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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Eastern Panhandle Mental Health Center (waiver) (NPI 1093135584)

Field	Value
Entity Type	Organization
Organization	Eastern Panhandle Mental Health Center (waiver)
Address	235 S Water St
City	Martinsburg
State	WV
ZIP	25401
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	April 23, 2014

Payer Source	Total Paid
Medicaid	$28.8M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and is effectively a single-payer (Medicaid) operation by scale: Total Medicaid revenue is $28.8M and there is no recorded Medicare revenue. Analysts should treat this entity as primarily participating in Medicaid waiver and community behavioral health markets rather than fee-for-service Medicare channels.

Revenue is highly concentrated in a very small set of Medicaid waiver codes: the top three codes together account for 88.7% of this provider's total Medicaid revenue, indicating that a few service lines drive nearly all billed Medicaid dollars. This concentration elevates operational and reimbursement risk tied to policy or rate changes affecting those specific codes.

S5125 (Attendant care services; per 15 minutes) is the single largest revenue driver with $19.2M revenue (66.7% of total Medicaid revenue) and 282.1K claims, and the provider ranks #2 of 43 in-state (98th percentile; extreme outlier). This positioning shows the organization operates a very large attendant care program relative to peers, implying substantial direct-support staffing and 15-minute unit billing volume.

T2021 (Day habilitation, waiver; per 15 minutes) is the second major driver with $5.3M revenue (18.5% of total Medicaid revenue) from 144K claims, and the provider ranks #1 of 57 in-state (100th percentile; extreme outlier). The combination of dominant T2021 and S5125 volumes indicates a business model centered on home- and community-based waiver services and day habilitation programs rather than episodic clinical encounters.

G9002 (Coordinated care fee, maintenance rate) contributes $1M (3.5% of Medicaid revenue) with 4.9K claims and ranks #39 of 123 in-state (69th percentile; typical, unremarkable). This suggests the provider receives routine coordinated care/maintenance payments at levels consistent with many peers, and it is not relying on care coordination fees to drive revenue.

Other Medicaid service lines show pockets of elevated activity that support the dominant waiver profile: A0120 (non-emergency transportation, mini-bus) generated $482.6K (1.7% of revenue) across 32.2K claims and ranks #4 of 50 (94th percentile; notably above typical), and T1003 (LPN/LVN, up to 15 minutes) delivered $374.3K (1.3%) across 20.8K claims and ranks #3 of 33 (94th percentile; notably above typical). These patterns are consistent with a provider operating substantial transportation and licensed nursing capacity to support high-volume community services.

More administrative and care-management activity appears routine rather than outsized: T1016 (case management) and T1002 (RN services) each produce under $1M in revenue and sit in mid to upper percentiles (T1016 rank #37 of 96, 62nd percentile; T1002 rank #44 of 151, 71st percentile), indicating case-management and nursing are regular components of the service mix but not the primary revenue levers. Stakeholders should view these functions as supportive infrastructure for the large attendant care and day habilitation operations.

The provider has an established operational tenure, with its NPI enumerated on 2014-04-23 (~12 years ago), which aligns with the scale and maturity implied by multi-year, high-volume waiver billing. Given the extreme outlier status on key waiver codes, payers and competitors should consider this entity a major statewide provider in attendant care and day habilitation services and monitor any policy or rate changes affecting those specific codes closely.

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
S5125	Attendant care services; per 15 minutes	282,080	$70	$19.2M
T2021	Day habilitation, waiver; per 15 minutes	144,040	$40	$5.3M
G9002	Coordinated care fee, maintenance rate	4,930	$210	$1M
T1016	Case management, each 15 minutes	4,890	$180	$885.1K
T1002	Rn services, up to 15 minutes	3,810	$150	$556.8K
A0160	Non-emergency transportation: per mile - case worker or social worker	3,770	$140	$515.9K
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	32,170	$20	$482.6K
T1003	Lpn/lvn services, up to 15 minutes	20,800	$20	$374.3K
T1005	Respite care services, up to 15 minutes	230	$1,110	$251.3K
T2024	Service assessment/plan of care development, waiver	2,760	$60	$176.8K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Eastern Panhandle Mental Health Center (waiver) — 2 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	2	40	14,820	$750	$30.5M
T2021	Day habilitation, waiver; per 15 minutes	1	60	6,490	$120	$2.2M
T1005	Respite care services, up to 15 minutes	29	30	2,980	$250	$1.5M
G9002	Coordinated care fee, maintenance rate	39	120	2,950	$150	$901.9K
T1003	Lpn/lvn services, up to 15 minutes	3	30	2,070	$90	$522.7K
T1016	Case management, each 15 minutes	37	100	2,790	$90	$496.2K
A0160	Non-emergency transportation: per mile - case worker or social worker	40	110	2,030	$50	$278.8K
T1002	Rn services, up to 15 minutes	44	150	1,980	$40	$232.6K
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	4	50	1,390	$30	$183.1K
T2024	Service assessment/plan of care development, waiver	9	50	760	$50	$95.5K

Nearby Providers

Other providers in the same ZIP code as Eastern Panhandle Mental Health Center (waiver), ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shenandoah Valley Medical System, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$61M
City Hospital, Inc	WV	General Acute Care Hospital	$0	$41.1M
Stepping Stones Cottages, LLC	WV	Counseling Psychologist	$0	$26.6M
University Healthcare Physicians, Inc.	WV	Family Medicine Physician	$0	$17.5M
American Family Matters LLC	WV	Community/Behavioral Health Agency	$0	$16.9M
Berkeley County Emergency Ambulance Authority	WV	Land Ambulance	$864.6K	$5.6M
Eastern Panhandle Mental Health (rehab)	WV	Community/Behavioral Health Agency	$0	$5.7M
City Of Martinsburg	WV	Land Ambulance	$222.2K	$2.7M
Lance Pittman	WV	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$2.3M
Wv Pediatric Dentistry PLLC	WV	Pediatric Dentistry	$0	$2M

Eastern Panhandle Mental Health Center (waiver) — Billing Profile & Reimbursement Data

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Eastern Panhandle Mental Health Center (waiver) — 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