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

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

Community Living Association (NPI 1144274564)

Field	Value
Entity Type	Organization
Organization	Community Living Association
Address	45 School St
City	Houlton
State	ME
ZIP	04730
Taxonomy	Nursing Care Agency
NPI Enumerated	May 20, 2006

Payer Source	Total Paid
Medicaid	$30.4M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $30.4M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid) operator in the tracked data. Analysts should treat Medicaid program changes as the primary driver of this entity's financial risk and opportunity given the absence of Medicare activity.

Revenue is highly concentrated: the top three Medicaid codes (T2016, T2021, G9012) account for 97.3% of the provider's Medicaid revenue. That concentration means shifts in reimbursement or utilization for these specific services would materially affect overall revenue.

The code mix points to a habilitation-centered operating model: T2016 (Habilitation, residential, waiver; per diem) generates $17.4M from 8.2K claims at an $2118 avg paid/claim, and T2021 (Day habilitation, waiver; per 15 minutes) contributes $8.2M from 19.2K claims at a $427 avg paid/claim. Together these codes (T2016 and T2021) account for 57.1% and 26.9% of Medicaid revenue respectively, indicating the provider focuses on residential and day habilitation services rather than acute skilled nursing or typical home health lines.

G9012 (Other specified case management service not elsewhere classified) represents $4M in revenue from 80.8K claims at a $50 avg paid/claim and is listed as having "typical, unremarkable volume" despite ranking #8 of 50 providers in-state (86th percentile). The combination of very high claim volume and low per-claim payment suggests a substantial case management or care coordination workload that complements the habilitation services.

Competitive standing by code is modest-to-strong in-state: T2016 ranks #35 of 75 (54th percentile) and T2021 ranks #30 of 72 (59th percentile), both described as "typical, unremarkable volume," so the provider is a routine participant for residential and day habilitation rather than a market leader. By contrast, G9012's rank of #8 of 50 (86th percentile) indicates relatively stronger placement among peers for case management activity even though the dataset labels that volume as "typical, unremarkable."

Ancillary service lines are small: S5140 (Foster care, adult; per diem) accounts for $621.8K (2.0% of Medicaid revenue) and ranks #31 of 31 providers in-state (0th percentile) with "typical, unremarkable volume," and H2023 (Supported employment, per 15 minutes) accounts for $208.3K (0.7% of Medicaid revenue) and ranks #12 of 21 (45th percentile) with "typical, unremarkable volume." These figures indicate limited exposure to foster care and supported employment revenue streams.

The provider's NPI was enumerated on 2006-05-20 (~20 years ago), signifying long tenure in the market and likely established relationships with state Medicaid programs and local referral sources. Tenure supports operational continuity but does not alter the concentrated Medicaid exposure identified above.

Given that the top three codes represent 97.3% of Medicaid revenue and there is no Medicare activity, analysts should prioritize monitoring policy, rate, and waiver changes affecting T2016, T2021, and G9012. Changes to per-diem residential habilitation, day habilitation billing rules, or case management reimbursement would be the most direct levers to impact this provider's financial profile.

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	8,200	$2,120	$17.4M
T2021	Day habilitation, waiver; per 15 minutes	19,190	$430	$8.2M
G9012	Other specified case management service not elsewhere classified	80,820	$50	$4M
S5140	Foster care, adult; per diem	160	$3,820	$621.8K
H2023	Supported employment, per 15 minutes	2,170	$100	$208.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Community Living Association — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	35	80	7,300	$1,670	$30.8M
S5140	Foster care, adult; per diem	31	30	9,310	$530	$13.6M
T2021	Day habilitation, waiver; per 15 minutes	30	70	13,340	$200	$5.1M
G9012	Other specified case management service not elsewhere classified	8	50	25,820	$80	$3M
H2023	Supported employment, per 15 minutes	12	20	2,330	$160	$673K

Nearby Providers

Other providers in the same ZIP code as Community Living Association, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Katahdin Valley Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$22.5M
Houlton Regional Hospital	ME	Rural Health Clinic/Center	$0	$7M
Houlton Band Of Maliseet Indians	ME	Clinic/Center	$0	$4.3M
Houlton Regional Hospital	ME	Critical Access Hospital	$0	$4.1M
A New Start LLC	ME	Social Worker	$0	$3.5M
Houlton Regional Hospital	ME	Rural Health Clinic/Center	$0	$3.1M
Town Of Houlton	ME	Land Ambulance	$243.2K	$1.6M
Abc Behave LLC	ME	Developmental Therapist	$0	$1.4M
Southern Aroostook Ems Authority	ME	Land Ambulance	$126.7K	$343.9K
Simon Ouaknine	ME	Urology Physician	$129.2K	$120

Community Living Association — Billing Profile & Reimbursement Data

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Community Living Association — 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