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

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

Ability360, Inc, (NPI 1174661078)

Field	Value
Entity Type	Organization
Organization	Ability360, Inc,
Address	5025 E Washington St Ste 200
City	Phoenix
State	AZ
ZIP	85034
Taxonomy	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NPI Enumerated	February 2, 2007

Payer Source	Total Paid
Medicaid	$274M
Medicare	$0

Key Findings

ABILITY360, INC reports no Medicare billing on file and is effectively a single-payer Medicaid provider with total Medicaid revenue of $274M. This makes Medicaid the exclusive recorded public-payer revenue stream for this entity and should drive payer-contracting and risk analyses accordingly.

Revenue is highly concentrated: the top three Medicaid codes account for 99.0% of this provider's total Medicaid revenue, led by S5125 ($257.7M, 94.0%), followed by S5150 ($11.7M, 4.3%), and S5165 ($1.8M, 0.7%). Such extreme concentration means that changes to reimbursement or utilization policies for these specific codes would materially affect overall revenue.

The code mix indicates a service model centered on high-volume, minute-based attendant care and community supports: S5125 (Attendant care services; per 15 minutes) is the dominant revenue driver, supplemented by respite (S5150), homemaker services (S5130), companion care (S5135), and targeted home modifications (S5165). This pattern is consistent with the provider taxonomy of an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility delivering in-home and community-based personal care and support services.

ABILITY360 is a major in-state provider for attendant care: S5125 shows 1.6M claims and ranks #4 of 223 providers in Arizona (99th percentile; notably above typical state volume for this code). That rank and claim volume position the organization as one of the largest attendants-of-care operators in the state and a key provider to monitor for system-wide utilization trends.

For several auxiliary service lines ABILITY360 appears dominant or uniquely positioned: S5130 (Homemaker service) and S5135 (Companion care) both rank #1 in-state among 14 and 25 providers respectively (100th percentile), with S5135 explicitly flagged as an "extreme outlier, far above typical state volume for this code." S5165 (Home modifications) also ranks #1 of 2 providers (100th percentile) and has a high avg paid/claim ($8658), indicating the provider delivers or coordinates relatively few but high-cost home modification services compared with peers.

Not all codes are outliers: S5150 (Unskilled respite care) ranks #8 of 192 providers (96th percentile) and is described as typical/unremarkable in volume for the state, and T1019 ranks #20 of 74 providers (74th percentile). These placements suggest ABILITY360’s core dominance is concentrated in attendant/homemaker/companion service lines while some ancillary codes reflect more typical provider participation.

The operational model implied by S5125’s 1.6M claims and $158 avg paid/claim (per 15 minutes) points to a very high-volume, time-based service delivery system that likely requires substantial frontline workforce capacity, scheduling infrastructure, and claims processing scale. Analysts should expect workforce and episodic visit dynamics to drive utilization trends and cost patterns for this provider.

ABILITY360’s NPI was enumerated on 2007-02-02 (~19 years ago), indicating long tenure in the market; that longevity combined with the provider’s high-percentile rankings suggests established operational scale and an entrenched position in Arizona’s Medicaid attendant- and homemaker-care ecosystem.

Medicaid: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5125	Attendant care services; per 15 minutes	1,631,080	$160	$257.7M
S5150	Unskilled respite care, not hospice; per 15 minutes	127,380	$90	$11.7M
S5165	Home modifications; per service	210	$8,660	$1.8M
S5130	Homemaker service, nos; per 15 minutes	23,060	$80	$1.8M
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	12,740	$60	$751.7K
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	3,290	$70	$233.4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Ability360, Inc, — 5 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	4	220	24,500	$120	$15.5M
S5150	Unskilled respite care, not hospice; per 15 minutes	8	190	5,090	$100	$2.9M
S5165	Home modifications; per service	1	10	140	$6,540	$928.6K
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	20	70	820	$30	$388.1K
S5130	Homemaker service, nos; per 15 minutes	1	10	3,750	$80	$379.8K
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	1	30	1,470	$60	$163.8K

Nearby Providers

Other providers in the same ZIP code as Ability360, Inc,, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sonora Quest Laboratories LLC	AZ	Clinical Medical Laboratory	$57.8M	$298.1M
City Of Phoenix Arizona	AZ	Paramedic	$4.9M	$138.9M
Founders Healthcare, LLC	AZ	Durable Medical Equipment & Medical Supplies	$0	$66.9M
Comtrans	AZ	Non-emergency Medical Transport (VAN)	$0	$40.1M
Phi Health, L.L.C.	AZ	Air Ambulance	$3.6M	$35.7M
F.a.c.t.s. Behavioral Health	AZ	Community/Behavioral Health Agency	$0	$21.3M
Pathology Specialist Of Arizona, LLP	AZ	Anatomic Pathology & Clinical Pathology Physician	$0	$16.7M
Apogee Mental Health Services	AZ	Behavior Analyst	$0	$12.4M
Empact - Suicide Prevention Center	AZ	Community/Behavioral Health Agency	$0	$11.2M
Physician Group Of Arizona Inc	AZ	Specialist	$0	$10.8M

Ability360, Inc, — Billing Profile & Reimbursement Data

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Ability360, 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