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

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

Pearl Health Clinic (NPI 1447426465)

Field	Value
Entity Type	Organization
Organization	Pearl Health Clinic
Address	2705 E 17th St
City	Ammon
State	ID
ZIP	83406
Taxonomy	Mental Health Counselor
NPI Enumerated	April 30, 2008

Payer Source	Total Paid
Medicaid	$9.9M
Medicare	$0

Key Findings

PEARL HEALTH CLINIC is effectively a Medicaid-centric practice: there is no Medicare billing on file and the provider reports $9.9M in lifetime Medicaid revenue, indicating a single‑payer footprint concentrated in state Medicaid programs rather than a mixed Medicare/Medicaid payer mix. This concentration should shape network and contracting considerations for payers focused on Idaho Medicaid populations.

Revenue is highly concentrated in a small set of services: the precomputed top three Medicaid codes — 90834, 99214, and H2017 — together account for 66.6% of the provider’s total Medicaid revenue. Individually those three appear as $3.1M (90834, 31.8%), $1.7M (99214, 17.4%), and $1.7M (H2017, 17.4%), signaling that a few service lines drive the majority of billed Medicaid dollars.

The code mix points to an outpatient behavioral health operation focused on time‑based psychotherapy and related care management: high volumes of 90834 (psychotherapy), add‑on psychotherapy 90833, E/M visits such as 99214 and 99215, and rehabilitation/case management codes like H2017 and T1017 indicate the clinic delivers regular individual psychotherapy, structured psychosocial rehabilitation, and targeted case management services. The presence of peer support and respite codes (H0038, S5150) further suggests integrated non‑clinical supports alongside clinical psychotherapy.

PEARL is a dominant statewide provider for core psychotherapy volume: 90834 shows 59.4K claims and $3.1M in revenue (31.8% of Medicaid revenue) and ranks #1 of 413 providers in-state (100th percentile; extreme outlier). This level of volume makes the clinic a primary source of billed psychotherapy in Idaho Medicaid and a key partner for payers managing access to time‑based psychotherapy.

The clinic also posts unusually high volumes for evaluation/management and psychosocial rehabilitation services: 99214 accounts for 22.9K claims and $1.7M (17.4% of Medicaid revenue) and ranks #16 of 618 (98th percentile; notably above typical state volume), while H2017 contributes $1.7M and ranks #16 of 135 (89th percentile; typical, unremarkable volume). Together these codes indicate both frequent E/M encounters and structured rehabilitation sessions, implying a mix of ongoing therapy plus medical decision‑making visits.

Several assessment and add‑on codes are outliers, suggesting intense assessment and adjunct psychotherapy activity: 90833 has 12.8K claims and $536.3K in revenue and ranks #2 of 66 (98th percentile; extreme outlier), 90791 has $192.6K and ranks #4 of 215 (99th percentile; extreme outlier), and 90785 ranks #5 of 126 (97th percentile; notably above typical state volume). These patterns are consistent with high throughput of diagnostic assessments and additional psychotherapy intensity billed alongside primary therapy sessions.

The provider’s mix includes substantial non‑therapy supports and case management that broaden its service line: H0038 (self‑help/peer services) generates $1M (10.3% of Medicaid revenue), T1017 (targeted case management) generates $533.3K (5.4%), and T1016/H0032 appear in the mid‑to‑low five‑figure ranges. This combination of peer support, case management, and traditional psychotherapy suggests the clinic operates multidisciplinary programs that address both clinical treatment and social/support needs of Medicaid beneficiaries.

PEARL HEALTH CLINIC has a long tenure in the NPI registry (enumerated 2008‑04‑30, ~18 years ago), indicating an established presence in the state Medicaid market. Combined with the clinic’s outsized rankings on multiple key codes, the longevity supports that this is a stable, high‑volume Medicaid behavioral health provider rather than a recent entrant or marginal participant.

Medicaid: Complete Services Breakdown

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

34 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	59,380	$50	$3.1M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	22,890	$80	$1.7M
H2017	Psychosocial rehabilitation services, per 15 minutes	15,590	$110	$1.7M
H0038	Self‑help/peer services, per 15 minutes	9,950	$100	$1M
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	12,770	$40	$536.3K
T1017	Targeted case management, each 15 minutes	11,590	$50	$533.3K
S5150	Unskilled respite care, not hospice; per 15 minutes	5,160	$40	$211.7K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	2,450	$80	$201.1K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	2,010	$100	$192.6K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	2,400	$50	$117.4K

Showing 1–10 of 34

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Pearl Health Clinic — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

34 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0004	Behavioral health counseling and therapy, per 15 minutes	140	160	4,020	$140	$1.6M
S5150	Unskilled respite care, not hospice; per 15 minutes	5	30	1,410	$80	$804.2K
H2017	Psychosocial rehabilitation services, per 15 minutes	16	140	2,000	$110	$633.3K
H0038	Self‑help/peer services, per 15 minutes	16	110	1,730	$90	$436.4K
H0005	Alcohol and/or drug services; group counseling by a clinician	79	80	2,240	$50	$257.3K
T1017	Targeted case management, each 15 minutes	18	190	1,060	$60	$221.8K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	196	670	740	$40	$193.6K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	16	620	560	$60	$191.8K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	1	410	740	$60	$174.3K
96139	A technician administers two or more psychological or neuropsychological tests and scores them requiring an additional 30 minutes beyond the initial 30 minutes.	5	10	190	$270	$113.9K

Showing 1–10 of 34

Related Providers

Other providers that share a Tax Identification Number (TIN) with Pearl Health Clinic, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Stephen Denagy	ID	Internal Medicine Physician	$61.1K	$0
Daniel Mcgrath	WV	Clinical Psychologist	$20.3K	$0

Nearby Providers

Other providers in the same ZIP code as Pearl Health Clinic, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Royal Journeys LLC	ID	Developmentally Disabled Services Day Training Agency	$0	$38.3M
Just 4 Kids Pediatrics	ID	Pediatrics Physician	$0	$10.8M
Qualicare Inc.	ID	Nursing Care Agency	$0	$10.3M
4 Pillars Of Success LLC	ID	Multi-Specialty Clinic/Center	$0	$8M
A Childs Smile	ID	Pediatric Dentistry	$0	$4.4M
4 Pillars Of Success LLC	ID	Psychologist	$0	$3.3M
Lincare Inc.	ID	Durable Medical Equipment & Medical Supplies	$0	$2M
Darryl Moffett	ID	Ophthalmology Physician	$2M	$0
Idaho Falls Pediatric Dentistry, PLLC	ID	Pediatric Dentistry	$0	$1.2M
4 Pillars Of Success LLC	ID	Clinic/Center	$0	$697.9K

Pearl Health Clinic — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References