23/2007
33bProvider typeFederally Qualified Health Center (FQHC)
28Total paid$4.86M
24GClaims85,086
24DCodes billed47
24AFirst – last monthJan 2018 – Apr 2022
Compared with peers
Next to other Federally Qualified Health Center (FQHC) providers in Wisconsin
Rank by total paid#9 of 46
Median peer was paid$590K
This provider vs. median8.2×
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.
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 | 22,904 | $1.04M | |
| 2019 | 25,166 | $1.52M | |
| 2020 | 15,844 | $877K | |
| 2021 | 19,448 | $1.30M | |
| 2022 | 1,724 | $120K |
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 | 86% | 20,212 | 16,116 | $4.19M |
| 90834 | Psychotherapy session, about 45 minutesPsychotherapy, 45 minutes with patient | 4.6% | 8,609 | 3,885 | $223K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 3.0% | 6,223 | 4,821 | $145K |
| 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 | 1.5% | 2,721 | 2,348 | $72K |
| G0467 | Community health center visit, returning patientFederally 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 time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit | <1% | 1,787 | 1,578 | $48K |
| 90832 | Psychotherapy session, about 30 minutesPsychotherapy, 30 minutes with patient | <1% | 1,667 | 834 | $36K |
| H0022 | Alcohol and/or drug intervention service (planned facilitation) | <1% | 2,711 | 1,228 | $22K |
| 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 practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a mental health visit | <1% | 548 | 250 | $15K |
| 80047 | <1% | 1,384 | 1,173 | $11K | |
| G2025 | Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only | <1% | 668 | 236 | $11K |
| D1110 | Prophylaxis - adult | <1% | 4,333 | 4,109 | $11K |
| D0140 | Limited oral evaluation - problem focused | <1% | 3,658 | 3,267 | $9K |
35 more codes
| D1206 | Topical application of fluoride varnish | <1% | 4,334 | $7K |
| D0274 | Bitewings - four radiographic images | <1% | 3,734 | $6K |
| D0120 | Dental checkup, returning patient | <1% | 4,247 | $6K |
| D2392 | Resin-based composite - two surfaces, posterior, primary or permanent | <1% | 1,597 | $5K |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | <1% | 429 | $4K |
| 83036 | Hemoglobin; glycosylated (A1C) | <1% | 654 | $4K |
| D2391 | Resin-based composite - one surface, posterior, primary or permanent | <1% | 1,113 | $4K |
| D7140 | Extraction, erupted tooth or exposed root | <1% | 1,121 | $4K |
| D1120 | Dental cleaning, child | <1% | 1,485 | $4K |
| D0150 | Comprehensive oral evaluation - new or established patient | <1% | 1,514 | $3K |
| D0330 | Panoramic radiographic image | <1% | 2,316 | $3K |
| 90791 | Psychiatric diagnostic evaluation | <1% | 72 | $2K |
| 90686 | <1% | 176 | $2K | |
| D0220 | Intraoral - periapical first radiographic image | <1% | 2,483 | $2K |
| 90658 | <1% | 158 | $2K | |
| 85025 | Blood count; complete (CBC), automated, and automated differential WBC count | <1% | 284 | $2K |
| 0012A | <1% | 67 | $1K | |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | <1% | 56 | $1K |
| D1351 | Sealant - per tooth | <1% | 620 | $924.80 |
| 0011A | <1% | 77 | $832.00 | |
| D0272 | Bitewings - two radiographic images | <1% | 537 | $666.43 |
| 0002A | <1% | 22 | $616.00 | |
| D2330 | <1% | 74 | $604.44 | |
| D0230 | Intraoral - periapical each additional radiographic image | <1% | 305 | $397.20 |
| 0001A | <1% | 27 | $384.00 | |
| G0071 | Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only | <1% | 15 | $64.74 |
| 36415 | Collection of venous blood by venipuncture | <1% | 1,943 | $26.23 |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | <1% | 395 | $2.92 |
| Q2037 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin) | 0% | 56 | $0.00 |
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 0% | 16 | $0.00 |
| D2394 | 0% | 12 | $0.00 | |
| D2393 | Resin-based composite - three surfaces, posterior, primary or permanent | 0% | 177 | $0.00 |
| D1208 | Topical application of fluoride, excluding varnish | 0% | 96 | $0.00 |
| D5899 | 0% | 337 | $0.00 | |
| D2335 | 0% | 16 | $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 officialPETERSON, JESSIE (COO)
| Provider | Location | Paid |
|---|---|---|
| Lake Superior Community Health Center | Superior, WI | $34K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.