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

Why is the Medicaid comparison limited to Rhode Island 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. Rhode Island (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.

The Arc Of Balckstone Valley (NPI 1295021426)

Field	Value
Entity Type	Organization
Organization	The Arc Of Balckstone Valley
Address	115 Manton St
City	Pawtucket
State	RI
ZIP	02861
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	June 27, 2011

Payer Source	Total Paid
Medicaid	$83.6M
Medicare	$0

Key Findings

THE ARC OF BALCKSTONE VALLEY is effectively a Medicaid-only biller: there is no Medicare billing on file and the provider reports $83.6M in lifetime Medicaid revenue, indicating its entire documented payer exposure in the dataset is concentrated in Medicaid programs. This makes the organization highly dependent on state Medicaid policy, rates, and waiver programs for its revenue profile.

Revenue is highly concentrated in a small set of waiver and habilitation codes: the precomputed top three Medicaid codes (T2033, T2021, T2017) account for 85.4% of the provider's total Medicaid revenue. Individually, T2033 represents $40.5M (48.5%), T2021 $15.9M (19.0%), and T2017 $15M (17.9%), so changes to rate-setting or authorization for any of these services would materially affect overall revenue.

The service mix reflects a residential and day habilitation operating model: T2033 (Residential care, waiver; per diem) is the single largest revenue driver by far, while T2021 (Day habilitation, waiver; per 15 minutes) and T2017 (Habilitation, residential, waiver; 15 minutes) together indicate substantial investment in both time-based day programs and time-based residential habilitation. High average paid-per-claim values (e.g., $3724 avg paid/claim for T2033 and $1047 for T2017) underscore that long-duration per-diem and per-15-minute habilitation services are core to how the organization delivers and monetizes care.

Competitive standing within Rhode Island is mixed but skewed toward above-average presence for certain residential habilitation lines. For the largest line, T2033, the provider ranks #8 of 22 (67th percentile), a typical but meaningful market position; for T2021 it ranks #8 of 33 (78th percentile), and for T2017 it ranks #6 of 36 (86th percentile), indicating stronger relative scale in residential habilitation time-based services compared with many in-state peers. Notably, for T2016 (Habilitation, residential, waiver; per diem) the provider ranks #1 of 5 (100th percentile) and is labeled “notably above typical state volume,” signaling a dominant position among the small set of providers offering that specific per-diem residential habilitation rate.

Operational footprint implications: claim volumes and average payments suggest a mix of high-dollar per-diem placements and high-frequency time-based day services. T2033 shows 10.9K claims with a $3724 avg paid/claim, while T2021 shows 27.3K claims at $582 avg paid/claim and T2017 shows 14.3K claims at $1047 avg paid/claim; this combination points to an operator running both residential placements (fewer, higher-dollar daily claims) and high-volume day habilitation sessions (many time-based claims).

There is measurable exposure to non-service revenue lines and ancillary supports, but these are small relative to core habilitation: T2003 (Non-emergency transportation) contributes $2.9M (3.4% of Medicaid revenue) with 9.4K claims, and T2022 (Case management, per month) contributes $1.7M (2.1%) with 12.8K claims. These ancillary lines support the primary habilitation and residential services but do not materially diversify the provider’s revenue base away from its top waiver codes.

Concentration risk is elevated due to the reliance on a few codes: with 85.4% of Medicaid revenue coming from T2033, T2021, and T2017, policy changes, reimbursement adjustments, or shifts in waiver authorizations for those specific codes could disproportionately impact the provider's financials. The presence of a single code where the provider is notably above typical state volume (T2016) further concentrates operational risk within specific residential habilitation modalities.

The provider is established in its field, with NPI enumeration dated 2011-06-27 (~15 years ago), suggesting sustained participation in state waiver programs and time to develop enrollment, relationships, and operational processes focused on developmental disability services. That tenure, combined with higher-than-typical rank positions on several residential habilitation codes, indicates an entrenched specialist role in Rhode Island’s developmental disability services market.

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	10,890	$3,720	$40.5M
T2021	Day habilitation, waiver; per 15 minutes	27,260	$580	$15.9M
T2017	Habilitation, residential, waiver; 15 minutes	14,310	$1,050	$15M
T2016	Habilitation, residential, waiver; per diem	6,100	$1,220	$7.5M
T2003	Non-emergency transportation; encounter/trip	9,360	$310	$2.9M
T2022	Case management, per month	12,830	$140	$1.7M
T2023	Targeted case management; per month	490	$260	$129.9K
T2020	Day habilitation, waiver; per diem	390	$90	$35.7K
H0004	Behavioral health counseling and therapy, per 15 minutes	10	$60	$670

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Rhode Island Distribution

The Arc Of Balckstone Valley — 1 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Rhode Island

Full comparison — all codes billed, vs. Rhode Island median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	8	20	6,780	$1,890	$39.8M
T2017	Habilitation, residential, waiver; 15 minutes	6	40	3,820	$510	$10.6M
T2021	Day habilitation, waiver; per 15 minutes	8	30	12,340	$410	$10M
T2016	Habilitation, residential, waiver; per diem	1	10	2,050	$1,830	$5M
T2022	Case management, per month	6	40	5,460	$150	$1.2M
T2003	Non-emergency transportation; encounter/trip	23	60	7,480	$80	$1.1M
T2020	Day habilitation, waiver; per diem	10	20	450	$950	$864.4K
H0004	Behavioral health counseling and therapy, per 15 minutes	77	80	340	$70	$223.7K
T2023	Targeted case management; per month	8	10	690	$260	$193K

Nearby Providers

Other providers in the same ZIP code as The Arc Of Balckstone Valley, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Access Ambulance Services Inc	RI	Ambulance	$0	$5.6M
Med Tech Inc	RI	Ambulance	$0	$2.9M
Margaret Frempong	RI	Mental Health Counselor	$0	$408.9K
Rhode Island Cvs Pharmacy, L.L.C.	RI	Pharmacy	$154.5K	$0
Shadi Kiriaki	RI	Emergency Medicine Physician	$76.8K	$0
Marta Rosol	RI	Clinical Social Worker	$36K	$0
Anne Tierney	RI	Certified Registered Nurse Anesthetist	$22.8K	$7.1K
Michael Macijeski	RI	Chiropractor	$24.5K	$0

The Arc Of Balckstone Valley — Billing Profile & Reimbursement Data

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The Arc Of Balckstone Valley — 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