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

Why is the Medicaid comparison limited to Rhode Island 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. Rhode Island (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.

James L Maher Center (NPI 1558492405)

Field	Value
Entity Type	Organization
Organization	James L Maher Center
Address	120 Hillside Avenue
City	Newport
State	RI
ZIP	02840
Taxonomy	Multi-Specialty Clinic/Center
NPI Enumerated	March 9, 2007

Payer Source	Total Paid
Medicaid	$52.5M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-only biller: there is no Medicare billing on file while total Medicaid revenue is $52.5M. The absence of Medicare activity combined with substantial Medicaid receipts means payer exposure and operational focus are concentrated almost entirely in state Medicaid programs.

Revenue is highly concentrated in a very small set of waiver and habilitation codes — the top three Medicaid codes account for 89.5% of the provider's Medicaid revenue. The single largest line is T2033 (Residential care, nos, waiver; per diem) at $32.1M (61.1% of Medicaid revenue), followed by T2021 (Day habilitation, waiver; per 15 minutes) at $10.9M (20.8%) and T2017 (Habilitation, residential, waiver; 15 minutes) at $4M (7.5%).

The code mix points to an operation focused on long-term habilitation and residential supports rather than episodic medical care: large per-diem residential payments (T2033) plus high-volume day habilitation (T2021) and residential habilitation (T2017) create a programmatic profile centered on waiver-funded developmental-disability services and congregate or supported-residential care. This profile implies staffing, facilities, and scheduling models aligned to full-day/day-program and 24-hour residential service delivery.

Competitive standing across in-state peers is mixed by service line. For the dominant T2033 residential per-diem the provider ranks #10 of 22 (57th percentile) indicating typical, unremarkable volume for that code statewide, but it is a stronger competitor on habilitation services where T2021 ranks #6 of 33 (84th percentile) and T2017 ranks #5 of 36 (89th percentile), suggesting a relatively strong market position in day and residential habilitation.

There are notable pockets of above-typical activity in niche case management: T2023 (Targeted case management; per month) is ranked #1 of 14 and described as notably above typical state volume for this code, even though it represents only $557K (1.1% of Medicaid revenue). This indicates a specific strength or emphasis on targeted case management relative to most peers despite its small share of total revenue.

Operationally, non-clinical logistics are material — T2003 (Non-emergency transportation; encounter/trip) shows 23.9K claims, $137 avg paid/claim, and $3.3M revenue (6.2% of Medicaid revenue) while ranking #6 of 55 providers in-state (91st percentile). High trip volume suggests substantial transportation capacity or coordination commitments tied to day-program and residential operations.

Payment profile and revenue risk are concentrated in high-dollar, recurring per-diem and per-interval waiver payments: T2033’s $3691 avg paid/claim per diem comprises the majority of revenue, meaning reimbursement policy changes to per-diem residential rates or waiver eligibility could have outsized impact on revenues. The balance of per-15-minute codes (T2021, T2017) further ties revenue to service-hour utilization and authorizations rather than single-visit procedures.

The provider has an established billing history with its NPI enumerated on 2007-03-09 (~19 years ago), indicating longevity in the market. Combined with the Medicaid-centric revenue base and the code mix, this tenure suggests an entrenched operational footprint in state-funded residential and habilitation services rather than a new market entrant.

Medicaid: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	8,690	$3,690	$32.1M
T2021	Day habilitation, waiver; per 15 minutes	36,180	$300	$10.9M
T2017	Habilitation, residential, waiver; 15 minutes	16,340	$240	$4M
T2003	Non-emergency transportation; encounter/trip	23,900	$140	$3.3M
T2022	Case management, per month	7,690	$150	$1.1M
T2023	Targeted case management; per month	2,440	$230	$557K
T2019	Habilitation, supported employment, waiver; per 15 minutes	2,650	$160	$427K
T2015	Habilitation, prevocational, waiver; per hour	160	$310	$47.9K
T2025	Waiver services; not otherwise specified (nos)	380	$100	$36K
T2020	Day habilitation, waiver; per diem	410	$50	$21.1K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Rhode Island Distribution

James L Maher Center — 1 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Rhode Island

Full comparison — all codes billed, vs. Rhode Island median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	10	20	6,780	$1,890	$39.8M
T2017	Habilitation, residential, waiver; 15 minutes	5	40	3,820	$510	$10.6M
T2021	Day habilitation, waiver; per 15 minutes	6	30	12,340	$410	$10M
T2025	Waiver services; not otherwise specified (nos)	15	30	620	$70	$1.2M
T2022	Case management, per month	13	40	5,460	$150	$1.2M
T2003	Non-emergency transportation; encounter/trip	6	60	7,480	$80	$1.1M
T2020	Day habilitation, waiver; per diem	9	20	450	$950	$864.4K
T2019	Habilitation, supported employment, waiver; per 15 minutes	6	10	1,870	$230	$688.6K
T2015	Habilitation, prevocational, waiver; per hour	15	20	330	$460	$396.2K
T1002	Rn services, up to 15 minutes	13	30	280	$110	$253.3K

Showing 1–10 of 12

Nearby Providers

Other providers in the same ZIP code as James L Maher Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Newport Hospital	RI	General Acute Care Hospital	$0	$15.8M
East Bay Communtiy Action Program	RI	Case Management Agency	$0	$4.9M
Newport Hospital	RI	Psychiatric Hospital Unit	$0	$3.1M
Faith Drennon	RI	Pediatric Dentistry	$0	$2.8M
East Bay Community Action Program	RI	Dental Clinic/Center	$0	$2M
Jasma Patel	RI	Dentist	$0	$1.9M
Newport Public Schools	RI	Local Education Agency (LEA)	$0	$1.6M
Charles Stengel	RI	Emergency Medicine Physician	$59K	$870.4K
City Of Newport	RI	Land Ambulance	$306K	$580.6K
St. Clare Home, Inc.	RI	Skilled Nursing Facility	$0	$464.8K

James L Maher Center — Billing Profile & Reimbursement Data

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James L Maher Center — 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