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

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

Vista Care South Dakota, LLC (NPI 1124586037)

Field	Value
Entity Type	Organization
Organization	Vista Care South Dakota, LLC
Address	708 Erie Ave
City	Sheboygan
State	WI
ZIP	53081
Taxonomy	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NPI Enumerated	March 10, 2019

Payer Source	Total Paid
Medicaid	$20M
Medicare	$0

Key Findings

VISTA CARE SOUTH DAKOTA, LLC is effectively a single‑payer Medicaid provider: it reports no Medicare billing on file and $20M in lifetime Medicaid revenue. The NPI was enumerated 2019-03-10 (~7 years ago), indicating roughly seven years of enrollment activity in this specialty area.

Revenue is extremely concentrated in a few waiver habilitation codes: the top three Medicaid codes together account for 96.3% of this provider’s total Medicaid revenue, with T2016 alone representing $14.7M (73.7% of Medicaid revenue) across 3.8K claims at an average paid per claim of $3914. This concentration means a large share of overall financial performance hinges on a very small set of per‑diem waiver services.

The provider’s code mix indicates a core business built around residential and day habilitation with care coordination: T2016 is billed as Habilitation, residential, waiver (per diem) and T2020 is Day habilitation, waiver (per diem), while S0281 reflects Medical home program/comprehensive care coordination. Together these codes suggest operations focused on long‑term residential supports plus facility‑based day programming and formal care planning for individuals with intellectual or developmental disabilities.

Despite T2016 driving 73.7% of this provider’s Medicaid revenue, its competitive standing on that code is modest within the state: T2016 ranks #4 of 4 providers in‑state (0th percentile; typical, unremarkable volume for this code). In other words, this provider relies heavily on residential waiver revenue but is not a dominant billed volume leader for that specific code among in‑state peers.

By contrast, the provider is a state leader for day habilitation: T2020 generated $3.3M (16.5% of Medicaid revenue) over 5.1K claims with a $649 average paid per claim and ranks #1 of 10 providers in‑state (100th percentile; notably above typical state volume for this code). That outlier status on T2020 signals relative market strength in day habilitation services despite that code representing a smaller share of total revenue than T2016.

S0281 (Medical home program, comprehensive care coordination) contributes $1.2M (6.1% of Medicaid revenue) across 3K claims at $401 average paid and ranks #2 of 3 providers in‑state (50th percentile; typical, unremarkable volume for this code). This indicates the provider maintains a meaningful, though not leading, role in formalized care coordination and planning within the waiver space.

The provider bills a range of additional waiver services at much smaller scale — for example, T2018 ($383K, 1.9% of Medicaid revenue) and T2019 ($165.7K, 0.8% of Medicaid revenue) — which shows some service breadth into supported employment and per‑15‑minute habilitation, but these are not material revenue drivers. These smaller lines likely support programmatic breadth rather than substitute for the revenue concentration tied to the top per‑diem codes.

The operational and payor risk profile is elevated by single‑payer dependence and revenue concentration: with no Medicare revenue and the top three Medicaid codes comprising 96.3% of Medicaid receipts, the provider is sensitive to Medicaid reimbursement policy, waiver rate adjustments, or utilization shifts affecting T2016/T2020/S0281. Given ~7 years since NPI enumeration, the organization appears established in the waiver market but would face notable financial impact from changes to a small number of high‑revenue codes.

Medicaid: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	3,770	$3,910	$14.7M
T2020	Day habilitation, waiver; per diem	5,100	$650	$3.3M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	3,030	$400	$1.2M
T2018	Habilitation, supported employment, waiver; per diem	1,540	$250	$383K
T2019	Habilitation, supported employment, waiver; per 15 minutes	560	$300	$165.7K
T2025	Waiver services; not otherwise specified (nos)	1,650	$80	$127.4K
T2014	Habilitation, prevocational, waiver; per diem	310	$150	$47K
T2028	Specialized supply, not otherwise specified, waiver	400	$60	$25.4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Vista Care South Dakota, LLC — 2 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	4	10	33,230	$460	$28.6M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	2	10	3,030	$110	$2M
T2020	Day habilitation, waiver; per diem	1	10	590	$650	$949.6K
T2019	Habilitation, supported employment, waiver; per 15 minutes	6	20	240	$270	$235.5K
T2014	Habilitation, prevocational, waiver; per diem	5	10	370	$420	$228K
T2018	Habilitation, supported employment, waiver; per diem	1	10	790	$280	$225.6K
T2028	Specialized supply, not otherwise specified, waiver	20	40	340	$210	$188.6K
T2025	Waiver services; not otherwise specified (nos)	10	30	570	$70	$149.4K

Nearby Providers

Other providers in the same ZIP code as Vista Care South Dakota, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sheboygan County Health & Human Services	WI	Community/Behavioral Health Agency	$0	$19.3M
Lakeshore Community Health Care, Inc	WI	Federally Qualified Health Center (FQHC)	$0	$14.7M
Aurora Health Care Central, Inc.	WI	General Acute Care Hospital	$0	$12.4M
Universal Home Health Care, Inc	WI	Home Health Agency	$0	$11.6M
St. Nicholas Hospital-sisters Of The Third Order Of St Francis	WI	General Acute Care Hospital	$0	$5M
Sheboygan County Health & Human Services	WI	Case Management Agency	$0	$4.1M
Sheboygan Area School District	WI	Local Education Agency (LEA)	$0	$3.9M
William Shows	WI	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$3.9M
Hospice Advantage, LLC	WI	Community Based Hospice Care Agency	$0	$3.6M
Vista Care Colorado, LLC	WI	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$3.2M

Vista Care South Dakota, LLC — Billing Profile & Reimbursement Data

Sign up for Vista Care South Dakota, LLC — Billing Profile & Reimbursement Data policy alerts

Vista Care South Dakota, LLC — Billing Profile & Reimbursement Data

Sign up for Vista Care South Dakota, LLC — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References