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NPI 1063501476 · Saint Albans, VT · Community/Behavioral Health Agency
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Northwestern Counseling & Support Services Inc is a community/behavioral health agency provider located in Saint Albans, Vermont. This profile covers 0 Medicare and 27 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Northwestern Counseling & Support Services Inc |
| Address | 107 Fisher Pond Rd |
| City | Saint Albans |
| State | VT |
| ZIP | 05478 |
| Taxonomy | Community/Behavioral Health Agency |
| NPI Enumerated | October 12, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $70.4M |
| Medicare | $0 |
This provider is effectively a single-payer Medicaid operation: there is no Medicare billing on file while Medicaid revenue totals $70.4M, indicating the organization’s clinical and billing activity is focused almost entirely on Medicaid populations and programs. Analysts should treat Medicare-related comparisons as inapplicable when evaluating scale or payer diversification for this entity.
Revenue concentration is high and concentrated in a small set of services: the top 3 Medicaid codes account for 88.0% of total Medicaid revenue, with H2015, H2017, and H0023 together dominating the revenue mix. This concentration implies the provider’s financial performance is tightly linked to reimbursement and utilization of community support, psychosocial rehabilitation, and outreach services.
Service-line profile points to community-based behavioral health and intensive support models: large revenue from H2015 (Comprehensive community support services) and H2017 (Psychosocial rehabilitation services) indicates the organization delivers frequent, time-based, community-focused therapeutic services (per 15 minutes). High volumes on these codes suggest operations oriented toward ongoing, contact-intensive psychosocial and community support rather than one-off medical office visits.
Competitive standing in-state is strong for several high-revenue codes: the provider ranks #3 of 19 for H2015 (89th percentile) and #2 of 28 for H2017 (96th percentile), positions that mark it as a major statewide provider of these community support and psychosocial rehabilitation services. For T2025 it ranks #1 of 5 (100th percentile), further signaling outsized volume in certain waiver-related services compared with in-state peers.
Specific code-level outlier signals: 90834 and 90791 are described as "extreme outlier" uses in-state (90834 ranks #2 of 165, 99th percentile; 90791 ranks #2 of 89, 99th percentile), showing unusually high volumes of psychotherapy and psychiatric evaluation claims compared with peers. These outlier patterns suggest the provider also delivers substantial direct psychotherapy and evaluation capacity in addition to its dominant community support work.
Higher-priced, lower-frequency services contribute meaningfully to revenue: H0023 (behavioral health outreach) has 16.1K claims at $692 avg paid/claim producing $11.1M (15.8% of Medicaid revenue), and T2025 (waiver services) records $6.4M (9.1% of Medicaid revenue). This mix of high-frequency low-unit services (H2015/H2017) and lower-frequency higher-unit services (H0023/T2025) shapes total revenue concentration and operational cashflow considerations.
Clinical breadth beyond the top codes is limited in revenue share but notable in scope: a range of psychotherapy CPT codes (90833, 90837, 90853) and evaluation/management codes (99213, 99214) appear with nonzero volumes, indicating the provider maintains outpatient psychotherapy and E/M services, though these account for under 1% each of total Medicaid revenue. These smaller lines may reflect ancillary clinic-based services layered on a dominant community-support program model.
Organizational tenure supports an established presence: the NPI was enumerated on 2006-10-12 (~20 years ago), which aligns with the high in-state ranks and large cumulative Medicaid volumes—consistent with a long-standing community behavioral health agency with entrenched payer relationships and service lines. Analysts should consider this tenure when benchmarking retention, referral networks, and historical volume trends.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
27 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H2015 | Comprehensive community support services, per 15 minutes | 201,900 | $130 | $26.9M |
| H2017 | Psychosocial rehabilitation services, per 15 minutes | 202,880 | $120 | $23.9M |
| H0023 | Alcohol and/or drug outreach | 16,110 | $690 | $11.1M |
| T2025 | Waiver services; not otherwise specified (nos) | 6,160 | $1,040 | $6.4M |
| H0046 | Mental health services, not otherwise specified | 490 | $2,280 | $1.1M |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 32,310 | $10 | $258.5K |
| T1017 | Targeted case management, each 15 minutes | 7,500 | $30 | $225.1K |
| H2011 | Crisis intervention service, per 15 minutes | 13,370 | $20 | $200.6K |
| H2014 | Skills training and development, per 15 minutes | 10,460 | $10 | $62.8K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 4,210 | $10 | $54.8K |
Showing 1–10 of 27
How this provider's Medicaid billing volume and revenue compare to other Vermont providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Vermont median
27 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0023 | Alcohol and/or drug outreach | 2 | 10 | 6,170 | $900 | $8.7M |
| H2015 | Comprehensive community support services, per 15 minutes | 3 | 20 | 64,230 | $90 | $7.1M |
| H2017 | Psychosocial rehabilitation services, per 15 minutes | 2 | 30 | 6,730 | $110 | $4.1M |
| H0046 | Mental health services, not otherwise specified | 5 | 10 | 330 | $1,360 | $3.1M |
| T2025 | Waiver services; not otherwise specified (nos) | 1 | 10 | 1,270 | $820 | $2.1M |
| H2014 | Skills training and development, per 15 minutes | 5 | 10 | 7,770 | $60 | $599.6K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 92 | 320 | 680 | $30 | $146.1K |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 360 | 670 | 760 | $70 | $143.9K |
| T1017 | Targeted case management, each 15 minutes | 6 | 20 | 1,580 | $30 | $102.9K |
| H2011 | Crisis intervention service, per 15 minutes | 3 | 20 | 1,680 | $20 | $96.2K |
Showing 1–10 of 27
Other providers in the same ZIP code as Northwestern Counseling & Support Services Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Northwestern Counseling & Support Services | VT | Community/Behavioral Health Agency | $0 | $129.9M |
| Amcare Medical Systems, Inc. | VT | Land Ambulance | $576.2K | $2.2M |
| Baart Behavioral Health Services, Inc. | VT | Substance Use Disorder Rehabilitation Clinic/Center | $180.2K | $2.5M |
| Northwestern Medical Center, Inc. | VT | Pediatrics Physician | $0 | $1.4M |
| Northwestern Medical Center, Inc. | VT | General Acute Care Hospital | $0 | $1.1M |
| Remy Vallee Dmd Inc | VT | Dentist | $0 | $1.1M |
| Calm Reflections Psychotherapy, LLC | VT | Clinical Social Worker | $0 | $840.8K |
| Northwestern Medical Center, Inc. | VT | Urgent Care Clinic/Center | $0 | $757.2K |
| Northern Valley Eyecare, Inc. | VT | Optometrist | $0 | $703.1K |
| Michelle Pelkey | VT | Clinical Social Worker | $0 | $550.9K |
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