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

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

State Of Delaware (NPI 1104871920)

Field	Value
Entity Type	Organization
Organization	State Of Delaware
Address	805 River Rd
City	Dover
State	DE
ZIP	19901
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	May 23, 2006

Payer Source	Total Paid
Medicaid	$8.2M
Medicare	$0

Key Findings

STATE OF DELAWARE reports $8.2M in lifetime Medicaid revenue and has no Medicare billing on file, making it effectively a Medicaid-only biller in this dataset. Its NPI was enumerated on 2006-05-23 (~20 years ago), indicating long tenure in the registry but a concentrated payer footprint focused on state Medicaid business.

Revenue is extremely concentrated in a single Medicaid service line: T2022 (Case management, per month) accounts for the entirety of reported Medicaid revenue, with the precomputed note that the top 3 Medicaid codes by revenue account for 100.0% of this provider's total Medicaid revenue. This concentration means operational and reimbursement risk is heavily tied to that one monthly case-management code.

Billing volume for T2022 is substantial in absolute claims: the provider reported 31.1K claims for T2022 with an average paid amount of $264 per claim that together comprise $8.2M in Medicaid revenue. The claim-count and the monthly case-management descriptor suggest ongoing, recurring service delivery to a stable client panel rather than episodic or procedure-based care.

The provider’s taxonomy as a Mental Health Clinic/Center (Including Community Mental Health Center) is consistent with heavy reliance on T2022; the code’s description (case management, per month) aligns with community behavioral-health operations that bill monthly care coordination and case-management services rather than discrete therapy or procedural codes. This indicates the organization operates primarily as a case-management / care-coordination provider within Medicaid.

State-level competitive standing for this code is modest: the provider ranks #2 of 2 in-state for T2022 and is listed at the 0th percentile with the label "typical, unremarkable volume for this code." That positioning signals it is not a dominant statewide player for this service and that its T2022 volume falls within expected norms rather than standing out as an outlier.

Because all Medicaid revenue is tied to a single code (T2022) and there is no Medicare revenue on file, payer mix risk is material: changes to Medicaid policy, reimbursement rates for T2022, or enrollment dynamics could materially affect the provider’s revenue stream. Analysts should treat this as a single-payer, single-service concentration when assessing financial vulnerability or contract negotiations.

The high proportion of monthly case-management claims (31.1K) implies significant administrative and billing operational load devoted to recurring monthly submissions; sustaining $8.2M from a single averaged-paid code ($264 avg paid/claim) suggests the business model depends on high-volume, repeatable billing workflows rather than high-margin episodic services. Operational capacity and billing accuracy for recurring claims are therefore likely critical to revenue stability.

Given long tenure in the NPI registry (enumerated 2006-05-23 (~20 years ago)) but limited breadth of billing, this entity appears to be an established community mental health actor with a narrow revenue base. For competitive or strategic analysis, focus on Medicaid case-management reimbursement trends, state-level provider competition for T2022, and any policy shifts affecting monthly case-management authorization and rates.

Medicaid: Complete Services Breakdown

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

1 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2022	Case management, per month	31,050	$260	$8.2M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

State Of Delaware — 0 of 1 code billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

1 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2022	Case management, per month	2	10	40,610	$260	$10.6M

Nearby Providers

Other providers in the same ZIP code as State Of Delaware, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayhealth Medical Center, Inc.	DE	General Acute Care Hospital	$0	$79.3M
Bayhealth Emergency Physicians LLC	DE	Emergency Medicine Physician	$0	$16.7M
Ahl And O'connor Orthodontics, LLC	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$12.5M
Bayhealth Medical Center, Inc	DE	Colon & Rectal Surgery Physician	$0	$12.4M
The Children's Secret Garden	DE	Medically Fragile Infants and Children Day Care	$0	$8.1M
Apogee Medical Group, Delaware, Inc	DE	Internal Medicine Physician	$0	$7.9M
First State Oral And Maxillofacial Surgery Corp	DE	Oral and Maxillofacial Surgery (Dentist)	$0	$5M
Jamie Ahl	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$4.9M
Kent Diagnostic Radiology Associates PA	DE	Diagnostic Radiology Physician	$0	$4.6M
The Mind And Body Consortium, LLC.	DE	Psychiatry Physician	$0	$3.9M

State Of Delaware — Billing Profile & Reimbursement Data

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State Of Delaware — 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