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

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

Plymouth Life, Inc. (NPI 1023166576)

Field	Value
Entity Type	Organization
Organization	Plymouth Life, Inc.
Address	214 Plymouth St Se
City	Le Mars
State	IA
ZIP	51031
Taxonomy	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NPI Enumerated	January 8, 2007

Payer Source	Total Paid
Medicaid	$47M
Medicare	$0

Key Findings

PLYMOUTH LIFE, INC. has no Medicare billing on file and is effectively a single-payer Medicaid provider with $47M in lifetime Medicaid revenue; this concentration on Medicaid suggests its operations are focused on services reimbursed through state programs rather than Medicare-covered care. The provider's NPI was enumerated on 2007-01-08, indicating roughly 19 years of enrollment and an established presence in the state Medicaid market.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes by revenue account for 98.4% of the provider's total Medicaid revenue, with H2016 and S5136 together making up the vast majority. This concentration implies that business performance and financial risk are closely tied to reimbursement and utilization trends for those specific service lines.

The code mix (H2016, S5136, T2020) aligns with an Intellectual and/or Developmental Disabilities community-based residential treatment model: H2016 (comprehensive community support services, per diem) and S5136 (companion care, per diem) together indicate a focus on day-to-day community supports and companion/ADL assistance, while T2020 (day habilitation, waiver; per diem) points to structured habilitation programming. In practice this profile suggests operations centered on sustained community support and habilitation rather than episodic medical services.

H2016 is the dominant revenue driver: 49.2K claims at $695 average paid per claim produced $34.2M in revenue, representing 72.8% of the provider's Medicaid revenue. The provider ranks #38 of 176 in-state for H2016 (79th percentile) and the dataset labels its volume for this code as typical and unremarkable, which together indicate a meaningful statewide presence for community support services without being an outlier.

S5136 is the second-largest contributor with 3.5K claims at a $3078 average paid per claim, generating $10.8M or 23.0% of Medicaid revenue; the provider ranks #54 of 82 in-state for this code (35th percentile) and the volume is described as typical and unremarkable. The relatively high average payment per claim for S5136 suggests delivery of resource-intensive companion/ADL supports, but the provider holds a modest statewide market position on this service.

T2020 and related habilitation codes are smaller revenue contributors: T2020 shows 20.3K claims at $60 average paid per claim for $1.2M (2.6% of revenue) and ranks #38 of 101 in-state (63rd percentile); T2021 and H2015 contribute $500.5K (1.1%) and $232.8K (0.5%) respectively and are also characterized as typical, unremarkable volumes. These figures indicate active day habilitation programming at scale of claims but at low per-claim reimbursement, consistent with standard waiver-supported habilitation models rather than specialty or niche services.

Across Medicaid service lines the provider's statistical standing is largely within typical statewide ranges: H2016 at the 79th percentile and T2020/T2021 above median suggest a solid, established provider for community support and habilitation, whereas S5136's 35th percentile ranking points to a less dominant footprint for companion care. The available rank/percentile information does not indicate extreme outlier behavior for any top code; instead it portrays a stable, focused operator within expected in-state patterns.

From a payer/provider analysis perspective, PLYMOUTH LIFE's financial and operational profile signals specialization in Medicaid-funded IDD supports with concentrated revenue risk around H2016 and S5136. Analysts evaluating network capacity, rate-setting, or competitive landscape should treat this entity as an established Medicaid-focused community support and day habilitation provider with modest-to-strong positioning on its primary codes rather than a multi-payer or Medicare-serving organization.

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2016	Comprehensive community support services, per diem	49,180	$700	$34.2M
S5136	Companion care, adult (e.g., iadl/adl); per diem	3,520	$3,080	$10.8M
T2020	Day habilitation, waiver; per diem	20,320	$60	$1.2M
T2021	Day habilitation, waiver; per 15 minutes	14,720	$30	$500.5K
H2015	Comprehensive community support services, per 15 minutes	1,990	$120	$232.8K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

Plymouth Life, Inc. — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5136	Companion care, adult (e.g., iadl/adl); per diem	54	80	9,410	$490	$17.9M
H2016	Comprehensive community support services, per diem	38	180	10,790	$390	$15.2M
T2020	Day habilitation, waiver; per diem	38	100	10,960	$110	$3M
H2015	Comprehensive community support services, per 15 minutes	65	100	4,130	$160	$1.9M
T2021	Day habilitation, waiver; per 15 minutes	14	100	2,780	$60	$386.9K

Nearby Providers

Other providers in the same ZIP code as Plymouth Life, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Plains Area Mental Health, Inc.	IA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$34.1M
Life Skills Training Center, Inc.	IA	Developmentally Disabled Services Day Training Agency	$0	$3.9M
Floyd Valley Healthcare	IA	Critical Access Hospital	$0	$1.6M
Floyd Valley Healthcare	IA	Family Medicine Physician	$0	$1.3M
City Of Lemars	IA	Land Ambulance	$136.2K	$146.5K
Gary Tillman	IA	Certified Registered Nurse Anesthetist	$27.3K	$0
Elizabeth Groetken	IA	Optometrist	$25.5K	$0
Anthony Larson	IA	Psychologist	$3.2K	$0

Plymouth Life, Inc. — Billing Profile & Reimbursement Data

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Plymouth Life, 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

Nearby Providers

Frequently Asked Questions

References