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

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

Qualicare Inc. (NPI 1629252994)

Field	Value
Entity Type	Organization
Organization	Qualicare Inc.
Address	3539 Briar Creek Ln
City	Ammon
State	ID
ZIP	83406
Taxonomy	Nursing Care Agency
NPI Enumerated	December 21, 2007

Payer Source	Total Paid
Medicaid	$10.3M
Medicare	$0

Key Findings

QUALICARE INC. is effectively a Medicaid-focused provider: there is no Medicare billing on file while lifetime Medicaid revenue totals $10.3M, indicating a single-payer footprint concentrated on state Medicaid business rather than dual Medicare/Medicaid operations. This payer mix suggests the organization’s reimbursement risk and contracting activity will be driven almost entirely by Medicaid policy and rates.

Revenue is highly concentrated in a very small set of service codes: the top three Medicaid codes (T1019, T1003, S5130) account for 95.6% of the provider’s total Medicaid revenue. The three leading lines are T1019 ($6.4M, 62.0%), T1003 ($1.8M, 17.7%), and S5130 ($1.6M, 15.9%), which implies that shifts in reimbursement or utilization policy for any of these codes would materially affect overall revenue.

The code mix points to a home- and community-based personal care operation with some licensed nursing services: T1019 (personal care services, per 15 minutes) and S5130 (homemaker service, per 15 minutes) together dominate revenue, while T1003 (Lpn/lvn services, up to 15 minutes) shows meaningful billing for licensed nursing time. This combination aligns with the Nursing Care Agency taxonomy and suggests day-to-day operations are labor-intensive and delivered in domiciliary/community settings rather than institutional care.

Despite being the largest revenue driver, T1019 is characterized in the peer data as a typical, unremarkable volume outcome: the provider reports 64.2K claims for T1019 with an average paid/claim of $100 and ranks #12 of 101 providers in-state (89th percentile), indicating a solid statewide presence on personal care but not an extreme outlier or monopoly position. This rank plus the per-claim averages imply scale in routine personal care delivery rather than niche or unusually high-priced services.

T1003 (Lpn/lvn services) behavior points to relative prominence within a small specialist pool: QUALICARE reports 2K claims for T1003 ($905 avg paid/claim, $1.8M revenue) and ranks #2 of 4 providers in-state (67th percentile). Being second among only four billed providers suggests the organization is one of a few in-state that bills materially for short-interval licensed nursing time, making it comparatively important in that limited subsegment even though the peer label is "typical, unremarkable volume for this code."

The provider operates a high-frequency, per-15-minute billing model typical of personal care and homemaker services: reported volumes include 64.2K claims for T1019 and 41K claims for S5130, with relatively low per-claim averages for homemaker/personal care ($40–$100) versus higher per-claim for licensed nursing ($905). These counts and average payments underscore a labor-heavy business model where revenue is driven by large claim volumes of short-duration care units rather than by high-value single encounters.

QUALICARE’s market position on S5130 (homemaker) is solid but not dominant: it records $1.6M in revenue from 41K claims ($40 avg paid/claim) and ranks #14 of 77 providers in-state (83rd percentile), described in the data as typical and unremarkable. Together with high ranks on other personal-care codes, this positions the provider as a meaningful, established participant in Idaho’s home- and community-based service market rather than an outlier.

The organization is long-tenured in the Medicare/Medicaid administrative system, with its NPI enumerated on 2007-12-21 (~19 years ago), which supports the inference of an established operational presence and likely sustained relationships with state Medicaid programs and referral sources. This tenure, combined with concentrated Medicaid revenue, suggests institutional stability but also exposure to changes in Medicaid policy for the top billing codes.

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
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…	64,190	$100	$6.4M
T1003	Lpn/lvn services, up to 15 minutes	2,020	$910	$1.8M
S5130	Homemaker service, nos; per 15 minutes	41,030	$40	$1.6M
S5125	Attendant care services; per 15 minutes	2,140	$150	$325.7K
T1001	Nursing assessment / evaluation	1,890	$60	$113.1K
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	620	$30	$19.2K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Qualicare Inc. — 0 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	27	40	5,180	$110	$2.3M
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…	12	100	11,400	$80	$2M
T1003	Lpn/lvn services, up to 15 minutes	2	10	1,350	$410	$641.7K
S5130	Homemaker service, nos; per 15 minutes	14	80	12,220	$20	$537.5K
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	4	10	620	$40	$169.5K
T1001	Nursing assessment / evaluation	8	50	260	$60	$77K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Royal Journeys LLC	ID	Developmentally Disabled Services Day Training Agency	$0	$38.3M
Just 4 Kids Pediatrics	ID	Pediatrics Physician	$0	$10.8M
Pearl Health Clinic	ID	Mental Health Counselor	$0	$9.9M
4 Pillars Of Success LLC	ID	Multi-Specialty Clinic/Center	$0	$8M
A Childs Smile	ID	Pediatric Dentistry	$0	$4.4M
4 Pillars Of Success LLC	ID	Psychologist	$0	$3.3M
Lincare Inc.	ID	Durable Medical Equipment & Medical Supplies	$0	$2M
Darryl Moffett	ID	Ophthalmology Physician	$2M	$0
Idaho Falls Pediatric Dentistry, PLLC	ID	Pediatric Dentistry	$0	$1.2M
4 Pillars Of Success LLC	ID	Clinic/Center	$0	$697.9K

Qualicare Inc. — Billing Profile & Reimbursement Data

Sign up for Qualicare Inc. — Billing Profile & Reimbursement Data policy alerts

Qualicare Inc. — Billing Profile & Reimbursement Data

Sign up for Qualicare Inc. — 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