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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Southeastern Behavioral Healthcare (NPI 1114002573)

Field	Value
Entity Type	Organization
Organization	Southeastern Behavioral Healthcare
Address	2000 S Summit Ave
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	October 26, 2006

Payer Source	Total Paid
Medicaid	$59.1M
Medicare	$0

Key Findings

This entity is effectively single-payer in the available data: there is no Medicare billing on file and all reported government revenue is Medicaid-based, totaling $59.1M. The absence of Medicare claims suggests the organization focuses on state-managed behavioral health and waiver programs rather than fee-for-service Medicare outpatient or inpatient billing.

Revenue is highly concentrated in a small set of waiver and community-support codes: T2016 (26.4M, 44.7%), T2020 (7.7M, 12.9%) and H2016 (6.7M, 11.4%) together account for 69.0% of the provider's total Medicaid revenue. That concentration implies a business model where a few per-diem habilitation and community-support streams drive the bulk of cash flow, increasing sensitivity to policy or rate changes affecting those codes.

T2016 appears to be the single largest revenue driver and is characterized by high per-claim payments and per-diem billing: 6K claims with $4429 avg paid/claim producing $26.4M (44.7%). This pattern is consistent with residential or intensive habilitation operations where fewer encounters generate outsized revenue per day, making T2016 both a financial anchor and a potential point of operational leverage.

H2016 and H2021 reflect a complementary high-volume, wraparound service footprint. H2016 has 87.5K claims at $77 avg paid/claim for $6.7M (11.4%) and ranks #2 of 11 providers in-state (90th percentile; typical, unremarkable volume for this code), while H2021 produced $5.2M (8.7%) on 82.1K claims at $63 avg and ranks #1 of 11 providers in-state (100th percentile; notably above typical state volume for this code). Together these codes indicate heavy delivery of community-based support and wrap-around services at scale.

Competitive standing is mixed by service line: the provider is a statewide leader for H2021 (rank #1 of 11, 100th percentile, notably above typical state volume) and is a strong performer on H2016 (rank #2 of 11, 90th percentile, typical, unremarkable volume), but is a more modest participant on T2016 (rank #12 of 21, 45th percentile, typical, unremarkable volume) and T2020 (rank #8 of 20, 63th percentile, typical, unremarkable volume). This suggests dominance in certain community-based wrap-around services while residential habilitation volumes are typical for the state.

The provider blends high-dollar per-diem services with very high-frequency per-15-minute services, creating a two-tier revenue model: T2016 and T2020 are per-diem habilitation lines (high $/claim), while H2016, H2021 and H0039 are per-diem or per-15-minute community support services with much lower avg paid/claim but very large claim counts (for example, H0039 is 45.4K claims, $79 avg paid/claim, $3.6M, 6.1%). Operationally, this implies separate staffing and capacity needs for residential/day programs versus intensive community support teams.

The billing mix also includes non-waiver clinical and coordination services that diversify revenues modestly: S0281 generated $2.7M (4.6%) on 5K claims at $542 avg paid/claim (rank #13 of 21, 40th percentile; typical, unremarkable volume), and 90863 accounted for $1.2M (2.0%) on 8K claims at $151 avg paid/claim (rank #4 of 12, 73th percentile; typical, unremarkable volume). These lines indicate the provider packages care coordination and pharmacologic management alongside waiver habilitation services.

The provider shows operational longevity with an NPI enumerated 2006-10-26 (~20 years ago), suggesting established participation in state Medicaid programs. That tenure, combined with the provider's concentrated Medicaid revenue base (69.0% coming from the top three codes), points to an established waiver-oriented business that could be sensitive to Medicaid rate or eligibility changes but potentially well-positioned within the state's wrap-around and community-support markets.

Medicaid: Complete Services Breakdown

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

24 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	5,960	$4,430	$26.4M
T2020	Day habilitation, waiver; per diem	7,880	$970	$7.7M
H2016	Comprehensive community support services, per diem	87,460	$80	$6.7M
H2021	Community-based wrap-around services, per 15 minutes	82,110	$60	$5.2M
H0039	Assertive community treatment, face-to-face, per 15 minutes	45,430	$80	$3.6M
T2031	Assisted living; waiver, per diem	2,210	$1,310	$2.9M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	5,020	$540	$2.7M
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	7,960	$150	$1.2M
T2025	Waiver services; not otherwise specified (nos)	5,040	$100	$518.9K
T2014	Habilitation, prevocational, waiver; per diem	5,020	$80	$421.8K

Showing 1–10 of 24

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Southeastern Behavioral Healthcare — 1 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

24 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	12	20	6,880	$1,660	$31.6M
T2020	Day habilitation, waiver; per diem	8	20	7,340	$500	$8.9M
H2016	Comprehensive community support services, per diem	2	10	29,180	$80	$3.6M
H2021	Community-based wrap-around services, per 15 minutes	1	10	47,600	$90	$3.5M
H0039	Assertive community treatment, face-to-face, per 15 minutes	3	10	45,430	$80	$3.3M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	13	20	6,090	$420	$3M
T2025	Waiver services; not otherwise specified (nos)	11	20	5,410	$180	$1.9M
T2031	Assisted living; waiver, per diem	6	40	340	$1,090	$1.1M
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	4	10	5,650	$90	$550.2K
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…	176	340	1,010	$100	$511K

Showing 1–10 of 24

Related Providers

Other providers that share a Tax Identification Number (TIN) with Southeastern Behavioral Healthcare, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Robert Nuss	SD	Neurology Physician	$168.7K	$0
Nicole Robideau	SD	Clinical Social Worker	$12.8K	$0

Nearby Providers

Other providers in the same ZIP code as Southeastern Behavioral Healthcare, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Dakota Achieve	SD	Developmental Disabilities Clinic/Center	$0	$166.9M
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M

Southeastern Behavioral Healthcare — Billing Profile & Reimbursement Data

Sign up for Southeastern Behavioral Healthcare — Billing Profile & Reimbursement Data policy alerts

Southeastern Behavioral Healthcare — Billing Profile & Reimbursement Data

Sign up for Southeastern Behavioral Healthcare — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References