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

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

South Community Inc (NPI 1639128176)

Field	Value
Entity Type	Organization
Organization	South Community Inc
Address	3095 Kettering Blvd
City	Moraine
State	OH
ZIP	45439
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	May 10, 2006

Payer Source	Total Paid
Medicaid	$54.4M
Medicare	$0

Key Findings

This provider is effectively a single‑payer Medicaid operation: there is no Medicare billing on file and total Medicaid revenue is reported as $54.4M. The absence of Medicare activity means analyses of scale, utilization, and competitive standing should be framed against Medicaid-only peers and managed‑care contracts.

Revenue is highly concentrated in a small set of behavioral‑health codes: the top three Medicaid codes by revenue account for 63.6% of total Medicaid revenue, driven by H2019 ($19.1M, 35.0%), 90837 ($8.2M, 15.0%), and 99214 ($7.4M, 13.5%). This concentration indicates a narrow set of service lines are producing the majority of cash flow.

The mix of high‑revenue codes points to an outpatient behavioral‑health clinic model focused on intensive therapeutic and psychotherapy services. H2019 (Therapeutic behavioral services, per 15 minutes), 90837 (long psychotherapy sessions), and 99214 (moderate‑complexity E/M for established patients) together imply the provider delivers high volumes of direct behavioral interventions plus ongoing medical management.

Claim volumes and average paid amounts show very large throughput in time‑based behavioral services: H2019 has 293.2K claims at $65 avg paid/claim, 90837 has 86.9K claims at $94 avg paid/claim, and 99214 has 75.9K claims at $97 avg paid/claim. The prominence of a per‑15‑minute code (H2019) suggests many brief, repeat encounters aggregated into large revenue via volume rather than high unit price.

Statewide ranking and percentile data position this organization as a dominant player for multiple behavioral‑health codes: H2019 ranks #13 of 840 providers (99th percentile, extreme outlier), 90837 ranks #18 of 2643 (99th percentile, extreme outlier), and 99214 ranks #62 of 4514 (99th percentile, notably above typical state volume). These ranks indicate the provider operates far above typical state volumes for core behavioral services and is a major Medicaid supplier in its state.

Beyond the top three, additional high‑volume behavioral codes reinforce the specialization: H0036 ($5.4M, 9.9%) ranks #6 of 735 (99th percentile, extreme outlier) and 90832 ($3.3M, 6.1%) ranks #7 of 1317 (100th percentile, extreme outlier). This broader pattern shows multiple time‑based, face‑to‑face therapeutic services are material revenue drivers rather than a single isolated code.

The heavy revenue concentration in a small set of behavioral codes creates both operational leverage and vulnerability: specialization provides scale and potential negotiating power with Medicaid managed‑care plans, but also means reimbursement changes or utilization shifts for H2019/90837/99214 could disproportionately affect total revenue. Analysts should track policy changes to per‑15‑minute behavioral codes and psychotherapy billing rules when modeling downside risk.

This entity has a long enrollment history with NPI enumeration on 2006-05-10 (~20 years ago), supporting an interpretation of established operational capacity and sustained Medicaid engagement. Longevity combined with the provider’s high ranks suggests the organization has built persistent referral and service delivery channels in its market.

Medicaid: Complete Services Breakdown

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

19 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2019	Therapeutic behavioral services, per 15 minutes	293,160	$70	$19.1M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	86,890	$90	$8.2M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	75,910	$100	$7.4M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	149,600	$40	$5.4M
H2020	Therapeutic behavioral services, per diem	28,330	$170	$4.8M
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	66,620	$50	$3.3M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	34,900	$70	$2.3M
H2017	Psychosocial rehabilitation services, per 15 minutes	29,160	$40	$1M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	8,080	$130	$1M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	9,160	$70	$595.1K

Showing 1–10 of 19

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

South Community Inc — 10 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

19 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2019	Therapeutic behavioral services, per 15 minutes	13	840	240	$90	$1.8M
H2020	Therapeutic behavioral services, per diem	31	310	1,190	$150	$1.5M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	6	740	480	$60	$669.5K
H2017	Psychosocial rehabilitation services, per 15 minutes	21	240	1,090	$50	$509.2K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	18	2,640	620	$90	$408.2K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	62	4,510	500	$60	$377.8K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	685	5,080	560	$40	$323.9K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	377	700	210	$60	$154.1K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	17	1,320	290	$50	$148.6K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	7	1,320	450	$40	$139.1K

Showing 1–10 of 19

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Compunet Clinical Laboratories LLC	OH	Clinical Medical Laboratory	$7.7M	$34.3M
Premier Health Specialists Inc	OH	Internal Medicine Physician	$0	$31.1M
Fidelity Health Care Inc	OH	Home Health Agency	$0	$10.1M
Fidelity Health Care Inc	OH	Durable Medical Equipment & Medical Supplies	$0	$10.1M
Project Cure, Inc.	OH	Community/Behavioral Health Agency	$0	$10.1M
Cleanslate Medical Group Of Ohio LLC	OH	Addiction Medicine (Internal Medicine) Physician	$0	$9.5M
Providence Medical Group	OH	Family Medicine Physician	$0	$7.9M
Excel Home Health Care LLC	OH	Home Health Agency	$0	$7.8M
Providence Medical Group	OH	Clinical Medical Laboratory	$213.6K	$1M
Fresenius Vascular Care Dayton Asc LLC	OH	Ambulatory Surgical Clinic/Center	$624K	$215.1K

South Community Inc — Billing Profile & Reimbursement Data

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South Community 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

Nearby Providers

Frequently Asked Questions

References