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

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

Virgin River Healthcare, Inc. (NPI 1417341777)

Field	Value
Entity Type	Organization
Organization	Virgin River Healthcare, Inc.
Address	1173 S 250 W Ste 401b
City	St George
State	UT
ZIP	84770
Taxonomy	In Home Supportive Care Agency
NPI Enumerated	March 25, 2015

Payer Source	Total Paid
Medicaid	$13.3M
Medicare	$0

Key Findings

This entity reports no Medicare billing on file and $13.3M in lifetime Medicaid revenue, making Medicaid the effective sole payer represented in the claims data. The absence of Medicare activity indicates the provider operates predominantly within the Medicaid home- and personal-care market rather than treating fee-for-service Medicare beneficiaries.

Revenue is highly concentrated in a very small set of service codes: the precomputed top three Medicaid codes account for 92.6% of total Medicaid revenue. The largest single contributor is T1021 with $9.5M (71.1% of Medicaid revenue), followed by T1019 with $1.6M (12.0%) and S9122 with $1.3M (9.4%), indicating narrow dependence on a few service lines.

The reported code mix (T1021, T1019, S9122, and T1001) describes a business model centered on in-home supportive care and personal assistance: T1021 and S9122 are home health aide/CNA services (per visit and per hour), T1019 covers personal care services billed per 15 minutes, and T1001 reflects nursing assessment/evaluation. This mix implies a labor-intensive operation focused on direct-care aides and episodic nursing assessments rather than medically complex procedures.

T1021 is an extreme outlier in-state: the provider reported 193.6K claims for T1021 with a $49 avg paid/claim and $9.5M in revenue, ranking #2 of 41 providers in Utah (98th percentile). That volume places the organization far above typical state activity for this code and makes T1021 the dominant revenue engine for the business.

T1019 also shows extreme statewide dominance: the provider reported 48.7K claims for T1019 with a $33 avg paid/claim and $1.6M in revenue, ranking #1 of 29 providers in Utah (100th percentile). Being the top reporter for T1019 signals unusually high reliance on billed 15-minute personal care units compared with peers.

S9122 and T1001 are significant but less dominant contributors: S9122 generated 22.5K claims, $56 avg paid/claim, and $1.3M revenue while ranking #4 of 11 providers (70th percentile), a typical volume level for this code. T1001 produced 10.1K claims, $97 avg paid/claim, and $978.9K revenue while ranking #7 of 65 providers (91th percentile), indicating meaningful activity in nursing assessments but not the same extreme concentration as the top aide/personal care codes.

Smaller codes are immaterial to total revenue: for example, S5135 accounted for 332 claims, a $26 avg paid/claim, and $8.6K in revenue (0.1% of Medicaid revenue), ranking #2 of 2 providers in-state (0th percentile). This underscores that nearly all Medicaid revenue is driven by aide and personal-care services rather than companion or ancillary codes.

The provider has an established enrollment history (NPI enumerated 2015-03-25 (~11 years ago)), suggesting a long-running local presence. Combined with the high ranks and percentiles on core aide and personal-care codes, the organization is a major Medicaid home-care participant in Utah for select services, but it does not appear to operate in the Medicare fee-for-service market based on available billing records.

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1021	Home health aide or certified nurse assistant, per visit	193,620	$50	$9.5M
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…	48,670	$30	$1.6M
S9122	Home health aide or certified nurse assistant, providing care in the home; per hour	22,470	$60	$1.3M
T1001	Nursing assessment / evaluation	10,090	$100	$978.9K
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	330	$30	$8.6K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Virgin River Healthcare, Inc. — 2 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1021	Home health aide or certified nurse assistant, per visit	2	40	10,290	$60	$1.7M
S9122	Home health aide or certified nurse assistant, providing care in the home; per hour	4	10	5,040	$80	$1.7M
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	30	6,130	$110	$1.1M
T1001	Nursing assessment / evaluation	7	70	700	$80	$603.4K
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	2	10	1,080	$40	$48K

Nearby Providers

Other providers in the same ZIP code as Virgin River Healthcare, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
American Logistics, LLC.	UT	Transportation Broker	$0	$299.6M
Southwest Center	UT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$58.3M
Red Rock Healthcare, Inc.	UT	Home Health Agency	$0	$27.3M
Crimson Heights LLC	UT	Community/Behavioral Health Agency	$0	$7.8M
Southwest Center	UT	Substance Use Disorder Rehabilitation Clinic/Center	$0	$7.7M
Crimson Heights LLC	UT	Behavior Analyst	$0	$6.8M
Washington County School District	UT	Local Education Agency (LEA)	$0	$6.8M
Red Mesa Home Care	UT	Home Health Agency	$0	$4M
The Learning Center For Families	UT	Developmentally Disabled Services Day Training Agency	$0	$3.9M
Vive Care	UT	Psychiatric Hospital	$0	$3.1M

Virgin River Healthcare, Inc. — Billing Profile & Reimbursement Data

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Virgin River Healthcare, 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