Is COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC flagged for Medicaid fraud?

COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC (NPI: 1003462102) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

What is NPI 1003462102?

NPI 1003462102 is the National Provider Identifier for COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC. They are a Clinic/Center, Federally Qualified Health Center (FQHC) provider based in PASO ROBLES, CA. This NPI is registered with the CMS NPI Registry.

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COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC

Clinic/Center, Federally Qualified Health Center (FQHC)·PASO ROBLES, CA·NPI: 1003462102Share

Compared to Clinic/Center, Federally Qualified Health Center (FQHC) Peers

Total spending distribution among 16 providers in this specialty

P25MedianP75P90

This provider's total spending of $20.8M is at the below 25th percentile among 16 Clinic/Center, Federally Qualified Health Center (FQHC) providers.

Active Billing Period:2020-10→2024-12(51 months)

Total Paid

$20.8M

$20,785,701

Total Claims

513K

Beneficiaries

359K

1.4 claims/patient

Avg Cost/Claim

$41

Monthly Spending Trend

Yearly Spending

2020

$291K

+1890%

2021

$5.8M

-13%

2022

$5.0M

-0%

2023

$5.0M

-7%

2024

$4.7M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 50 distinct procedure codes. The top code (T1015 (Clinic visit/encounter, all-inclusive)) accounts for 90% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

T1015Clinic visit/encounter, all-inclusiveSee all providers →

$18.7M

109K claims

$171.04

$121.16

1.4×

Normal range

T1015Normal range

Clinic visit/encounter, all-inclusive

$18.7M

109K claims · 90.0%

Your Cost: $171.04/claim|Median: $121.16

1.4× median

0521 See all providers →

$1.3M

175K claims

$7.40

1.0×

Normal range

0521Normal range

$1.3M

175K claims · 6.2%

Your Cost: $7.40/claim|Median: $7.40

1.0× median

0301 See all providers →

$250K

7,232 claims

$34.60

$11.15

3.1×

Normal range

0301Normal range

$250K

7,232 claims · 1.2%

Your Cost: $34.60/claim|Median: $11.15

3.1× median

87635COVID-19 SARS-CoV-2 amplified probe detectionSee all providers →

$128K

7,033 claims

$18.27

$39.70

0.5×

Normal range

87635Normal range

COVID-19 SARS-CoV-2 amplified probe detection

$128K

7,033 claims · 0.6%

Your Cost: $18.27/claim|Median: $39.70

0.5× median

0636 See all providers →

$82K

9,378 claims

$8.69

$5.41

1.6×

Normal range

0636Normal range

$82K

9,378 claims · 0.4%

Your Cost: $8.69/claim|Median: $5.41

1.6× median

92340Fitting of spectacles, except for aphakiaSee all providers →

$57K

5,784 claims

$9.91

$19.46

0.5×

Normal range

92340Normal range

Fitting of spectacles, except for aphakia

$57K

5,784 claims · 0.3%

Your Cost: $9.91/claim|Median: $19.46

0.5× median

V2020Frames, purchasesSee all providers →

$55K

5,888 claims

$9.36

$19.33

0.5×

Normal range

V2020Normal range

Frames, purchases

$55K

5,888 claims · 0.3%

Your Cost: $9.36/claim|Median: $19.33

0.5× median

92014Ophthalmological exam, comprehensive, established patientSee all providers →

