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.

Lexington Learning Center (NPI 1245699065)

Field	Value
Entity Type	Organization
Organization	Lexington Learning Center
Address	1555 S Gilbert Rd Ste 109-113
City	Mesa
State	AZ
ZIP	85204
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	February 22, 2016

Payer Source	Total Paid
Medicaid	$60.8M
Medicare	$0

Key Findings

LEXINGTON LEARNING CENTER operates primarily as a Medicaid-focused community/behavioral health and waiver services provider: its top revenue codes are time-based waiver and attendant-care services such as S5125 (Attendant care services; per 15 minutes), T2021 (Day habilitation, waiver; per 15 minutes), and T2017 (Habilitation, residential, waiver; 15 minutes), which aligns with a service mix centered on hands-on, labor-intensive home- and community-based supports. The presence of multiple habilitation, respite, transportation, and therapy codes (e.g., S5150, A0120, 97535, 92507) further suggests an integrated operations model that combines day programs, residential habilitation, personal attendant care, and allied therapy services.

Revenue is highly concentrated in a few time-based waiver codes: the precomputed top 3 Medicaid codes (S5125, T2021, T2017) account for 69.1% of this provider's total Medicaid revenue. Those three codes individually are reported as $14.9M (S5125, 24.6%), $14.2M (T2021, 23.4%), and $12.8M (T2017, 21.1%), indicating that most financial performance depends on continued volume and reimbursement for these specific service lines.

This provider is effectively single-payer at scale: there is no Medicare billing on file while total Medicaid revenue is $60.8M, so Medicaid represents the practical entirety of billed public-payer activity. Analysts should treat this entity as Medicaid-dependent for revenue risk and forecasting, with limited diversification into Medicare fee-for-service streams.

LEXINGTON’s competitive standing varies by service line within Arizona. For day habilitation (T2021) the provider ranks #5 of 48 in-state and is labeled at the 91th percentile as "notably above typical state volume," indicating it is a major regional provider for day habilitation services. By contrast, for attendant care (S5125) the provider ranks #46 of 223 (80th percentile) and for residential habilitation (T2017) it ranks #11 of 63 (84th percentile), both described as "typical, unremarkable volume," which implies solid but not dominant positions in those categories.

The provider shows especially high relative volume in non-clinical support and therapy-adjacent codes: A0120 (non-emergency transportation) is $2.7M and ranks #19 of 509 (96th percentile; notably above typical state volume), while 97535 (therapeutic instruction) is $3.6M and ranks #18 of 312 (95th percentile). These rankings signal above-typical activity in transportation logistics and therapy instruction compared with most in-state peers, which has operational implications for fleet/staffing and coordination capacity.

Several other service codes reflect broad habilitation and therapy capacity but at more typical state volumes: S5150 (unskilled respite care) is $7.0M and described as "typical, unremarkable volume" at rank #16 of 192 (92th percentile), and 92507 (speech-language therapy) is $3.5M and ranked #28 of 398 (93th percentile). Together these data points indicate established program breadth across respite and allied therapies, supporting multidisciplinary care rather than narrow specialization.

Operational risk and resource focus should be interpreted through the time-based nature of the revenue mix: many top codes (S5125, T2021, T2017, S5150) are billed per 15 minutes, which implies the business model is labor- and schedule-intensive and sensitive to staffing availability, productivity, and waiver authorization practices. Given the concentration in per-15-minute waiver codes, shifts in Medicaid reimbursement rates, utilization controls, or staffing constraints could materially affect revenue and capacity.

Provider tenure is established but not long-standing: the NPI was enumerated 2016-02-22 (~10 years ago), indicating roughly a decade of claimed operations in the Medicaid market. That tenure combined with high percentile placements for several codes suggests the organization has scaled its waiver and support-service operations relatively quickly within the Arizona market.

Medicaid: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5125	Attendant care services; per 15 minutes	100,240	$150	$14.9M
T2021	Day habilitation, waiver; per 15 minutes	154,840	$90	$14.2M
T2017	Habilitation, residential, waiver; 15 minutes	142,590	$90	$12.8M
S5150	Unskilled respite care, not hospice; per 15 minutes	82,740	$90	$7M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	42,590	$90	$3.6M
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…	43,190	$80	$3.5M
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	111,690	$20	$2.7M
S5151	Unskilled respite care, not hospice; per diem	2,480	$350	$875.4K
H2017	Psychosocial rehabilitation services, per 15 minutes	1,510	$280	$415.3K
H2014	Skills training and development, per 15 minutes	2,440	$170	$404.4K

Showing 1–10 of 15

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

Lexington Learning Center — 1 of 15 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

15 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	46	220	24,500	$120	$15.5M
T2017	Habilitation, residential, waiver; 15 minutes	11	60	32,290	$90	$9M
T2021	Day habilitation, waiver; per 15 minutes	5	50	19,210	$100	$5.3M
T2019	Habilitation, supported employment, waiver; per 15 minutes	14	20	19,190	$90	$2.9M
S5150	Unskilled respite care, not hospice; per 15 minutes	16	190	5,090	$100	$2.9M
H2017	Psychosocial rehabilitation services, per 15 minutes	84	270	600	$410	$983.9K
H2014	Skills training and development, per 15 minutes	302	780	1,610	$100	$868.2K
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…	28	400	2,110	$70	$800.7K
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	18	310	960	$60	$705.5K
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.	390	510	1,320	$60	$454.9K

Showing 1–10 of 15

Nearby Providers

Other providers in the same ZIP code as Lexington Learning Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
My House LLC	AZ	In Home Supportive Care Agency	$0	$24.8M
Native Country Healthcare Systems	AZ	Adult Mental Health Clinic/Center	$0	$14.3M
Terros, Inc.	AZ	Federally Qualified Health Center (FQHC)	$0	$6.6M
Mukesh Ahluwalia	AZ	Pulmonary Disease Physician	$324.3K	$585.3K
Daniel Adelberg	AZ	Retina Specialist (Ophthalmology) Physician	$854.7K	$0
Joel Schein	AZ	Diagnostic Radiology Physician	$262K	$463.6K
Jeffrey Wine	AZ	Optometrist	$673.6K	$0
Sankalp Choudhri	AZ	Pulmonary Disease Physician	$598.6K	$0
Seyed Javadpoor	AZ	Pulmonary Disease Physician	$435.6K	$0
Phillip Boyer	AZ	Ophthalmology Physician	$363.8K	$0

Lexington Learning Center — Billing Profile & Reimbursement Data

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Lexington Learning Center — 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