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

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

Douglas A. Thom Clinic, Inc. (NPI 1396771820)

Field	Value
Entity Type	Organization
Organization	Douglas A. Thom Clinic, Inc.
Address	126 Phoenix Ave
City	Lowell
State	MA
ZIP	01852
Taxonomy	Developmental Disabilities Clinic/Center
NPI Enumerated	June 25, 2006

Payer Source	Total Paid
Medicaid	$132.9M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused operator: lifetime Medicaid revenue on file is $132.9M and there is no Medicare billing on file, so all observed claim activity and revenue are driven by Medicaid programs rather than a dual Medicare/Medicaid mix. The absence of Medicare activity means comparisons to national Medicare peers are not applicable for this entity and analyses should concentrate on state Medicaid dynamics.

Revenue is highly concentrated in a very small set of service lines — the precomputed top three Medicaid codes (H2015, T1024, H2019) account for 92.8% of total Medicaid revenue. Specifically, H2015 accounts for $88.2M (66.4% of Medicaid revenue), T1024 accounts for $27.8M (20.9%), and H2019 accounts for $7.4M (5.6%), indicating that a handful of services drive nearly all reported revenue.

The code mix and the provider taxonomy (Developmental Disabilities Clinic/Center) indicate an operational focus on community-based, developmental-disability and pediatric specialty care: H2015 (Comprehensive community support services) shows extremely large volume (808.9K claims) consistent with ongoing community support programs, while T1024 (integrated specialty team for severely handicapped children) with 115.8K claims points to coordinated, multi-disciplinary care for complex pediatric patients. These patterns suggest the organization operates large-scale, recurring community and care-coordination programs rather than episodic acute-care visits.

On competitive standing within the state, the provider is a dominant outlier for several high-revenue lines. H2015 ranks #1 of 147 providers in-state (100th percentile; extreme outlier) and T1024 ranks #1 of 49 providers in-state (100th percentile; extreme outlier), indicating market-leading scale in both community support services and integrated specialty-team encounters for severely handicapped children. The provider also ranks #1 of 37 for 96153 (100th percentile; extreme outlier), reinforcing dominance in certain assessment/psychometric or related service volumes.

Beyond the two revenue leaders, the provider reports notably above-typical state volume for several non-physician behavioral health services: H0032 (service plan development) generated $1.8M and ranks #5 of 164 providers (98th percentile; notably above typical), and H0031 (mental health assessment) generated $1.6M and ranks #7 of 251 providers (98th percentile; notably above typical). These placements indicate the organization is a major regional provider of non-physician behavioral health assessment and planning work associated with developmental-disability populations.

The presence and scale of group/psychological intervention codes suggest substantial use of multi-patient behavioral interventions: 96165 (19.1K claims, $708K revenue) ranks #3 of 33 providers (94th percentile; notably above typical) and 96164 (21.7K claims, $391.1K revenue) also ranks #3 of 34 providers (94th percentile; notably above typical). Together with the 96153 volume (29K claims, $1.6M revenue), this indicates a program model that includes frequent group-based or multi-participant psychological services alongside individual supports.

Although the provider shows breadth across many Medicaid codes, the extreme concentration of revenue into H2015, T1024, and H2019 (92.8% of Medicaid revenue) creates operational and reimbursement sensitivity: changes in coverage policy, authorization rules, or payment rates for those specific codes would materially affect overall revenue. Analysts and payers evaluating contracting, rate-setting, or utilization management should prioritize oversight and program design around these top service lines given their outsized contribution to the $132.9M Medicaid total.

This organization has a long tenure in the registry, with an NPI enumerated date of 2006-06-25 (~20 years ago), indicating sustained activity and an established presence in the state Medicaid market. Combined with the reported volume metrics (for example 808.9K H2015 claims and 115.8K T1024 claims), the data reflect both scale and programmatic continuity that are important context for competitive and network planning decisions.

Medicaid: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2015	Comprehensive community support services, per 15 minutes	808,860	$110	$88.2M
T1024	Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter	115,810	$240	$27.8M
H2019	Therapeutic behavioral services, per 15 minutes	48,900	$150	$7.4M
T1015	Clinic visit/encounter, all-inclusive	19,250	$110	$2.1M
H0032	Mental health service plan development by non-physician	9,760	$190	$1.8M
H0031	Mental health assessment, by non-physician	10,680	$150	$1.6M
96153	N/A	29,040	$60	$1.6M
T1027	Family training and counseling for child development, per 15 minutes	15,260	$50	$732.4K
96165	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	19,130	$40	$708K
96164	The provider, typically a psychologist, provides counseling and strategies for management of cognitive, emotional, social, cultural factors that impact management of the patients’ physical health…	21,730	$20	$391.1K

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Douglas A. Thom Clinic, Inc. — 5 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2015	Comprehensive community support services, per 15 minutes	1	150	7,770	$140	$4.8M
H2019	Therapeutic behavioral services, per 15 minutes	32	290	3,680	$150	$2.9M
T1024	Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter	1	50	3,060	$240	$2.4M
T1027	Family training and counseling for child development, per 15 minutes	32	130	4,300	$110	$2.1M
T1015	Clinic visit/encounter, all-inclusive	48	550	90	$140	$1.5M
H2012	Behavioral health day treatment, per hour	34	110	840	$70	$575.6K
96153	N/A	1	40	1,620	$60	$280.1K
H0032	Mental health service plan development by non-physician	5	160	430	$180	$269.5K
H0031	Mental health assessment, by non-physician	7	250	380	$140	$200.8K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	29	60	900	$100	$197.2K

Showing 1–10 of 13

Nearby Providers

Other providers in the same ZIP code as Douglas A. Thom Clinic, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lowell Community Health Center, Inc.	MA	Federally Qualified Health Center (FQHC)	$0	$86.8M
Bridgewell, Inc	MA	Community/Behavioral Health Agency	$0	$43.3M
Lowell House, Inc.	MA	Community/Behavioral Health Agency	$0	$20.7M
Tufts Medicine Care At Home, Inc.	MA	Community Based Hospice Care Agency	$0	$11.9M
Merrimack Valley Oral Surgeons, Inc.	MA	Oral and Maxillofacial Surgery (Dentist)	$0	$10.6M
Md Consultants	MA	Dental Clinic/Center	$0	$10.5M
Accucare, Inc.	MA	Home Health Agency	$0	$8.9M
Home Away From Home	MA	Adult Day Care Clinic/Center	$0	$7.4M
Trinity Care Associate	MA	Multi-Specialty Clinic/Center	$0	$7.2M
Bio-medical Applications Of Massachusetts, Inc.	MA	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$6.3M

Douglas A. Thom Clinic, Inc. — Billing Profile & Reimbursement Data

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Douglas A. Thom Clinic, 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