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.

Downeast Horizons Inc (NPI 1073653754)

Field	Value
Entity Type	Organization
Organization	Downeast Horizons Inc
Address	1200 State Highway 3
City	Bar Harbor
State	ME
ZIP	04609
Taxonomy	Case Management Agency
NPI Enumerated	February 8, 2007

Payer Source	Total Paid
Medicaid	$52.5M
Medicare	$0

Key Findings

DOWNEAST HORIZONS INC reports $52.5M in lifetime Medicaid revenue and has no Medicare billing on file, making its operational footprint effectively single-payer (Medicaid) at scale. The absence of Medicare activity suggests the organization’s services and billing profile are concentrated in Medicaid-covered habilitation and waiver programs rather than traditional Medicare-covered clinical services.

Revenue concentration is high: the provider’s top three Medicaid codes—T2016, T2021, and H2021—together account for 87.4% of its total Medicaid revenue. Those three codes individually generated $22.2M (42.2%), $15.2M (28.9%), and $8.6M (16.3%) respectively, indicating that a small set of waivered habilitation and community-support services drive the vast majority of receipts.

The code mix (T2016 – Habilitation, residential, waiver; per diem; T2021 – Day habilitation, waiver; per 15 minutes; and H2021 – Community-based wrap-around services, per 15 minutes) points to a business model focused on ongoing residential habilitation, day-program services, and time-based community supports. This pattern is consistent with a case management agency that delivers direct, recurring care under Medicaid waiver structures rather than episodic medical procedures.

DOWNEAST HORIZONS is a significant state-level provider for day habilitation services: T2021 revenue of $15.2M ranks #3 of 72 providers in-state (97th percentile) and is explicitly described as “notably above typical state volume.” This ranking signals a strong competitive position in the in-state market for day habilitation.

For residential habilitation and wrap-around services the provider’s standing is solid though not singularly dominant: T2016 ($22.2M) ranks #6 of 75 (93rd percentile) and H2021 ($8.6M) ranks #15 of 104 (86th percentile), both characterized as typical or unremarkable volume relative to peers. S5140 (Foster care, adult; per diem) also contributes meaningful scale ($6.5M, 12.4% of Medicaid revenue) and ranks #7 of 31 (80th percentile), reinforcing a broader footprint across waiver-related service lines.

Several listed codes are negligible in economic impact and indicate limited diversification into ancillary services: T2017 contributed $104.3K (0.2% of Medicaid revenue, rank #29 of 34, 15th percentile) and H2023 contributed $24.8K (0.0% of Medicaid revenue, rank #21 of 21, 0th percentile). These low-volume items suggest the provider’s operations and billing are tightly concentrated in a few core waiver service types rather than across many small service lines.

The provider’s NPI has been enumerated since 2007-02-08 (~19 years ago), indicating long tenure in Medicaid-managed waivers and related service contracts. That longevity, combined with a $52.5M Medicaid revenue base, supports the view of an established regional operator in waiver habilitation and community supports.

The heavy dependence on per-diem and per-15-minute waiver codes and the fact that 87.4% of Medicaid revenue is concentrated in three codes imply sensitivity to reimbursement or policy shifts affecting those specific codes. Given the absence of Medicare revenue, any state-level Medicaid policy changes affecting T2016, T2021, or H2021 would likely have outsized impact on the provider’s financial profile and competitive position.

Medicaid: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	53,260	$420	$22.2M
T2021	Day habilitation, waiver; per 15 minutes	96,610	$160	$15.2M
H2021	Community-based wrap-around services, per 15 minutes	35,910	$240	$8.6M
S5140	Foster care, adult; per diem	40,390	$160	$6.5M
T2017	Habilitation, residential, waiver; 15 minutes	930	$110	$104.3K
H2023	Supported employment, per 15 minutes	40	$650	$24.8K

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

Downeast Horizons Inc — 1 of 6 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

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	6	80	7,300	$1,670	$30.8M
S5140	Foster care, adult; per diem	7	30	9,310	$530	$13.6M
T2021	Day habilitation, waiver; per 15 minutes	3	70	13,340	$200	$5.1M
H2021	Community-based wrap-around services, per 15 minutes	15	100	8,660	$290	$5.1M
T2017	Habilitation, residential, waiver; 15 minutes	29	30	8,960	$260	$3M
H2023	Supported employment, per 15 minutes	21	20	2,330	$160	$673K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mount Desert Island Hospital	ME	Critical Access Hospital	$0	$1.6M
Maureen Magut Charette	ME	Diagnostic Radiology Physician	$114.1K	$0
Town Of Bar Harbor	ME	Ambulance	$79.4K	$16.2K
Michael Mason	ME	Surgery Physician	$23.2K	$0
John Bernhard	ME	Nurse Practitioner	$14.9K	$0
Gerald Gerrish	ME	Chiropractor	$13.9K	$0
Aaron Perme	ME	Surgery Physician	$5.5K	$0

Downeast Horizons Inc — Billing Profile & Reimbursement Data

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Downeast Horizons 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