$25K

4,513 claims

$5.44

$47.08

0.1×

Normal range

92014Normal range

Ophthalmological exam, comprehensive, established patient

$25K

4,513 claims · 0.1%

Your Cost: $5.44/claim|Median: $47.08

0.1× median

0761 See all providers →

$18K

783 claims

$22.52

$24.10

0.9×

Normal range

0761Normal range

$18K

783 claims · 0.1%

Your Cost: $22.52/claim|Median: $24.10

0.9× median

87804Influenza virus detection, rapid testSee all providers →

$16K

3,316 claims

$4.88

$12.59

0.4×

Normal range

87804Normal range

Influenza virus detection, rapid test

$16K

3,316 claims · 0.1%

Your Cost: $4.88/claim|Median: $12.59

0.4× median

0771 See all providers →

$15K

1,311 claims

$11.79

$4.66

2.5×

Top 10%

0771Top 10%

$15K

1,311 claims · 0.1%

Your Cost: $11.79/claim|Median: $4.66

2.5× median

0309 See all providers →

$15K

805 claims

$18.16

$6.56

2.8×

Top 1%

0309Top 1%

$15K

805 claims · 0.1%

Your Cost: $18.16/claim|Median: $6.56

2.8× median

99213Office/outpatient visit, est. patient, low-mod complexitySee all providers →

$14K

58K claims

$0.24

$37.81

0.0×

Normal range

99213Normal range

Office/outpatient visit, est. patient, low-mod complexity

$14K

58K claims · 0.1%

Your Cost: $0.24/claim|Median: $37.81

0.0× median

99051 See all providers →

$13K

3,881 claims

$3.38

$7.89

0.4×

Normal range

99051Normal range

$13K

3,881 claims · 0.1%

Your Cost: $3.38/claim|Median: $7.89

0.4× median

87426SARS-CoV-2 COVID-19 antigen detection, immunoassaySee all providers →

$9K

2,473 claims

$3.84

$30.04

0.1×

Normal range

87426Normal range

SARS-CoV-2 COVID-19 antigen detection, immunoassay

$9K

2,473 claims · 0.0%

Your Cost: $3.84/claim|Median: $30.04

0.1× median

0770 See all providers →

$9K

3,610 claims

$2.39

$4.23

0.6×

Normal range

0770Normal range

$9K

3,610 claims · 0.0%

Your Cost: $2.39/claim|Median: $4.23

0.6× median

99396Preventive medicine, established patient, age 40-64See all providers →

$9K

1,182 claims

$7.27

$76.06

0.1×

Normal range

99396Normal range

Preventive medicine, established patient, age 40-64

$9K

1,182 claims · 0.0%

Your Cost: $7.27/claim|Median: $76.06

0.1× median

87880Streptococcus, Group A, rapid antigen detectionSee all providers →

$9K

3,290 claims

$2.61

$11.48

0.2×

Normal range

87880Normal range

Streptococcus, Group A, rapid antigen detection

$9K

3,290 claims · 0.0%

Your Cost: $2.61/claim|Median: $11.48

0.2× median

92004Ophthalmological exam, comprehensive, new patientSee all providers →

$7K

737 claims

$9.24

$59.72

0.2×

Normal range

92004Normal range

Ophthalmological exam, comprehensive, new patient

$7K

737 claims · 0.0%

Your Cost: $9.24/claim|Median: $59.72

0.2× median

98941Chiropractic manipulative treatment, 3-4 spinal regionsSee all providers →

$6K

6,775 claims

$0.84

$20.83

0.0×

Normal range

98941Normal range

Chiropractic manipulative treatment, 3-4 spinal regions

$6K

6,775 claims · 0.0%

Your Cost: $0.84/claim|Median: $20.83

0.0× median

92250Fundus photography with interpretation and reportSee all providers →

$5K

650 claims

$8.33

$27.95

0.3×

Normal range

92250Normal range

Fundus photography with interpretation and report

$5K

650 claims · 0.0%

Your Cost: $8.33/claim|Median: $27.95

0.3× median

83036Hemoglobin A1c (glycated hemoglobin)See all providers →

$4K

2,570 claims

$1.43

$5.50

0.3×

Normal range

83036Normal range

Hemoglobin A1c (glycated hemoglobin)

$4K

2,570 claims · 0.0%

Your Cost: $1.43/claim|Median: $5.50

0.3× median

99460Initial hospital or birthing center care, newborn, per daySee all providers →

