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

Why is the Medicaid comparison limited to Delaware 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. Delaware (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.

National Mentor Healthcare, LLC (NPI 1588937486)

Field	Value
Entity Type	Organization
Organization	National Mentor Healthcare, LLC
Address	28417 Dupont Highway
City	Millsboro
State	DE
ZIP	19966
Taxonomy	Intellectual & Developmental Disabilities Psychologist
NPI Enumerated	February 23, 2012

Payer Source	Total Paid
Medicaid	$108.7M
Medicare	$0

Key Findings

NATIONAL MENTOR HEALTHCARE, LLC is essentially a Medicaid-focused provider with no Medicare billing on file; lifetime Medicaid revenue on record totals $108.7M and Medicare revenue is listed as none, indicating the organisation operates predominantly or exclusively within state Medicaid programs rather than the Medicare market. The provider’s NPI has been enumerated since 2012-02-23 (~14 years ago), establishing a multi-year operational history in the Medicaid space.

Revenue concentration is extremely high: the top three Medicaid codes (T2025, T2016, T2020) together account for 94.2% of the provider’s total Medicaid revenue, indicating that a small set of waiver and habilitation services drive nearly all billed Medicaid dollars. This concentration suggests the business model is centered on those specific waiver habilitation service lines rather than a diversified set of Medicaid services.

T2025 (Waiver services; nos) is the single largest revenue driver with $58.2M in revenue (53.5% of the provider’s total Medicaid revenue) across 111K claims at an average paid/claim of $524. The volume and dollar share imply this provider is delivering broad, high-volume waiver services that constitute the majority of its Medicaid operations.

T2016 (Habilitation, residential, waiver; per diem) is the second major driver with $40.6M (37.3% of Medicaid revenue) across 66.5K claims at $610 avg paid/claim, reinforcing that residential habilitation under Medicaid waivers is a core service line. Together with T2025 these two per-diem and unspecified waiver codes form the backbone of the provider’s service mix and revenue base.

The third top code, T2020 (Day habilitation, waiver; per diem), contributes $3.7M (3.4% of Medicaid revenue) and 23.6K claims, which is materially smaller than the top two codes but still part of the concentrated waiver/habilitation profile. The precomputed top-3 share (94.2%) highlights that ancillary services and assessments constitute only a small minority of revenues.

Competitive standing in-state is mixed but generally indicates substantial scale within Delaware’s waiver market: the provider ranks #2 of 10 for T2025 (89th percentile) and #2 of 9 for T2016 (88th percentile), suggesting it is a leading, high-volume state participant for those major waiver codes rather than a marginal operator. For T2020 the provider ranks #5 of 11 (60th percentile), indicating more typical mid-tier volume for day habilitation relative to peers.

For ancillary codes, the provider shows notable state-level specialization: T1001 (Nursing assessment / evaluation) records 41.9K claims and $2.1M (2.0% of Medicaid revenue) and ranks #2 of 51 providers in-state (98th percentile), which the data labels as notably above typical state volume. This suggests the organisation also performs a high volume of nursing assessments in support of its waiver/habilitation services.

Several lower-revenue codes appear but do not materially alter the revenue mix: T2014, T2013, G0175, A0110, and T2004 together contribute small percentages of total Medicaid revenue and largely fall into typical or unremarkable volume ranges based on their state rank/percentile notes. These codes indicate complementary services (prevocational, educational habilitation, team conferences, and transport) that support the core waiver/residential habilitation operations rather than serving as independent revenue pillars.

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
T2025	Waiver services; not otherwise specified (nos)	111,050	$520	$58.2M
T2016	Habilitation, residential, waiver; per diem	66,540	$610	$40.6M
T2020	Day habilitation, waiver; per diem	23,620	$160	$3.7M
T1001	Nursing assessment / evaluation	41,910	$50	$2.1M
T2014	Habilitation, prevocational, waiver; per diem	14,310	$120	$1.7M
T2013	Habilitation, educational, waiver; per hour	4,050	$310	$1.3M
G0175	Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present	26,750	$40	$989.6K
A0110	Non-emergency transportation and bus, intra or inter state carrier	9,480	$10	$123.2K
T2004	Non-emergency transport; commercial carrier, multi-pass	11,330	$10	$101.9K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

National Mentor Healthcare, LLC — 1 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2025	Waiver services; not otherwise specified (nos)	2	10	37,650	$670	$43M
T2016	Habilitation, residential, waiver; per diem	2	10	23,150	$620	$21.9M
T2020	Day habilitation, waiver; per diem	5	10	19,250	$120	$6.3M
T2014	Habilitation, prevocational, waiver; per diem	4	10	46,520	$70	$3.4M
T2013	Habilitation, educational, waiver; per hour	1	10	4,050	$310	$1.3M
G0175	Scheduled interdisciplinary team conference (minimum of three exclusive of patient care nursing staff) with patient present	3	10	20,370	$50	$986.1K
T1001	Nursing assessment / evaluation	2	50	1,950	$50	$294K
T2004	Non-emergency transport; commercial carrier, multi-pass	4	10	11,330	$10	$187.5K
A0110	Non-emergency transportation and bus, intra or inter state carrier	2	10	9,480	$10	$123.8K

Nearby Providers

Other providers in the same ZIP code as National Mentor Healthcare, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Coras Wellness And Behavioral Health, LLC	DE	Substance Use Disorder Rehabilitation Clinic/Center	$703K	$18.2M
Peninsula Dental, LLC	DE	General Practice Dentistry	$0	$12.3M
Sleepy Tooth Orthodontics LLC	DE	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$8.3M
Ctm Medical Associates LLC	DE	Surgery Physician	$0	$1.9M
Green Valley Terrace Snf LLC	DE	Skilled Nursing Facility	$0	$822K
Georges Dahr	DE	Cardiovascular Disease Physician	$763.7K	$0
Millsboro Fire Company Inc.	DE	Land Ambulance	$517.4K	$165.3K
Mid Sussex Rescue Squad Inc.	DE	Ambulance	$497.1K	$178K
William Singleton	DE	Addiction (Substance Use Disorder) Counselor	$0	$636.8K
Beebe Medical Center, Inc.	DE	Home Health Agency	$0	$559.9K

National Mentor Healthcare, LLC — Billing Profile & Reimbursement Data

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National Mentor Healthcare, LLC — 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