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

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

Commonwealth Of Pennsylvania Department Of Education (NPI 1245430438)

Field	Value
Entity Type	Organization
Organization	Commonwealth Of Pennsylvania Department Of Education
Address	75 Kiwanis Blvd
City	West Hazleton
State	PA
ZIP	18202
Taxonomy	Local Education Agency (LEA)
NPI Enumerated	July 25, 2007

Payer Source	Total Paid
Medicaid	$325.3M
Medicare	$0

Key Findings

This entity is effectively a single‑payer Medicaid billing organization: Medicare revenue is listed as none (no Medicare billing on file) while lifetime Medicaid revenue totals $325.3M, indicating Medicaid is the exclusive source of billed federal program revenue on file. The provider’s taxonomy as a Local Education Agency (LEA) and the absence of Medicare billing underscore a payer mix concentrated entirely in Medicaid.

Revenue concentration is extremely high: the precomputed top three Medicaid codes account for 71.0% of this provider’s total Medicaid revenue. Those top three codes are T1019 ($117.4M, 36.1%), 97530 ($57.3M, 17.6%), and 92507 ($56.4M, 17.3%), demonstrating that a small set of service lines drives the majority of revenue.

The code mix points to an operational focus on personal care and rehabilitative therapies delivered in an educational or community‑based context. High revenues and claim volumes for T1019 (personal care services), 97530 (therapeutic activities), and 92507 (individual speech‑language services) are consistent with an LEA delivering school‑based personal care, physical/occupational therapy interventions, and speech therapy services to enrolled populations.

Claim volumes reveal very large throughput: 2M claims for T1019, 2.5M claims for 97530, 1.8M claims for 92507, plus 3.7M claims for 92508 and 1.5M claims for A0434, signaling sustained, high-frequency service delivery rather than occasional episodic billing. These multi‑million claim counts support the interpretation that services are ongoing and programmatic (for example, recurring therapy or care sessions scheduled by an LEA).

On competitive standing within Pennsylvania this provider is a dominant statewide player for its highest‑volume services: T1019 ranks #1 of 85 providers in-state (100th percentile; extreme outlier), 97530 ranks #1 of 710 providers in-state (100th percentile; extreme outlier), and 92507 ranks #1 of 412 providers in-state (100th percentile; extreme outlier). Additional top codes such as A0434 (#1 of 14, 100th percentile; extreme outlier) and 97110 (#1 of 1279, 100th percentile; extreme outlier) reinforce a pattern of market dominance in several school‑based care and therapy categories.

Several other service lines extend the provider’s scope beyond core personal care and speech therapy: 92508 (group speech services) generated $37.3M (11.5%) and ranks #1 of 4 providers in-state (100th percentile; described as typical), 97110 (therapeutic exercise) produced $19.8M (6.1%) and ranks #1 of 1279 providers (100th percentile; extreme outlier), and H0046 (mental health services) contributed $6.9M (2.1%) while ranking #1 of 173 providers (100th percentile; extreme outlier). These codes indicate a broad set of allied health and behavioral services billed to Medicaid.

There is concentrated revenue risk around a handful of codes: T1019 alone represents $117.4M (36.1%) of Medicaid revenue and the top three codes together represent 71.0% of Medicaid revenue, which makes the provider sensitive to reimbursement rate changes, prior authorization policy shifts, or programmatic eligibility changes affecting those specific service categories. Several of the highest‑volume codes are flagged as extreme outliers in statewide comparisons, meaning any regulatory or audit attention focused on these service lines could materially affect overall revenue.

The provider has an established billing history with nearly two decades of enrollment: NPI enumerated 2007-07-25 (~19 years ago). That longevity, combined with consistently high claim volumes and repeated #1 statewide rankings across multiple therapy and personal care codes, suggests entrenched operational capacity and long‑standing Medicaid billing relationships within Pennsylvania.

Medicaid: Complete Services Breakdown

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	1,955,950	$60	$117.4M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	2,490,880	$20	$57.3M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	1,820,170	$30	$56.4M
92508	The provider treats a group of two or more individuals with communication and hearing difficulties by directly interacting with them. He assesses the patients with impairment in their ability to make…	3,728,210	$10	$37.3M
A0434	Specialty care transport (sct)	1,459,550	$20	$24.8M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	732,530	$30	$19.8M
H0046	Mental health services, not otherwise specified	360,550	$20	$6.9M
T1502	Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit	380,240	$10	$2.3M
97533	In this procedure, the provider uses sensory integrative techniques in patients with established dysfunction of sensory processing, for example, children with autism, and brain injuries. This service…	15,110	$80	$1.2M
T1002	Rn services, up to 15 minutes	6,890	$100	$668.3K

Showing 1–10 of 20

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Commonwealth Of Pennsylvania Department Of Education — 9 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

20 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
92508	The provider treats a group of two or more individuals with communication and hearing difficulties by directly interacting with them. He assesses the patients with impairment in their ability to make…	1	10	90	$10	$9.3M
T1003	Lpn/lvn services, up to 15 minutes	44	100	7,910	$530	$5.3M
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…	1	90	8,060	$110	$3.9M
T1502	Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit	1	10	380,240	$10	$2.4M
A0434	Specialty care transport (sct)	1	10	350	$20	$2M
T1002	Rn services, up to 15 minutes	14	90	1,850	$400	$1.5M
H0046	Mental health services, not otherwise specified	1	170	1,200	$130	$909.6K
96151	N/A	12	20	3,710	$130	$750.3K
97533	In this procedure, the provider uses sensory integrative techniques in patients with established dysfunction of sensory processing, for example, children with autism, and brain injuries. This service…	1	10	7,590	$60	$495.8K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	1	410	1,130	$60	$455.4K

Showing 1–10 of 20

Nearby Providers

Other providers in the same ZIP code as Commonwealth Of Pennsylvania Department Of Education, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northeast Counseling Services	PA	Clinic/Center	$0	$10M
Caring Community Health Center	PA	Federally Qualified Health Center (FQHC)	$0	$9.7M
Nicholas Barna	PA	Ophthalmology Physician	$924.6K	$990
Hazleton Ambulatory Surgical Center LLC	PA	Ambulatory Surgical Clinic/Center	$803.6K	$0
James Deom	PA	Optometrist	$529.9K	$0
Yaqoob Mohyuddin	PA	Cardiovascular Disease Physician	$318.5K	$6.8K
Hazleton Surgery Center, LLC	PA	Ambulatory Surgical Clinic/Center	$202.1K	$97K
Mark Lobitz	PA	Family Medicine Physician	$291.2K	$3.1K
Siang Oh	PA	Physical Medicine & Rehabilitation Physician	$246.2K	$0
Steven Sopkie	PA	Primary Podiatric Medicine Podiatrist	$209K	$17.4K

Commonwealth Of Pennsylvania Department Of Education — Billing Profile & Reimbursement Data

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Commonwealth Of Pennsylvania Department Of Education — 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