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.

Looking Upwards, Inc. (NPI 1578693172)

Field	Value
Entity Type	Organization
Organization	Looking Upwards, Inc.
Address	1184 E Main Rd
City	Portsmouth
State	RI
ZIP	02871
Taxonomy	Intellectual and/or Developmental Disabilities Residential Treatment Facility
NPI Enumerated	March 6, 2007

Payer Source	Total Paid
Medicaid	$15.7M
Medicare	$0

Key Findings

LOOKING UPWARDS, INC. has no Medicare billing on file and reports $15.7M in Medicaid revenue, which makes Medicaid effectively the sole payer driving this provider’s billed activity and financial footprint in the available data. This single-payer profile suggests its operations and payer contracting are concentrated on state Medicaid programs rather than Medicare populations or fee-for-service medical procedures.

Revenue is highly concentrated: the top three Medicaid revenue drivers — T1019 ($7.7M, 49.0%), T1024 ($3.3M, 21.0%), and T1016 ($2.1M, 13.2%) — together account for 83.2% of this provider’s total Medicaid revenue. That concentration implies that a small set of service lines dominate the organization’s Medicaid billing and financial risk exposure.

The code mix (T1019 personal care services, T1016 case management, and T1024 evaluation and treatment by an integrated specialty team) aligns with an operation focused on labor-intensive, community- and residential-based support and care coordination for individuals with intellectual and developmental disabilities. These codes indicate the provider delivers high-frequency direct care and structured interdisciplinary services rather than procedure-driven, high-acuity medical interventions.

Several Medicaid codes show the provider is a large statewide participant: T1016 ranks #2 of 180 providers in-state at the 99th percentile and T1024 ranks #6 of 91 providers at the 94th percentile, while H2016 ranks #2 of 39 providers at the 97th percentile. These rankings and percentiles (where labeled “notably above typical”) indicate the provider is a major, above-typical volume supplier for case management, integrated-team treatment, and comprehensive community support within Rhode Island.

Claim volumes are substantial for the top services, signaling high-frequency delivery: T1016 reports 103.5K claims, T1019 68.1K claims, and T1024 25.1K claims. Such high claim counts are consistent with ongoing, episodic service delivery models (per-15-minute and per-encounter billing) and suggest either a large client base or frequent recurring visits per client.

The reimbursement profile favors many low-dollar units rather than high-dollar single events: average paid per claim is $20 for T1016, $113 for T1019, $131 for T1024, and $4 for H2016 per diem. This pattern is typical of community support and personal-care oriented providers where revenue scales with service minutes and claim frequency rather than high-cost procedures.

Secondary service lines provide clinical and family support complementing the core care model: H0046 (mental health services) generated $1.1M (6.9% of Medicaid revenue) and T1027 (family training and counseling) generated $634.5K (4.0% of Medicaid revenue), both ranked in the mid-to-upper state percentiles and described as typical or unremarkable volumes. These add a therapeutic and family-focused dimension to the provider’s primarily personal-care and case-management business.

LOOKING UPWARDS, INC. has an NPI enumerated on 2007-03-06 (~19 years ago), indicating a long-standing presence in the state Medicaid market which likely reflects established administrative processes and payer relationships. Combined with the concentrated revenue mix and high claim counts, the tenure supports the conclusion that this provider operates a stable, high-volume Medicaid service platform rather than a new or transient program.

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	68,120	$110	$7.7M
T1024	Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter	25,140	$130	$3.3M
T1016	Case management, each 15 minutes	103,530	$20	$2.1M
H0046	Mental health services, not otherwise specified	12,870	$80	$1.1M
T1027	Family training and counseling for child development, per 15 minutes	6,220	$100	$634.5K
H2016	Comprehensive community support services, per diem	151,950	$1	$607.8K
H2014	Skills training and development, per 15 minutes	3,510	$80	$262.9K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	360	$150	$53.4K
T1013	Sign language or oral interpretive services, per 15 minutes	20	$70	$1.4K

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

Looking Upwards, Inc. — 2 of 9 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

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	4	30	9,040	$150	$5.7M
T1024	Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter	6	90	510	$160	$975K
H0046	Mental health services, not otherwise specified	16	70	2,310	$70	$698K
T1027	Family training and counseling for child development, per 15 minutes	18	90	350	$100	$363.8K
H2014	Skills training and development, per 15 minutes	12	30	1,420	$90	$300.3K
T1016	Case management, each 15 minutes	2	180	400	$20	$230.7K
H2016	Comprehensive community support services, per diem	2	40	10,150	$10	$230.4K
T1013	Sign language or oral interpretive services, per 15 minutes	15	20	900	$70	$206.7K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	12	40	110	$140	$109.8K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Looking Upwards, Inc.	RI	Multi-Specialty Clinic/Center	$0	$7.4M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Looking Upwards, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$136.2M
Girls And Boys Town Of New England	RI	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$5.9M
Newport County Regional Special Education	RI	Local Education Agency (LEA)	$0	$1.5M
Tom Swanson	RI	Pediatric Dentistry	$0	$1.3M
Gina Digati	RI	Adult Psychiatric/Mental Health Clinical Nurse Specialist	$12.3K	$817.1K
Lighthouse Counseling Associates	RI	Clinical Social Worker	$0	$343.5K
Town Of Portsmouth	RI	Land Ambulance	$265.6K	$75.3K
East Bay Endoscopy Center LLC	RI	Endoscopy Clinic/Center	$330.2K	$0
Julie Deleo	RI	Internal Medicine Physician	$156.9K	$4.4K
Rhode Island Cvs Pharmacy, L.L.C.	RI	Pharmacy	$145.1K	$0

Looking Upwards, Inc. — Billing Profile & Reimbursement Data

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Looking Upwards, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References