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

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

Sundown M Ranch (NPI 1154474104)

Field	Value
Entity Type	Organization
Organization	Sundown M Ranch
Address	2280 State Route 821
City	Yakima
State	WA
ZIP	98901
Taxonomy	Substance Abuse Rehabilitation Facility
NPI Enumerated	January 20, 2007

Payer Source	Total Paid
Medicaid	$39.8M
Medicare	$0

Key Findings

SUNDOWN M RANCH is effectively a Medicaid-focused provider: there is no Medicare billing on file and the provider reports $39.8M of Medicaid revenue. The NPI was enumerated on 2007-01-20 (~19 years ago), indicating an established presence in the market but with revenue concentrated in a single public payer.

Medicaid revenue is highly concentrated in a very small set of codes: the precomputed top three Medicaid codes account for 97.5% of the provider’s total Medicaid revenue, with H0018 alone making up $36.7M (92.2% of Medicaid revenue). This concentration implies that a single service line — short-term residential per-diem care — is the dominant revenue driver for the business.

The top revenue-driving code, H0018 (short-term residential, per diem), shows very high volume with 34.6K claims and an average paid/claim of $1060. H0018 ranks #9 of 59 in-state (86th percentile) and is described in the source as having "typical, unremarkable volume" for this code; operationally this positions the facility as an upper-tier but not uniquely dominant provider of short-term residential treatment within the state.

Secondary Medicaid revenue comes from per-diem and group-treatment codes: H2036 (alcohol and/or other drug treatment program, per diem) generated $1.3M from 5.5K claims at $243 avg paid/claim, and 96165 (group behavioral health service, additional 15 minutes) produced $748.3K from 11.5K claims at $65 avg paid/claim. Together with H0018 these three codes drive the bulk of revenue (97.5%), reflecting a mixed service model of residential per-diem care supplemented by frequent, lower-paid group therapy sessions.

Competitive standing across the top non-H0018 codes is modest. H2036 ranks #32 of 68 in-state (54th percentile) and 96165 ranks #48 of 224 in-state (79th percentile), with both labeled as "typical, unremarkable volume"; this suggests the provider participates steadily in statewide markets for per-diem and group behavioral services but is not an outlier or market dominator for those lines.

A small portion of revenue is tied to long-term residential care: H0019 accounts for $457.9K (1.2% of Medicaid revenue) from 113 claims at a $4052 avg paid/claim and ranks #52 of 54 (4th percentile). This indicates long-term residential services are present but limited in scale relative to the provider’s dominant short-term residential activity.

The claims and payment mix highlights how price and volume interact to create the revenue profile: H0018 combines very high claim volume (34.6K claims) with a relatively high avg paid/claim ($1060) to generate the lion’s share of revenue, while 96165 and H2036 show much higher claim counts relative to their per-claim payments (11.5K claims at $65 and 5.5K claims at $243, respectively). This mix suggests operational emphasis on occupancy-based, per-diem residential care supported by routine group-based clinical encounters.

Several smaller codes point to administrative or ancillary activity that does not materially affect revenue: for example, H0047 shows 509 claims with $0 avg paid/claim and $0 revenue, and lower-volume assessment/screening codes (H0001, H0003) together contribute negligible revenue. These entries may reflect non-billable or zero-paid encounters and underscore how the provider’s financial exposure is concentrated in the paid per-diem residential codes rather than dispersed across many modestly paid services.

Medicaid: Complete Services Breakdown

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

11 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	34,590	$1,060	$36.7M
H2036	Alcohol and/or other drug treatment program, per diem	5,550	$240	$1.3M
96165	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	11,510	$70	$748.3K
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	110	$4,050	$457.9K
96164	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	13,030	$20	$273.6K
H0004	Behavioral health counseling and therapy, per 15 minutes	2,340	$70	$152.2K
96153	N/A	4,870	$20	$102.3K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	80	$80	$6.4K
H0001	Alcohol and/or drug assessment	300	$10	$2.4K
H0003	Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs	50	$10	$500

Showing 1–10 of 11

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Sundown M Ranch — 0 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

11 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	9	60	8,670	$280	$4.9M
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	52	50	4,000	$60	$1.5M
H0004	Behavioral health counseling and therapy, per 15 minutes	149	320	2,080	$60	$495.5K
96165	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	48	220	2,880	$50	$431K
H2036	Alcohol and/or other drug treatment program, per diem	32	70	4,930	$20	$344.7K
96164	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	47	230	3,070	$20	$135.6K
96153	N/A	72	210	2,910	$20	$105.2K
H0001	Alcohol and/or drug assessment	90	210	220	$150	$104K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	264	530	80	$90	$87.4K
H0003	Alcohol and/or drug screening; laboratory analysis of specimens for presence of alcohol and/or drugs	28	30	250	$20	$54.6K

Showing 1–10 of 11

Nearby Providers

Other providers in the same ZIP code as Sundown M Ranch, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Yakima Valley Council On Alcoholism	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$38.6M
Yakima Valley Farm Workers Clinic	WA	Federally Qualified Health Center (FQHC)	$0	$22.3M
Yakima Neighborhood Health Services	WA	Federally Qualified Health Center (FQHC)	$0	$15.2M
Yakima Neighborhood Health Services	WA	Federally Qualified Health Center (FQHC)	$0	$14.2M
Yakima Neighborhood Health Services	WA	Federally Qualified Health Center (FQHC)	$0	$12.6M
Barth And Associates	WA	Case Management Agency	$0	$4.2M
The Valley Alcohol Council	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$3.6M
Yakima Valley Farm Workers Clinic	WA	Federally Qualified Health Center (FQHC)	$0	$3.4M
Evan Shute	WA	Physical Therapist	$122.5K	$0
Amelia Rutter	WA	Family Nurse Practitioner	$6.2K	$1.4K

Sundown M Ranch — 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