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

Why is the Medicaid comparison limited to New Hampshire 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. New Hampshire (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.

Spaulding Academy & Family Services (NPI 1477739175)

Field	Value
Entity Type	Organization
Organization	Spaulding Academy & Family Services
Address	72 Spaulding Rd
City	Northfield
State	NH
ZIP	03276
Taxonomy	Emotionally Disturbed Childrens' Residential Treatment Facility
NPI Enumerated	January 14, 2008

Payer Source	Total Paid
Medicaid	$26.8M
Medicare	$0

Key Findings

This provider is effectively single-payer: there is no Medicare billing on file and all reported lifecycle revenue is Medicaid-driven, totaling $26.8M. The absence of Medicare activity indicates the organization’s operations and reimbursement exposure are concentrated entirely within Medicaid programs.

Revenue is extremely concentrated in a few Medicaid codes: the precomputed top-3 codes account for 97.0% of total Medicaid revenue, with H0019 alone representing $22.5M (84.2% of Medicaid revenue). T1025 ($2M, 7.5%) and H0043 ($1.4M, 5.3%) round out the dominant revenue lines, meaning a small set of per-diem services drives nearly all payments.

The code mix and descriptions point to a core business of long-term residential care and intensive child-focused services: H0019 is long-term residential (non-medical, non-acute) per diem billing, T1025 is intensive, extended multidisciplinary services for children, and H0043 is supported housing per diem. Together these suggest the provider operates a residential treatment model for emotionally disturbed children with associated multidisciplinary clinic and housing supports.

Operational scale and unit economics are visible in the claim and unit-payment figures: H0019 shows 5.2K claims at $4349 avg paid/claim, T1025 shows 424 claims at $4741 avg paid/claim, and H0043 shows 1.1K claims at $1321 avg paid/claim. These per-diem average payments reinforce that the provider’s revenue base is dominated by high-volume residential per-diem billing rather than numerous low-dollar service lines.

On competitive standing within the state, the provider is a modest participant rather than a dominant leader: H0019 ranks #7 of 13 providers in-state (50th percentile; described as typical, unremarkable volume), T1025 ranks #4 of 8 (57th percentile; typical), and H0043 ranks #6 of 10 (44th percentile; typical). These ranks indicate the provider’s volumes are in the middle of the state distribution for its primary service lines.

Smaller Medicaid lines are present but immaterial to overall revenue: H2022 contributes $726.7K (2.7% of Medicaid revenue) and ranks #13 of 15 in-state (14th percentile; typical), while H0040 contributes $71.3K (0.3%) and ranks #12 of 12 (0th percentile; typical). These figures show limited activity in community-based wrap-around and assertive community treatment relative to the provider’s core residential services.

The provider’s NPI has been active since 2008-01-14 (~18 years ago), indicating an established tenure in the market. This longevity, coupled with concentrated Medicaid revenue, suggests a stable specialty operator focused on child residential treatment rather than a new or diversified provider.

From a financial and operational perspective, the heavy dependence on H0019 and the top-3 concentration (97.0%) implies the organization’s Medicaid revenue profile is highly concentrated in per-diem residential billing; any material changes to per-diem rates, state program policies, or residential utilization patterns would disproportionately affect overall revenue.

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
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	5,180	$4,350	$22.5M
T1025	Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem	420	$4,740	$2M
H0043	Supported housing, per diem	1,080	$1,320	$1.4M
H2022	Community-based wrap-around services, per diem	620	$1,170	$726.7K
H0040	Assertive community treatment program, per diem	60	$1,210	$71.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Hampshire Distribution

Spaulding Academy & Family Services — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Hampshire

Full comparison — all codes billed, vs. New Hampshire median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	7	10	5,180	$1,400	$17.7M
H2022	Community-based wrap-around services, per diem	13	20	3,860	$200	$5M
H0040	Assertive community treatment program, per diem	12	10	3,700	$270	$2.8M
H0043	Supported housing, per diem	6	10	1,780	$180	$1.6M
T1025	Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem	4	10	360	$240	$527.9K

Nearby Providers

Other providers in the same ZIP code as Spaulding Academy & Family Services, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Winnisquam Regional School District	NH	Local Education Agency (LEA)	$0	$1.4M
Sharon Wolf	NH	Mental Health Counselor	$0	$572.1K
Tilton - Northfield Fire District	NH	Land Ambulance	$145K	$125.2K
Belknap Occupational Health LLC	NH	Physical Therapist	$0	$143.1K
Archways	NH	Recovery Care Clinic/Center	$0	$142K
Walgreen Co	NH	Pharmacy	$97.5K	$0
Wal-mart Stores East LP	NH	Community/Retail Pharmacy	$76.1K	$0
Michael Smirnioudis	NH	Family Nurse Practitioner	$50.5K	$1.6K
Jilian Stogniew	NH	Chiropractor	$42.1K	$0

Spaulding Academy & Family Services — Billing Profile & Reimbursement Data

Sign up for Spaulding Academy & Family Services — Billing Profile & Reimbursement Data policy alerts

Spaulding Academy & Family Services — Billing Profile & Reimbursement Data

Sign up for Spaulding Academy & Family Services — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References