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

Why is the Medicaid comparison limited to North Dakota 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. North Dakota (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.

Bismarck Public Schools Early Intervention (NPI 1275131005)

Field	Value
Entity Type	Organization
Organization	Bismarck Public Schools Early Intervention
Address	806 N Washington St
City	Bismarck
State	ND
ZIP	58501
Taxonomy	Early Intervention Provider Agency
NPI Enumerated	October 14, 2020

Payer Source	Total Paid
Medicaid	$12M
Medicare	$0

Key Findings

This provider is effectively single-payer: Medicare revenue on file is none (no Medicare billing on file) while Medicaid accounts for $12M of lifetime revenue, indicating the organization’s operations and financials are almost entirely dependent on Medicaid reimbursements. The absence of Medicare billing suggests the provider’s service lines, contracts, and growth opportunities are focused on pediatric/early-intervention Medicaid populations rather than Medicare beneficiaries.

The provider’s NPI was enumerated on 2020-10-14 (~6 years ago), implying a relatively recent market presence compared with long-established institutions. This tenure is long enough to have built recurring Medicaid volume but short enough that observed patterns may still reflect an early-growth or consolidation phase in the state marketplace.

Revenue is highly concentrated in a small set of Medicaid codes: the top three codes (S5111, W0500, T2025) together account for 60.8% of this provider’s total Medicaid revenue. Specifically, S5111 generated $2.9M (23.8%), W0500 generated $2.8M (23.1%), and T2025 generated $1.7M (13.9%), so changes to reimbursement or utilization for any of these three codes would have outsized impact on overall revenue.

The reported CPT/HCPCS mix is consistent with an early-intervention, home- and waiver-focused operation. S5111 (S5111 – Home care training, family; per session) and high-volume screening/waiver codes such as T2025 (Waiver services; nos) and T2024 (Service assessment/plan of care development, waiver) indicate the provider delivers in-home family training, waiver program services, care planning, and screening (T1023) rather than clinic-based procedural care. Several high-revenue entries are W05xx codes with no description available in the dataset, suggesting meaningful state-specific billing categories tied to early-intervention or waiver programs.

Volume and payment characteristics point to a mix of high-frequency, low-unit services and lower-frequency, higher-intensity encounters. S5111 shows very high utilization with 19.7K claims at $145 avg paid/claim, and W0500 has 15.4K claims at $181 avg paid/claim, consistent with session-based family training. By contrast, W0530 ($447 avg paid/claim, 2.6K claims) and T2024 ($443 avg paid/claim, 2.5K claims) generate similar dollar amounts with far fewer encounters, consistent with more resource-intensive or specialized waiver-related activities.

State competitive standing is modest-to-strong but not dominant across its top codes: S5111 ranks #3 of 9 providers in-state (75th percentile) and W0500 also ranks #3 of 9 (75th percentile), both labeled in the data as "typical, unremarkable volume for this code." The provider ranks higher on certain narrower codes—W0530 and W0520 are #2 of 7 providers in-state (83th percentile) and T2024 is #3 of 10 (78th percentile)—indicating pockets of relative strength in specific waiver or specialized service lines rather than statewide dominance across the board.

For all top Medicaid codes listed (S5111, W0500, T2025, W0510, W0530, T2024, W0520, T1023) the dataset flags volume as "typical, unremarkable volume for this code," signaling that while this provider is a reliable participant in these categories, it is not an extreme statistical outlier in utilization patterns within the state. That reduces the chance that observed patterns reflect atypical coding behavior and instead points to standard operational concentration.

The high concentration of Medicaid revenue (60.8% from three codes) combined with full dependence on Medicaid funding creates both operational leverage and revenue sensitivity: reimbursement changes, waiver policy adjustments, or authorization shifts for S5111, W0500, or T2025 would materially affect the provider’s finances. Conversely, the mix of high-frequency session codes and higher-paid, lower-frequency waiver codes suggests tactical opportunities to balance volume and intensity if the provider pursues diversification within state Medicaid services.

Medicaid: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5111	Home care training, family; per session	19,720	$150	$2.9M
W0500	N/A	15,380	$180	$2.8M
T2025	Waiver services; not otherwise specified (nos)	5,250	$320	$1.7M
W0510	N/A	3,780	$330	$1.2M
W0530	N/A	2,650	$450	$1.2M
T2024	Service assessment/plan of care development, waiver	2,530	$440	$1.1M
W0520	N/A	1,320	$450	$597.1K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	1,240	$460	$570.7K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Bismarck Public Schools Early Intervention — 0 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

Full comparison — all codes billed, vs. North Dakota median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5111	Home care training, family; per session	3	10	12,520	$140	$2.8M
W0500	N/A	3	10	10,780	$140	$2M
T2025	Waiver services; not otherwise specified (nos)	4	10	3,670	$300	$1.4M
W0510	N/A	4	10	3,780	$290	$1M
T2024	Service assessment/plan of care development, waiver	3	10	2,140	$410	$880.1K
W0530	N/A	2	10	1,580	$400	$854.1K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	3	10	800	$420	$412.2K
W0520	N/A	2	10	380	$390	$346.3K

Nearby Providers

Other providers in the same ZIP code as Bismarck Public Schools Early Intervention, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Enable, Inc.	ND	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$40.8M
Heartview Foundation	ND	Substance Use Disorder Rehabilitation Clinic/Center	$0	$13.6M
Sanford Bismarck	ND	General Acute Care Hospital	$0	$12.5M
West Central Behavioral Health Clinic	ND	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.2M
D. Michael Goebel D.d.s., PC	ND	Pediatric Dentistry	$0	$5.8M
Poppy's Promise LLC	ND	Community/Behavioral Health Agency	$0	$5.6M
Sanford Bismarck	ND	Clinical Medical Laboratory	$726.9K	$4.3M
St. Alexius Medical Center	ND	Specialist	$0	$3.6M
Lasting Love Homecare	ND	In Home Supportive Care Agency	$0	$3.6M
St. Alexius Medical Center	ND	General Acute Care Hospital	$0	$3.5M

Bismarck Public Schools Early Intervention — Billing Profile & Reimbursement Data

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Bismarck Public Schools Early Intervention — 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