$4K

86 claims

$42.67

$62.48

0.7×

Normal range

99460Normal range

Initial hospital or birthing center care, newborn, per day

$4K

86 claims · 0.0%

Your Cost: $42.67/claim|Median: $62.48

0.7× median

99395Preventive medicine, established patient, age 18-39See all providers →

$4K

1,267 claims

$2.88

$72.71

0.0×

Normal range

99395Normal range

Preventive medicine, established patient, age 18-39

$4K

1,267 claims · 0.0%

Your Cost: $2.88/claim|Median: $72.71

0.0× median

98940 See all providers →

$4K

1,919 claims

$1.90

$14.55

0.1×

Normal range

98940Normal range

$4K

1,919 claims · 0.0%

Your Cost: $1.90/claim|Median: $14.55

0.1× median

92015Determination of refractive stateSee all providers →

$3K

5,637 claims

$0.58

$10.36

0.1×

Normal range

92015Normal range

Determination of refractive state

$3K

5,637 claims · 0.0%

Your Cost: $0.58/claim|Median: $10.36

0.1× median

0307 See all providers →

$2K

1,164 claims

$1.59

$1.09

1.5×

Normal range

0307Normal range

$2K

1,164 claims · 0.0%

Your Cost: $1.59/claim|Median: $1.09

1.5× median

99214Office/outpatient visit, est. patient, mod-high complexitySee all providers →

$2K

4,429 claims

$0.35

$53.41

0.0×

Normal range

99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

$2K

4,429 claims · 0.0%

Your Cost: $0.35/claim|Median: $53.41

0.0× median

90677 See all providers →

$2K

1,139 claims

$1.35

$12.96

0.1×

Normal range

90677Normal range

$2K

1,139 claims · 0.0%

Your Cost: $1.35/claim|Median: $12.96

0.1× median

0306 See all providers →

$1K

109 claims

$12.42

$3.72

3.3×

Top 25%

0306Top 25%

$1K

109 claims · 0.0%

Your Cost: $12.42/claim|Median: $3.72

3.3× median

0054A See all providers →

$1K

59 claims

$22.83

$35.83

0.6×

Normal range

0054ANormal range

$1K

59 claims · 0.0%

Your Cost: $22.83/claim|Median: $35.83

0.6× median

99394Preventive medicine, established patient, age 12-17See all providers →

$1K

2,650 claims

$0.48

$80.15

0.0×

Normal range

99394Normal range

Preventive medicine, established patient, age 12-17

$1K

2,650 claims · 0.0%

Your Cost: $0.48/claim|Median: $80.15

0.0× median

99392Preventive medicine, established patient, age 1-4See all providers →

$1K

3,421 claims

$0.32

$75.18

0.0×

Normal range

99392Normal range

Preventive medicine, established patient, age 1-4

$1K

3,421 claims · 0.0%

Your Cost: $0.32/claim|Median: $75.18

0.0× median

0004A See all providers →

$1K

37 claims

$27.03

$35.62

0.8×

Normal range

0004ANormal range

$1K

37 claims · 0.0%

Your Cost: $27.03/claim|Median: $35.62

0.8× median

92552Pure tone audiometry, air only, each earSee all providers →

$938

6,719 claims

$0.14

$12.63

0.0×

Normal range

92552Normal range

Pure tone audiometry, air only, each ear

$938

6,719 claims · 0.0%

Your Cost: $0.14/claim|Median: $12.63

0.0× median

0900 See all providers →

$938

4,122 claims

$0.23

$2.08

0.1×

Normal range

0900Normal range

$938

4,122 claims · 0.0%

Your Cost: $0.23/claim|Median: $2.08

0.1× median

99391Preventive medicine, established patient, infant (under 1)See all providers →

$926

2,492 claims

$0.37

$69.35

0.0×

Normal range

99391Normal range

Preventive medicine, established patient, infant (under 1)

