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.

Philhaven (NPI 1508081639)

Field	Value
Entity Type	Organization
Organization	Philhaven
Address	283 S Butler Rd
City	Lebanon
State	PA
ZIP	17042
Taxonomy	Clinic/Center
NPI Enumerated	April 16, 2007

Payer Source	Total Paid
Medicaid	$19.8M
Medicare	$0

Medicaid: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0004	Behavioral health counseling and therapy, per 15 minutes	37,460	$170	$6.3M
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	25,810	$140	$3.6M
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	30,380	$110	$3.3M
H2021	Community-based wrap-around services, per 15 minutes	31,600	$110	$3.3M
97154	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	5,130	$250	$1.3M
97151	The provider, a physician or other qualified healthcare professional, identifies the adaptive or maladaptive behavior of the patient by administering several different types of tests in person; he…	3,780	$180	$669.6K
H2019	Therapeutic behavioral services, per 15 minutes	8,220	$60	$518K
97156	The provider discusses a patient’s adaptive behavior treatment face–to–face with the guardian(s) or caregiver(s), with or without the patient present. Report this code for each 15 minutes that the…	3,180	$120	$393.7K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	1,290	$150	$195.2K
T1016	Case management, each 15 minutes	760	$90	$64.7K

Showing 1–10 of 15

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

Philhaven — 1 of 13 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

15 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	24	150	8,280	$220	$4.1M
97154	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	9	20	1,780	$210	$2.6M
H2021	Community-based wrap-around services, per 15 minutes	28	220	3,810	$100	$1.5M
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	9	150	2,770	$200	$1.4M
H0032	Mental health service plan development by non-physician	207	210	3,020	$130	$1.3M
T1016	Case management, each 15 minutes	100	160	2,180	$80	$965.8K
H0046	Mental health services, not otherwise specified	164	170	1,200	$130	$909.6K
H2015	Comprehensive community support services, per 15 minutes	9	20	830	$140	$791.2K
H2019	Therapeutic behavioral services, per 15 minutes	55	180	3,510	$80	$685K
97151	The provider, a physician or other qualified healthcare professional, identifies the adaptive or maladaptive behavior of the patient by administering several different types of tests in person; he…	28	120	1,330	$180	$557.5K

Showing 1–10 of 15

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Wellspan Medical Group	PA	Psychiatry Physician	$0	$22.3M
Philhaven	PA	Clinic/Center	$0	$10.9M
Philhaven	PA	Clinic/Center	$0	$7.1M
Philhaven	PA	Psychiatric Hospital	$0	$5.9M
Alfred Sylvester	PA	Psychiatry Physician	$41.1K	$0
Thomas Fenstermacher	PA	Psychiatry Physician	$30.2K	$0
April Mandeville-palm	PA	Clinical Social Worker	$17K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Good Samaritan Hospital Of Lebanon, Pennsylvania	PA	General Acute Care Hospital	$0	$18.2M
Wicare Home Care Agency, LLC.	PA	Home Health Agency	$0	$5.5M
Lebanon Fire Department First Aid And Safety Patrol	PA	Ambulance	$1M	$3.8M
Surgery Center Of Lebanon, LP	PA	Ambulatory Surgical Clinic/Center	$945.9K	$0
Mark Maria	PA	Ophthalmology Physician	$581K	$0
Lebanon Internal Medicine Associates PC	PA	Clinical Medical Laboratory	$529.8K	$7.5K
Thomas Kantor	PA	Rheumatology Physician	$448.3K	$0
Francis Gallagher	PA	Rheumatology Physician	$399.9K	$0
Ernesto Gutierrez	PA	Rheumatology Physician	$382.6K	$310
Raymond Demaio	PA	Ophthalmology Physician	$314.5K	$0

Philhaven — Billing Profile & Reimbursement Data

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Philhaven — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References