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

Why is the Medicaid comparison limited to Rhode Island 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. Rhode Island (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.

Avatar Residential, Inc. (NPI 1053607754)

Field	Value
Entity Type	Organization
Organization	Avatar Residential, Inc.
Address	33 College Hill Rd
City	Warwick
State	RI
ZIP	02886
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	June 22, 2011

Payer Source	Total Paid
Medicaid	$72.9M
Medicare	$0

Key Findings

AVATAR RESIDENTIAL, INC. reports $72.9M in lifetime Medicaid revenue and has no Medicare billing on file, making its active business footprint effectively single-payer Medicaid. The NPI was enumerated 2011-06-22 (~15 years ago), indicating a sustained presence in the market over a multi-year period.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 91.9% of this provider's total Medicaid revenue, driven primarily by T2033, T2021, and T2017. That concentration means a large share of the provider’s financial performance depends on a small set of waiver-related residential and habilitation services.

The code mix indicates a service model centered on residential and day habilitation for individuals with developmental disabilities: T2033 (Residential care, waiver; per diem) contributes $49.2M (67.5%) and T2021 (Day habilitation, waiver; per 15 minutes) contributes $13M (17.8%), with T2017 (Habilitation, residential, waiver; 15 minutes) adding $4.8M (6.6%). The prominence of T2033 and the per-diem structure supports an operational emphasis on long-stay residential care supplemented by day habilitation programs.

Despite the large dollar share of T2033 ($49.2M, 67.5%), AVATAR ranks #11 of 22 in-state for T2033 (52th percentile; typical, unremarkable volume for this code), suggesting that while this code dominates the provider’s revenue mix, the provider is a middling participant statewide rather than a dominant outlier. The percentile and rank position indicate the provider occupies a typical market slot for residential per-diem services.

For T2021 and T2017 the provider also sits in typical in-state positions: T2021 is #17 of 33 (50th percentile; typical, unremarkable volume for this code) and T2017 is #22 of 36 (40th percentile; typical, unremarkable volume for this code). These ranks imply AVATAR’s day habilitation and residential habilitation volumes are unremarkable relative to peers and that it is not a leading statewide provider in those specific service lines.

Secondary service lines contribute modestly to revenue and appear to support the core residential/day habilitation model: T2003 Non-emergency transportation accounted for $2.8M (3.9%), T1005 Respite care accounted for $1.7M (2.3%), and T2022 Case management accounted for $1.1M (1.6%). Each of these codes ranks near the middle of in-state peers (T2003 #30 of 55, 46th percentile; T1005 #11 of 20, 47th percentile; T2022 #16 of 41, 63th percentile), indicating these are modest but consistent ancillary revenue streams.

Payment scale varies markedly across the top codes: T2033 shows an average paid/claim of $6627, far larger than T2021 at $1054 per claim and T2017 at $1572 per claim, reflecting that residential per-diem reimbursement is substantially higher per claim than time-based habilitation services. This disparity in per-claim payments underscores that the provider’s revenue is driven more by room-and-board–style residential reimbursements than by higher-frequency, lower-dollar habilitation units.

Operational anomalies to note: many of the listed codes are described as "typical, unremarkable volume for this code," and no code is flagged as an extreme outlier in the provided data, which supports a characterization of AVATAR as a typical Medicaid waiver provider in Rhode Island. One exception to monitor operationally is T2020, which shows 231 claims with $0 avg paid/claim and $0 revenue (0.0% of total Medicaid revenue) and ranks #13 of 15 (14th percentile; typical, unremarkable volume for this code), suggesting claims activity that did not translate into recorded revenue and warranting further record-level review if needed.

Medicaid: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	7,430	$6,630	$49.2M
T2021	Day habilitation, waiver; per 15 minutes	12,340	$1,050	$13M
T2017	Habilitation, residential, waiver; 15 minutes	3,050	$1,570	$4.8M
T2003	Non-emergency transportation; encounter/trip	6,200	$460	$2.8M
T1005	Respite care services, up to 15 minutes	2,530	$660	$1.7M
T2022	Case management, per month	6,860	$170	$1.1M
T1002	Rn services, up to 15 minutes	650	$310	$198K
T2019	Habilitation, supported employment, waiver; per 15 minutes	70	$670	$44.6K
T2025	Waiver services; not otherwise specified (nos)	20	$580	$13.9K
T2020	Day habilitation, waiver; per diem	230	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Rhode Island Distribution

Avatar Residential, Inc. — 0 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Rhode Island

Full comparison — all codes billed, vs. Rhode Island median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	11	20	6,780	$1,890	$39.8M
T2017	Habilitation, residential, waiver; 15 minutes	22	40	3,820	$510	$10.6M
T2021	Day habilitation, waiver; per 15 minutes	17	30	12,340	$410	$10M
T1005	Respite care services, up to 15 minutes	11	20	2,540	$190	$1.4M
T2025	Waiver services; not otherwise specified (nos)	22	30	620	$70	$1.2M
T2022	Case management, per month	16	40	5,460	$150	$1.2M
T2003	Non-emergency transportation; encounter/trip	30	60	7,480	$80	$1.1M
T2020	Day habilitation, waiver; per diem	13	20	450	$950	$864.4K
T2019	Habilitation, supported employment, waiver; per 15 minutes	12	10	1,870	$230	$688.6K
T1002	Rn services, up to 15 minutes	9	30	280	$110	$253.3K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Bay Residential Services Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$145.8M
Kent County Memorial Hospital	RI	General Acute Care Hospital	$0	$90.8M
Thrive Behavioral Health, Inc.	RI	Community/Behavioral Health Agency	$0	$71.9M
Bayada Home Health Care, Inc.	RI	Home Health Agency	$0	$69.5M
Community Living Of Rhode Island	RI	Developmentally Disabled Services Day Training Agency	$0	$65.7M
J.arthur Trudeau Memorial Center Conversion Waivers	RI	Developmentally Disabled Services Day Training Agency	$0	$57.1M
Gateways To Change, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$54.5M
Affinity Physicians LLC.	RI	Internal Medicine Physician	$0	$41.8M
J, Arthur Trudeau Memorial Center	RI	Developmentally Disabled Services Day Training Agency	$0	$33.9M
J.arthur Trudeau Memorial Home Based Therapy Services	RI	Community/Behavioral Health Agency	$0	$20.3M

Avatar Residential, Inc. — Billing Profile & Reimbursement Data

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Avatar Residential, 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