$926

2,492 claims · 0.0%

Your Cost: $0.37/claim|Median: $69.35

0.0× median

99393Preventive medicine, established patient, age 5-11See all providers →

$877

2,694 claims

$0.33

$74.82

0.0×

Normal range

99393Normal range

Preventive medicine, established patient, age 5-11

$877

2,694 claims · 0.0%

Your Cost: $0.33/claim|Median: $74.82

0.0× median

99203Office/outpatient visit, new patient, low-mod complexitySee all providers →

$812

216 claims

$3.76

$57.85

0.1×

Normal range

99203Normal range

Office/outpatient visit, new patient, low-mod complexity

$812

216 claims · 0.0%

Your Cost: $3.76/claim|Median: $57.85

0.1× median

69200 See all providers →

$671

20 claims

$33.56

$51.29

0.7×

Normal range

69200Normal range

$671

20 claims · 0.0%

Your Cost: $33.56/claim|Median: $51.29

0.7× median

82947Blood glucose level testSee all providers →

$488

547 claims

$0.89

$2.38

0.4×

Normal range

82947Normal range

Blood glucose level test

$488

547 claims · 0.0%

Your Cost: $0.89/claim|Median: $2.38

0.4× median

0001ACOVID-19 vaccine admin, Pfizer, 1st doseSee all providers →

$408

51 claims

$8.00

$33.72

0.2×

Normal range

0001ANormal range

COVID-19 vaccine admin, Pfizer, 1st dose

$408

51 claims · 0.0%

Your Cost: $8.00/claim|Median: $33.72

0.2× median

90619 See all providers →

$405

584 claims

$0.69

$8.36

0.1×

Normal range

90619Normal range

$405

584 claims · 0.0%

Your Cost: $0.69/claim|Median: $8.36

0.1× median

85018 See all providers →

$371

7,122 claims

$0.05

$1.71

0.0×

Normal range

85018Normal range

$371

7,122 claims · 0.0%

Your Cost: $0.05/claim|Median: $1.71

0.0× median

90750 See all providers →

$370

78 claims

$4.75

$96.16

0.0×

Normal range

90750Normal range

$370

78 claims · 0.0%

Your Cost: $4.75/claim|Median: $96.16

0.0× median

99238Hospital discharge day management, 30 minutes or lessSee all providers →

$339

32 claims

$10.59

$37.22

0.3×

Normal range

99238Normal range

Hospital discharge day management, 30 minutes or less

$339

32 claims · 0.0%

Your Cost: $10.59/claim|Median: $37.22

0.3× median

99381Preventive visit, new patient, infant (<1 yr)See all providers →

$335

186 claims

$1.80

$73.46

0.0×

Normal range

99381Normal range

Preventive visit, new patient, infant (<1 yr)

$335

186 claims · 0.0%

Your Cost: $1.80/claim|Median: $73.46

0.0× median

J3420Injection, vitamin B-12 cyanocobalamin, up to one thousand mcgSee all providers →

$327

346 claims

$0.95

$1.04

0.9×

Normal range

J3420Normal range

Injection, vitamin B-12 cyanocobalamin, up to one thousand mcg

$327

346 claims · 0.0%

Your Cost: $0.95/claim|Median: $1.04

0.9× median

G0467Federally qualified health center visit, mental healthSee all providers →

$304

157 claims

$1.93

$21.91

0.1×

Normal range

G0467Normal range

Federally qualified health center visit, mental health

$304

157 claims · 0.0%

Your Cost: $1.93/claim|Median: $21.91

0.1× median

99188 See all providers →

$252

1,127 claims

$0.22

$12.80

0.0×

Normal range

99188Normal range

$252

1,127 claims · 0.0%

Your Cost: $0.22/claim|Median: $12.80

0.0× median

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$1.34B

Los Angeles County Department of Public Health

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$1.13B

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