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

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

Pyramid Health Care Inc. (NPI 1477674828)

Field	Value
Entity Type	Organization
Organization	Pyramid Health Care Inc.
Address	306 Penn Ave
City	Wilkinsburg
State	PA
ZIP	15221
Taxonomy	Substance Abuse Rehabilitation Facility
NPI Enumerated	April 3, 2007

Payer Source	Total Paid
Medicaid	$128.8M
Medicare	$0

Key Findings

PYRAMID HEALTH CARE INC. is effectively a Medicaid-focused operator: it has no Medicare billing on file and reports $128.8M in lifetime Medicaid revenue, indicating Medicaid is its primary — effectively sole — payer relationship in the available data. This payer concentration shapes both its revenue profile and the types of services it bills.

Revenue is extremely concentrated in just a few per-diem behavioral health codes: the precomputed top 3 Medicaid codes account for 99.5% of this provider's total Medicaid revenue. H2036 drives the majority of receipts with $101.6M (78.9% of Medicaid revenue), followed by H0013 with $22.8M (17.7%), and H0018 at $3.7M (2.9%), leaving only a small residual from other codes.

The code mix and descriptions identify the provider as a residential substance use disorder operator: H2036 (Alcohol and/or other drug treatment program, per diem) and H0013 (acute detoxification) together account for ~96.6% of Medicaid revenue, showing a business model centered on per‑diem residential addiction treatment and detox services rather than outpatient or mixed ambulatory care. H0018 (short-term residential without room and board) and T2048 (long-term care residential with room and board) further confirm a bed‑based treatment footprint.

Operational and reimbursement exposure is high because two codes dominate revenue: H2036 (343.3K claims, $296 avg paid/claim, $101.6M) and H0013 (62.9K claims, $363 avg paid/claim, $22.8M). Any changes in Medicaid per‑diem rates, eligibility, or utilization management for these specific residential and detox codes could disproportionately impact overall revenue.

Competitive standing within Pennsylvania is dominant for the two top revenue codes: PYRAMID ranks #1 of 117 providers for H2036 (100th percentile, described as an extreme outlier, far above typical state volume) and #1 of 61 providers for H0013 (100th percentile, also an extreme outlier). These rankings indicate PYRAMID is a statewide leader in billed volume and revenue for residential addiction treatment and detox services.

For other residential code types PYRAMID’s footprint is more typical: H0018 (14K claims, $263 avg paid/claim, $3.7M) ranks #21 of 95 (79th percentile) and T2048 (2.5K claims, $260 avg paid/claim, $643.8K) ranks #22 of 58 (63th percentile), suggesting above‑median but not market‑leading participation in short‑term non‑room-and‑board residential and long‑term residential with room and board services.

Tenure data show longstanding enrollment: the NPI was enumerated on 2007-04-03 (~19 years ago), indicating nearly two decades of presence in the provider marketplace that likely supported accrual of the high claim volumes reported here. This longevity may contribute to the provider's capacity to sustain large residential programs at scale.

From a payer strategy and network perspective, PYRAMID’s profile signals a specialized, high‑volume residential addiction services provider with concentrated Medicaid reliance and dominant statewide positions on the primary per‑diem codes. Analysts and contract negotiators should treat it as a major Medicaid supplier of residential substance use treatment in Pennsylvania, while also accounting for the revenue concentration risks tied to a narrow set of billing codes.

Medicaid: Complete Services Breakdown

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

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2036	Alcohol and/or other drug treatment program, per diem	343,320	$300	$101.6M
H0013	Alcohol and/or drug services: acute detox (residential addiction program outpatient)	62,890	$360	$22.8M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	13,980	$260	$3.7M
T2048	Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem	2,480	$260	$643.8K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Pyramid Health Care Inc. — 2 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

4 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2036	Alcohol and/or other drug treatment program, per diem	1	120	7,190	$420	$8.7M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	21	100	5,130	$370	$4.5M
H0013	Alcohol and/or drug services: acute detox (residential addiction program outpatient)	1	60	2,400	$450	$2.6M
T2048	Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem	22	60	1,280	$360	$1.8M

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pyramid Healthcare	PA	Substance Abuse Rehabilitation Facility	$0	$87.4M
Pyramid Healthcare, Inc.	VA	Community/Behavioral Health Agency	$0	$40.6M
Pyramid Health Care Inc.	PA	Substance Abuse Rehabilitation Facility	$0	$23.9M
Pyramid Healthcare Inc.	PA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$14.3M
Pyramid Healthcare Inc.	PA	Methadone Clinic	$125.2K	$13.3M
Pyramid Healthcare Inc.	PA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$11M
Pyramid Healthcare Inc.	PA	Substance Abuse Rehabilitation Facility	$0	$10.4M
Pyramid Healthcare Inc.	PA	Substance Abuse Rehabilitation Facility	$0	$8.6M
Pyrmaid Healthcare Inc.	PA	Methadone Clinic	$96.6K	$8.1M
Pyramid Healthcare Inc	PA	Children's Substance Abuse Rehabilitation Facility	$0	$8.2M

Nearby Providers

Other providers in the same ZIP code as Pyramid Health Care Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wesley Family Services	PA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$123.4M
Bayada Home Health Care, Inc.	PA	Home Health Agency	$0	$21.7M
Therapeutic Early Intervention Services, LP.	PA	Home Health Agency	$0	$12.6M
Milestone Centers Inc.	PA	Community/Behavioral Health Agency	$0	$5.7M
Brian Carlin	PA	Pulmonary Disease Physician	$183K	$29K
Vasantha Madhavan	PA	Cardiovascular Disease Physician	$47.9K	$44.6K
Rong-chung Lin	PA	Urology Physician	$29.3K	$33.1K
Isaac Levari	PA	Family Medicine Physician	$47.1K	$2.1K

Pyramid Health Care Inc. — Billing Profile & Reimbursement Data

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Pyramid Health Care 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

Related Providers

Nearby Providers

Frequently Asked Questions

References