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

Why is the Medicaid comparison limited to West 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. West 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.

Open Doors For The Developmentally Challenged, Inc. (NPI 1508907338)

Field	Value
Entity Type	Organization
Organization	Open Doors For The Developmentally Challenged, Inc.
Address	211 E Washington St
City	Lewisburg
State	WV
ZIP	24901
Taxonomy	Developmental Disabilities Clinic/Center
NPI Enumerated	February 12, 2007

Payer Source	Total Paid
Medicaid	$25.2M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and is effectively single-payer in scope: total Medicaid revenue is $25.2M and there is no recorded Medicare revenue to compare against. For payer-mix analysis this makes the provider highly dependent on Medicaid policy, rates, and waiver programs.

Revenue is extremely concentrated in a very small set of Medicaid codes: the precomputed top 3 Medicaid codes account for 94.3% of the provider's total Medicaid revenue, with S5125 alone contributing $22.1M (87.9% of Medicaid revenue). That concentration implies material financial exposure if reimbursement or eligibility for those units changes.

The mix of high-volume codes (S5125 – attendant care services; per 15 minutes) alongside T1002 (Rn services, up to 15 minutes), T2021 (Day habilitation, waiver; per 15 minutes), T1016 (case management), and T1003 (Lpn/lvn services) points to an operation focused on home- and community-based attendant care and waiver habilitation services for individuals with developmental disabilities. Billing patterns emphasize frequent short-interval units and a combination of direct hands-on care and care coordination.

Despite S5125 accounting for the vast bulk of revenue, the provider is not a dominant statewide performer on that code: S5125 ranks #36 of 43 providers in-state (17th percentile) and is labeled in the data as typical/unremarkable volume. In other words, this organization’s business model is highly concentrated on a service where it is a modest participant in the broader state market.

Other leading Medicaid codes show similar modest statewide standing: T1002 generated $972.7K (3.9% of Medicaid revenue) and ranks #90 of 151 in-state (41st percentile, characterized as typical/unremarkable), while T2021 produced $635.5K (2.5%) and ranks #44 of 57 (23rd percentile, typical/unremarkable). These ranks indicate the provider is generally a middle- to lower-tier competitor across its secondary service lines rather than a market leader.

Operational volume details reinforce the attendant-care focus: S5125 had 4K claims with $5539 avg paid/claim, T1002 had 1.6K claims with $616 avg paid/claim, and T2021 had 2.2K claims with $289 avg paid/claim. The combination of large claim counts and short-interval unit codes suggests staffing and scheduling are centered on frequent, time-based service delivery.

From a payer or contracting perspective, the provider’s lack of Medicare activity and the fact that nearly all revenue flows through a handful of Medicaid waiver and attendant-care codes mean that state waiver rules, unit-rate adjustments, or service-authorization changes could materially affect its financial picture. Monitoring state-level rate-setting and waiver policy updates for S5125, T1002, and T2021 should be a priority.

The provider’s NPI was enumerated 2007-02-12 (~19 years ago), indicating long tenure in the market which may reflect established relationships with state Medicaid and waiver programs. However, tenure has not translated into top-tier statewide ranks for the provider’s principal billed services, so longevity appears to support steady operations rather than market leadership.

Medicaid: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5125	Attendant care services; per 15 minutes	3,990	$5,540	$22.1M
T1002	Rn services, up to 15 minutes	1,580	$620	$972.7K
T2021	Day habilitation, waiver; per 15 minutes	2,200	$290	$635.5K
G9002	Coordinated care fee, maintenance rate	1,920	$220	$425.8K
T1016	Case management, each 15 minutes	1,790	$210	$370.7K
T1003	Lpn/lvn services, up to 15 minutes	1,530	$220	$342K
A0160	Non-emergency transportation: per mile - case worker or social worker	1,670	$170	$277.6K
T2024	Service assessment/plan of care development, waiver	170	$70	$11.2K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Open Doors For The Developmentally Challenged, Inc. — 0 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	36	40	14,820	$750	$30.5M
T2021	Day habilitation, waiver; per 15 minutes	44	60	6,490	$120	$2.2M
G9002	Coordinated care fee, maintenance rate	77	120	2,950	$150	$901.9K
T1003	Lpn/lvn services, up to 15 minutes	20	30	2,070	$90	$522.7K
T1016	Case management, each 15 minutes	58	100	2,790	$90	$496.2K
A0160	Non-emergency transportation: per mile - case worker or social worker	64	110	2,030	$50	$278.8K
T1002	Rn services, up to 15 minutes	90	150	1,980	$40	$232.6K
T2024	Service assessment/plan of care development, waiver	34	50	760	$50	$95.5K

Nearby Providers

Other providers in the same ZIP code as Open Doors For The Developmentally Challenged, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Virginia School Of Osteopathic Medicine Clinic Inc	WV	Rural Health Clinic/Center	$0	$9.5M
Rebecca Kucera	WV	Pediatric Dentistry	$0	$5.1M
Davis-stuart, Inc.	WV	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$3.6M
Greenbrier County Emergency Ambulance Service, Inc	WV	Ambulance	$352.4K	$2.6M
Lincare Inc.	WV	Durable Medical Equipment & Medical Supplies	$0	$1.8M
Rainelle Medical Center, Inc	WV	Federally Qualified Health Center (FQHC)	$0	$1.3M
Rainelle Medical Center, Inc	WV	Federally Qualified Health Center (FQHC)	$0	$1.2M
West Virginia Radiation Therapy Services Inc	WV	Radiation Oncology Physician	$0	$1.1M
Wecare Medical LLC	WV	Oxygen Equipment & Supplies (DME)	$0	$868.6K
Rainelle Medical Center, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$798.4K

Open Doors For The Developmentally Challenged, Inc. — Billing Profile & Reimbursement Data

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Open Doors For The Developmentally Challenged, 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

Nearby Providers

Frequently Asked Questions

References