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

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

Gandara Mental Health Center Inc (NPI 1134107113)

Field	Value
Entity Type	Organization
Organization	Gandara Mental Health Center Inc
Address	2155 Main St
City	Springfield
State	MA
ZIP	01104
Taxonomy	Mental Health Counselor
NPI Enumerated	January 9, 2006

Payer Source	Total Paid
Medicaid	$133.1M
Medicare	$0

Key Findings

GANDARA MENTAL HEALTH CENTER INC reports $133.1M in lifetime Medicaid revenue and has no Medicare billing on file, meaning its footprint is effectively single‑payer Medicaid-focused rather than split across Medicare/Medicaid. The provider’s NPI was enumerated 2006-01-09 (~20 years ago), indicating a long-tenured operation concentrated in the Medicaid market.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 64.2% of the provider’s total Medicaid revenue, led by H2019 ($38.5M, 29.0%), H0019 ($30.8M, 23.1%), and H0023 ($16.2M, 12.2%). This concentration signals that a few high-volume behavioral health service lines drive most of the organization’s Medicaid income.

The code mix (H2019, H0019, H0023, plus strong volumes in H2014 and T1027) maps to a service model built around intensive community and residential behavioral health: H0019 is long‑term residential per diem care, H2019 and H2014 are per‑15‑minute therapeutic services and skills training, and H0023 is planned outreach. Together these codes indicate the provider operates both high‑volume direct therapeutic contact (per‑15‑minute services) and per‑diem residential placements, suggesting a blended residential/community treatment platform rather than a narrow outpatient-only practice.

GANDARA is a dominant statewide provider for several core codes: H0019 ranks #1 of 75 in-state (100th percentile; extreme outlier) and H2019 ranks #3 of 294 (99th percentile; extreme outlier), which positions the organization as a major player for long‑term residential and therapeutic behavioral services in Massachusetts. By contrast, H0023 ranks #6 of 37 (86th percentile; typical, unremarkable volume), indicating outreach is substantial but less uniquely dominant versus residential and therapeutic services.

Beyond the three revenue leaders, the provider shows notable scale in psychotherapy and skill-building services that broaden its clinical offering: H2014 ($14.2M, 10.7%) ranks #4 of 189 (98th percentile; notably above typical), T1027 ($11.1M, 8.4%) ranks #6 of 131 (96th percentile; notably above typical), and 90834 ($7.7M, 5.8%) ranks #37 of 1617 (98th percentile; notably above typical). These placements demonstrate significant outpatient psychotherapy, family training, and skills development activity that function as complementary revenue streams to the residential/per‑diem business.

Claim volumes are very large for core codes, consistent with high utilization intensity: H0023 shows 300.1K claims, H2016 259.4K claims, H2019 258.6K claims, and H0019 184.3K claims. Those multi‑hundred‑thousand claim counts point to either high-frequency service delivery, a large patient census, or multi-site operations and imply operational scale that should be considered when benchmarking cost, capacity, and utilization.

The provider’s heavy reliance on per‑diem and per‑15‑minute Medicaid reimbursement streams concentrates financial exposure to state policy and rate changes tied to those codes. Given that the top three codes (H2019, H0019, H0023) together make up 64.2% of Medicaid revenue, shifts in per‑unit rates, prior authorization rules, or eligibility requirements for these specific services would likely materially affect overall revenue.

For analysts, the absence of Medicare billing limits direct Medicare comparisons and benchmarking; state peer ranks and percentiles are the appropriate competitive context. With ~20 years of enumeration and extreme outlier rankings on H0019 and H2019, GANDARA should be treated as an established, high‑volume Medicaid behavioral health provider in Massachusetts whose competitive posture is strongest in residential and high‑frequency therapeutic service lines.

Medicaid: Complete Services Breakdown

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

27 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2019	Therapeutic behavioral services, per 15 minutes	258,630	$150	$38.5M
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	184,250	$170	$30.8M
H0023	Alcohol and/or drug outreach	300,140	$50	$16.2M
H2014	Skills training and development, per 15 minutes	95,520	$150	$14.2M
T1027	Family training and counseling for child development, per 15 minutes	97,800	$110	$11.1M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	84,160	$90	$7.7M
H2016	Comprehensive community support services, per diem	259,410	$20	$4.4M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	27,810	$120	$3.4M
H2015	Comprehensive community support services, per 15 minutes	16,310	$80	$1.3M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	7,440	$140	$1M

Showing 1–10 of 27

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Gandara Mental Health Center Inc — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

27 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	1	80	5,200	$370	$8.4M
H0023	Alcohol and/or drug outreach	6	40	127,370	$50	$8.2M
H2015	Comprehensive community support services, per 15 minutes	62	150	7,770	$140	$4.8M
H2014	Skills training and development, per 15 minutes	4	190	21,080	$110	$3M
H2019	Therapeutic behavioral services, per 15 minutes	3	290	3,680	$150	$2.9M
T1027	Family training and counseling for child development, per 15 minutes	6	130	4,300	$110	$2.1M
H2016	Comprehensive community support services, per diem	5	80	4,550	$30	$1.6M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	119	410	140	$110	$742.2K
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	28	60	2,800	$110	$659.4K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	37	1,620	580	$80	$599.6K

Showing 1–10 of 27

Nearby Providers

Other providers in the same ZIP code as Gandara Mental Health Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Behavioral Health Network Inc	MA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$238.6M
Behavioral Health Network, Inc	MA	Methadone Clinic	$1.3M	$108.4M
The Mercy Hospital Inc	MA	General Acute Care Hospital	$0	$98.9M
Behavioral Health Network, Inc	MA	Adult Day Care Clinic/Center	$0	$76.5M
American Medical Response Of Massachusetts Inc	MA	Ambulance	$8.7M	$51.7M
Greater Springfield Senior Services, Inc.	MA	Case Management Agency	$0	$55.1M
Viability, Inc.	MA	Adult Care Home Facility	$0	$46.8M
Riverbend Medical Group, Inc.	MA	Internal Medicine Physician	$0	$38.8M
International Health Solutions,inc	MA	Home Health Agency	$0	$27.3M
Greater Springfield Senior Services, Inc.	MA	Case Management Agency	$0	$25.4M

Gandara Mental Health Center Inc — Billing Profile & Reimbursement Data

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Gandara Mental Health Center 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