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

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

Middle Peninsula Northern Neck Mental Health & Retardation (NPI 1497717615)

Field	Value
Entity Type	Organization
Organization	Middle Peninsula Northern Neck Mental Health & Retardation
Address	9228 George Washington Memorial Hwy
City	Gloucester
State	VA
ZIP	23061
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	April 4, 2006

Payer Source	Total Paid
Medicaid	$68M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid operation: there is no Medicare billing on file and the provider reports $68M in lifetime Medicaid revenue. The absence of Medicare activity combined with a substantial Medicaid revenue base indicates its business is concentrated in state behavioral health funding and programs.

Revenue is highly concentrated in a small set of community-based codes: the precomputed top 3 Medicaid codes by revenue account for 65.8% of this provider's total Medicaid revenue, driven by H0023 ($19.3M, 28.4%), H2022 ($15.6M, 23.0%), and T1017 ($9.8M, 14.4%). These three line items together represent the majority of billed Medicaid dollars and should be the primary focus for any financial or utilization review.

The code mix points to an operational model built around community outreach, intensive per-diem wrap-around services, and targeted case management: H0023 (Behavioral health outreach service), H2022 (Community-based wrap-around services, per diem), and T1017 (Targeted case management, each 15 minutes) are the top revenue drivers. High claim volumes for outreach (58.3K claims for H0023) and case management (28.4K claims for T1017) suggest a field- and community-facing staffing model rather than a predominantly clinic-based ambulatory practice.

On competitive standing for its top revenue drivers, the provider is a typical to modest participant within the state: H0023 ranks #16 of 50 providers (69th percentile; typical, unremarkable volume), H2022 ranks #93 of 136 (32th percentile; typical, unremarkable volume), and T1017 ranks #19 of 46 (60th percentile; typical, unremarkable volume). In short, the organization is not a statewide dominant provider for these categories but maintains meaningful, mid-tier volume in core community services.

The provider shows outsized statewide volume in several clinical and therapy-oriented services: H0046 (Mental health services, not otherwise specified) ranks #31 of 509 (94th percentile; notably above typical state volume), 90837 ranks #26 of 1337 (98th percentile; notably above typical state volume), 90791 ranks #28 of 612 (96th percentile; notably above typical state volume), and 90847 ranks #4 of 142 (98th percentile; notably above typical state volume). These high percentiles indicate relatively strong capacity or focus on psychotherapy and psychiatric evaluation services compared with in-state peers.

The provider’s service portfolio spans outreach and community programs through more intensive day and partial-hospital services: H0035 (Mental health partial hospitalization) generates $3.8M and ranks #17 of 145 (89th percentile; typical), H0040 (Assertive community treatment, per diem) yields $2.3M and ranks #18 of 38 (54th percentile; typical), and H2017 (Psychosocial rehabilitation) contributes $1.5M and ranks #24 of 97 (76th percentile; typical). This distribution supports a continuum of care from engagement and case management to structured day services.

There is evidence of investment in care coordination and virtual access: 99490 (chronic care management) produced $249.4K and ranks #10 of 105 (91st percentile; typical), and Q3014 (telehealth originating site facility fee) produced $82.7K and ranks #12 of 87 (87th percentile; typical). These entries suggest the provider uses both telehealth and formal care-management mechanisms as part of its service mix.

The organization is long-tenured in federal enrollment: the NPI is enumerated 2006-04-04 (~20 years ago). This longevity, combined with a $68M Medicaid revenue footprint and a dominant reliance on community behavioral-health codes, points to an established community mental health center role in its region rather than a newly formed or transient program.

Medicaid: Complete Services Breakdown

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

37 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0023	Alcohol and/or drug outreach	58,280	$330	$19.3M
H2022	Community-based wrap-around services, per diem	2,270	$6,890	$15.6M
T1017	Targeted case management, each 15 minutes	28,430	$340	$9.8M
H0046	Mental health services, not otherwise specified	55,370	$100	$5.3M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	45,080	$90	$3.8M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	12,900	$220	$2.8M
H0040	Assertive community treatment program, per diem	12,730	$180	$2.3M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	19,770	$90	$1.8M
H2017	Psychosocial rehabilitation services, per 15 minutes	32,310	$50	$1.5M
H0039	Assertive community treatment, face-to-face, per 15 minutes	1,950	$630	$1.2M

Showing 1–10 of 37

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Middle Peninsula Northern Neck Mental Health & Retardation — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

37 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2022	Community-based wrap-around services, per diem	93	140	4,450	$1,150	$15.3M
H0023	Alcohol and/or drug outreach	16	50	33,630	$320	$15M
T1017	Targeted case management, each 15 minutes	19	50	23,860	$330	$9.4M
H0046	Mental health services, not otherwise specified	31	510	6,100	$190	$2.8M
H0040	Assertive community treatment program, per diem	18	40	10,830	$200	$2.7M
H0039	Assertive community treatment, face-to-face, per 15 minutes	21	30	2,740	$530	$2M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	17	150	5,420	$110	$1.9M
H2017	Psychosocial rehabilitation services, per 15 minutes	24	100	15,920	$60	$1.9M
H2012	Behavioral health day treatment, per hour	223	360	3,770	$200	$1.8M
T2023	Targeted case management; per month	19	40	3,000	$300	$1.3M

Showing 1–10 of 37

Related Providers

Other providers that share a Tax Identification Number (TIN) with Middle Peninsula Northern Neck Mental Health & Retardation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Daeryl Williamson	VA	Psychiatric/Mental Health Nurse Practitioner	$9.6K	$0
Parthiv Sheth	VA	Psychiatry Physician	$9.6K	$0

Nearby Providers

Other providers in the same ZIP code as Middle Peninsula Northern Neck Mental Health & Retardation, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Riverside Middle Peninsula Hospital Inc	VA	General Acute Care Hospital	$0	$19M
Sola Inc.	VA	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$14.3M
Peter Zullo	VA	Internal Medicine Physician	$347.5K	$0
James Larue	VA	Internal Medicine Physician	$200.3K	$0
Ronald Haggerty	VA	Internal Medicine Physician	$161.6K	$0
Aashna Faizy	VA	Physician Assistant	$136.4K	$0
Joseph Morris	VA	Nephrology Physician	$114K	$0
Ines Stromberg	VA	Urology Physician	$98.8K	$0
Christopher Schultz	VA	Medical Physician Assistant	$85.7K	$0
Jonathan Sardina	VA	Internal Medicine Physician	$77.5K	$0

Middle Peninsula Northern Neck Mental Health & Retardation — Billing Profile & Reimbursement Data

Sign up for Middle Peninsula Northern Neck Mental Health & Retardation — Billing Profile & Reimbursement Data policy alerts

Middle Peninsula Northern Neck Mental Health & Retardation — Billing Profile & Reimbursement Data

Sign up for Middle Peninsula Northern Neck Mental Health & Retardation — Billing Profile & Reimbursement Data policy alerts

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