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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

Sumter County Disabilities And Special Needs Boards (NPI 1558823880)

Field	Value
Entity Type	Organization
Organization	Sumter County Disabilities And Special Needs Boards
Address	750 Electric Dr
City	Sumter
State	SC
ZIP	29153
Taxonomy	Early Intervention Provider Agency
NPI Enumerated	April 4, 2019

Payer Source	Total Paid
Medicaid	$25M
Medicare	$0

Key Findings

This entity is effectively a single-payer Medicaid operator: it reports no Medicare billing on file and $25M in lifetime Medicaid revenue, indicating Medicaid overwhelmingly drives its business activity and financial scale. Analysts should treat Medicare exposure as nil for payer-mix modeling and focus on Medicaid waiver programs when evaluating revenue risk and growth opportunities.

Revenue is highly concentrated in a very small set of per-diem habilitation codes: the top 3 codes account for 97.9% of this provider's total Medicaid revenue. Specifically, T2016 accounts for $20.2M (80.9%), T2014 accounts for $2.2M (8.9%), and T2020 accounts for $2M (8.1%), so changes to reimbursement or utilization for these three codes would materially affect total revenue.

The code mix (T2016: habilitation, residential, waiver; T2014: habilitation, prevocational, waiver; T2020: day habilitation, waiver) and the provider taxonomy (Early Intervention Provider Agency) indicate the organization operates waiver-funded residential and day habilitation and prevocational services for individuals with developmental disabilities. This profile suggests operational capacity for long-term per-diem care and day programs rather than episodic clinical services.

Despite T2016 driving the bulk of revenue ($20.2M; 80.9%), the provider is not a statewide dominant billing outlier for that code: it ranks #13 of 52 providers in-state (76th percentile) and is described as having typical, unremarkable volume for this code. In other words, the provider earns a large share of its own revenue from T2016 but, relative to peers, it is a modest-to-midsize participant rather than a top statewide volume leader.

The secondary revenue drivers T2014 ($2.2M; 8.9%) and T2020 ($2M; 8.1%) likewise show typical, unremarkable volumes in-state, ranking #11 of 34 (70th percentile) and #14 of 40 (67th percentile) respectively. These ranks imply the provider participates in prevocational and day habilitation markets at a comparable level to many peers, reinforcing a diversified program mix within the waiver habilitation space but not a commanding competitive position.

Smaller service lines contribute only marginally to overall revenue: T1017 reported $375.6K (1.5%) and ranks #26 of 57 (55th percentile, typical, unremarkable volume), T1027 reported $140.3K (0.6%) and ranks #54 of 81 (34th percentile, typical, unremarkable volume), and T1016 reported $2.3K (0.0%) and ranks #98 of 102 (4th percentile, typical, unremarkable volume). These sums indicate limited diversification outside the three per-diem habilitation codes and minimal scale in case management and family training billings.

The concentration of revenue in per-diem waiver habilitation codes implies operational and reimbursement sensitivity: program-level capacity, occupancy, and state waiver rate changes for T2016/T2014/T2020 would disproportionately impact this provider's financial performance. Payers and contracting analysts should therefore prioritize monitoring waiver rate adjustments and utilization trends for these specific codes when assessing financial stability or negotiating managed payment arrangements.

The provider's NPI was enumerated on 2019-04-04 (~7 years ago), so it has an established multi-year presence in the state waiver market but is not a long-tenured legacy provider. Combined with the concentrated Medicaid revenue base and the code-rank profile, this suggests an established but regionally modest operator focused on waiver habilitation services rather than rapid network expansion or diversification into Medicare lines.

Medicaid: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	83,980	$240	$20.2M
T2014	Habilitation, prevocational, waiver; per diem	29,180	$80	$2.2M
T2020	Day habilitation, waiver; per diem	26,450	$80	$2M
T1017	Targeted case management, each 15 minutes	9,160	$40	$375.6K
T1027	Family training and counseling for child development, per 15 minutes	2,000	$70	$140.3K
T1016	Case management, each 15 minutes	50	$50	$2.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

Sumter County Disabilities And Special Needs Boards — 0 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	13	50	42,240	$250	$15.4M
T2014	Habilitation, prevocational, waiver; per diem	11	30	17,930	$70	$1.9M
T2020	Day habilitation, waiver; per diem	14	40	18,120	$70	$1.8M
T1017	Targeted case management, each 15 minutes	26	60	7,610	$50	$1.2M
T1027	Family training and counseling for child development, per 15 minutes	54	80	3,560	$100	$857.8K
T1016	Case management, each 15 minutes	98	100	4,210	$50	$614.8K

Nearby Providers

Other providers in the same ZIP code as Sumter County Disabilities And Special Needs Boards, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
South Carolina Dept Of Mental Health Accounting Office	SC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$28M
Acsr, Inc.	SC	Adult Day Care Clinic/Center	$0	$3.5M
Med-trans Corporation	SC	Air Ambulance	$577.2K	$263.5K
Bnt Transportation Service LLC	SC	Ambulance	$566.2K	$0

Sumter County Disabilities And Special Needs Boards — Billing Profile & Reimbursement Data

Sign up for Sumter County Disabilities And Special Needs Boards — Billing Profile & Reimbursement Data policy alerts

Sumter County Disabilities And Special Needs Boards — Billing Profile & Reimbursement Data

Sign up for Sumter County Disabilities And Special Needs Boards — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References