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

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

Opportunity Enterprises, Inc. (NPI 1053586586)

Field	Value
Entity Type	Organization
Organization	Opportunity Enterprises, Inc.
Address	400 Center St
City	Auburn
State	ME
ZIP	04210
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	April 25, 2008

Payer Source	Total Paid
Medicaid	$47.6M
Medicare	$0

Key Findings

This provider is effectively single-payer in scope: there is no Medicare billing on file and all recorded lifetime public-payer revenue is Medicaid, totaling $47.6M. The absence of Medicare activity indicates the provider’s operations are concentrated in state Medicaid waiver and support services rather than reimbursable Medicare clinical services.

Revenue is highly concentrated in a small set of waiver and habilitation codes: the top three Medicaid codes (T2016, T2021, S5140) account for 84.7% of this provider’s total Medicaid revenue. Those three codes alone generate $25.5M (T2016, 53.6%), $10.4M (T2021, 21.9%), and $4.4M (S5140, 9.2%) respectively, indicating most Medicaid dollars flow through a narrow service mix.

The code mix points to a business model centered on developmental disabilities support and waiver-based residential and day habilitation services. T2016 (Habilitation, residential, waiver; per diem) and T2021 (Day habilitation, waiver; per 15 minutes) together represent the bulk of revenue, while S5140 (Foster care, adult; per diem) and G9012 (case management) show complementary social-support roles consistent with a Developmentally Disabled Services Day Training Agency taxonomy.

Operational intensity and unit-payment profile differ by code: T2021 shows very high volume with 37.8K claims at $276 avg paid/claim totaling $10.4M, while T2016 delivers higher per-unit revenue with 18.1K claims at $1409 avg paid/claim totaling $25.5M. S5140 contributes 9.6K claims at $456 avg paid/claim ($4.4M), and G9012 appears as a material ancillary line with 22.1K claims at $181 avg paid/claim ($4M), showing a mix of high-volume low-unit and lower-volume high-unit revenue streams.

Statewide competitive standing on core codes is above average but not dominant. T2016 ranks #19 of 75 providers in-state at the 76th percentile and is characterized as typical/unremarkable volume for the code; T2021 ranks #18 of 72 at the 76th percentile with a similar characterization; S5140 ranks #15 of 31 at the 53th percentile (typical, unremarkable volume). These ranks indicate the provider is an established, above-average participant for its largest habilitation codes but not a top outlier or market leader.

Other Medicaid lines are meaningful but secondary: G9012 (Other specified case management) accounts for $4M (8.4% of Medicaid revenue) and ranks #27 of 50 in-state at the 47th percentile (typical), while T2017 (residential habilitation, 15 minutes) contributes $3.3M (6.9%) with 15.5K claims at $213 avg and ranks #9 of 34 at the 76th percentile. Together these lines support service delivery and case management around the core residential and day habilitation programs rather than driving revenue independently.

The provider has an established presence, with an NPI enumerated on 2008-04-25 (~18 years ago), consistent with sustained participation in state waiver programs. That tenure aligns with the concentrated, programmatic revenue mix observed and suggests operational continuity in Medicaid-funded developmental disability services.

Because 84.7% of Medicaid revenue is concentrated in three codes tied to waiver habilitation and foster-care per-diems, the provider’s financial performance is sensitive to changes in waiver enrollment, utilization patterns, or per-diem/15-minute reimbursement rates for these specific codes. This concentration presents a focused operational profile that payers and network planners should monitor for utilization shifts or policy-driven rate changes affecting those major revenue drivers.

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
T2016	Habilitation, residential, waiver; per diem	18,110	$1,410	$25.5M
T2021	Day habilitation, waiver; per 15 minutes	37,850	$280	$10.4M
S5140	Foster care, adult; per diem	9,590	$460	$4.4M
G9012	Other specified case management service not elsewhere classified	22,090	$180	$4M
T2017	Habilitation, residential, waiver; 15 minutes	15,510	$210	$3.3M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

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

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	19	80	7,300	$1,670	$30.8M
S5140	Foster care, adult; per diem	15	30	9,310	$530	$13.6M
T2021	Day habilitation, waiver; per 15 minutes	18	70	13,340	$200	$5.1M
G9012	Other specified case management service not elsewhere classified	27	50	25,820	$80	$3M
T2017	Habilitation, residential, waiver; 15 minutes	9	30	8,960	$260	$3M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
John F Murphy Homes, Inc.	ME	Nursing Facility/Intermediate Care Facility	$0	$260.1M
Happy Haven, LLC	ME	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$65.3M
Health Affiliates Maine, LLC	ME	Community/Behavioral Health Agency	$0	$61.6M
New Communities, Inc.	ME	Mental Illness Community Based Residential Treatment Facility	$0	$26.4M
Bedard Medical Inc	ME	Durable Medical Equipment & Medical Supplies	$0	$24.6M
Personal Onsite Development	ME	Developmentally Disabled Services Day Training Agency	$0	$9M
Community Clinical Services, Inc.	ME	Federally Qualified Health Center (FQHC)	$0	$5.2M
New England Home Therapies, Inc.	ME	Oxygen Equipment & Supplies (DME)	$0	$4.2M
Maine Oral & Maxillofacial Surgery Associates, P.A.	ME	Oral and Maxillofacial Surgery (Dentist)	$0	$3.5M
City Of Auburn	ME	Land Ambulance	$317.2K	$2.7M

Opportunity Enterprises, Inc. — Billing Profile & Reimbursement Data

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Opportunity Enterprises, 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