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

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

Commonwealth Of Massachusetts (NPI 1497870943)

Field	Value
Entity Type	Organization
Organization	Commonwealth Of Massachusetts
Address	365 East St
City	Tewksbury
State	MA
ZIP	01876
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	March 20, 2007

Payer Source	Total Paid
Medicaid	$212.8M
Medicare	$0

Key Findings

This entity is effectively a Medicaid-centric provider: it reports $212.8M in lifetime Medicaid revenue and has no Medicare billing on file, so its financial footprint in the available claims data is concentrated entirely in Medicaid. The absence of Medicare billing on file means payer mix is overwhelmingly single-payer (Medicaid) in the observed data set.

Revenue is extremely concentrated in a very small set of codes: the top 3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with H2018 alone producing $199.1M (93.6% of Medicaid revenue). The dominance of H2018 is also reflected in volume (654.9K claims) and a modest average payment per claim ($304 avg paid/claim), showing revenue driven by high per-diem volume rather than high unit prices.

The code mix points to a residential and psychosocial rehabilitation business model: H2018 (Psychosocial rehabilitation services, per diem), H0019 (Behavioral health; long-term residential, without room and board, per diem), and H0018 (Behavioral health; short-term residential, without room and board, per diem) together comprise the provider’s entire Medicaid revenue profile. This suggests the organization operates large-scale per-diem residential and rehabilitation programs where bed-days and length of stay are the primary drivers of revenue.

Competitive standing for H2018 is strong within the state: the provider ranks #1 of 6 in-state for H2018 and is at the 100th percentile, indicating it is the leading in-state reporter of psychosocial rehabilitation per-diem revenue among the compared peers. Note that the precomputed characterization labels this as "typical, unremarkable volume for this code," but the ranking and share (93.6%) nevertheless establish a dominant position for this specific service in-state.

For H0019 the provider shows a meaningful but not dominant presence: H0019 generated $11.6M (5.5% of Medicaid revenue) from 21.1K claims at $551 avg paid/claim and the provider ranks #19 of 75 in-state (76th percentile). This rank and percentile indicate a legitimate statewide footprint in long-term residential behavioral health without being among the very largest providers for that code.

Participation in short-term residential (H0018) is limited: H0018 accounts for $2.1M (1.0% of Medicaid revenue) from 701 claims at $3015 avg paid/claim and the provider ranks #3 of 4 in-state (33th percentile). The small revenue share and low rank among a small peer group suggest short-term residential is a marginal line of business for this provider compared with its psychosocial rehabilitation offering.

Operationally, the business appears optimized for high-volume per-diem billing and bed-day management: 654.9K claims for H2018 at a $304 average indicate administrative and operational processes oriented around sustained, repetitive per-diem claims rather than episodic, high-dollar procedures. Payers and analysts should therefore monitor occupancy, length-of-stay, and per-diem rate negotiations as primary levers affecting the provider’s revenue.

The provider has a long tenure in the NPI file (NPI enumerated 2007-03-20 (~19 years ago)), establishing it as an established participant in the state behavioral health market. However, the combination of long tenure and extreme revenue concentration in a single service line and payer means the provider’s financial position could be sensitive to Medicaid policy, reimbursement changes for H2018/H0019/H0018, or shifts in utilization patterns tied to residential behavioral health services.

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2018	Psychosocial rehabilitation services, per diem	654,920	$300	$199.1M
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	21,060	$550	$11.6M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	700	$3,020	$2.1M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Commonwealth Of Massachusetts — 1 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2018	Psychosocial rehabilitation services, per diem	1	10	483,500	$330	$139.9M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	3	10	60,540	$1,530	$132.9M
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	19	80	5,200	$370	$8.4M

Nearby Providers

Other providers in the same ZIP code as Commonwealth Of Massachusetts, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Altranais Home Care, LLC	MA	Respite Care	$0	$48M
Integrity Home Care Solutions, LLC	MA	Home Health Agency	$0	$26.2M
Horizon Home Care	MA	Home Health Agency	$0	$9.6M
Town Of Tewksbury	MA	Ambulance	$435.2K	$1.5M
Michael Maliszewski	MA	Clinical Psychologist	$173.4K	$176.9K
Michael Bove	MA	Physical Therapist	$95K	$0
Joel Leclerc	MA	Physical Therapist	$84.3K	$0
David Thomas	MA	Physical Therapist	$80.1K	$0
Rebecca Wallach	MA	Family Medicine Physician	$70K	$0
Denise Farnsworth	MA	Physical Therapist	$34K	$0

Commonwealth Of Massachusetts — Billing Profile & Reimbursement Data

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Commonwealth Of Massachusetts — 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