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

Why is the Medicaid comparison limited to North Dakota 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. North Dakota (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.

Red Door Pediatric Therapy, Inc (NPI 1639257033)

Field	Value
Entity Type	Organization
Organization	Red Door Pediatric Therapy, Inc
Address	2625 N 19th St
City	Bismarck
State	ND
ZIP	58503
Taxonomy	Speech-Language Pathologist
NPI Enumerated	November 2, 2006

Payer Source	Total Paid
Medicaid	$5.6M
Medicare	$0

Key Findings

RED DOOR PEDIATRIC THERAPY, INC is effectively a single-payer Medicaid provider: there is no Medicare billing on file while lifetime Medicaid revenue totals $5.6M, indicating the organization’s entire documented federal claims footprint is concentrated in Medicaid. This concentration should be treated as the baseline when assessing payer risk and growth opportunities.

Revenue is highly concentrated in a very small set of service lines: the precomputed top three Medicaid codes account for 98.8% of total Medicaid revenue, with 97530 and 92507 together driving the lion’s share of billings. That level of concentration implies business performance and marginal revenue are tightly tied to utilization of those specific therapy codes.

The provider’s operational profile aligns with pediatric speech and functional therapy: 92507 (speech-language treatment) produced $2.4M in revenue and 34K claims at a $71 avg paid/claim, while 97530 (therapeutic activities to improve functional performance) generated $2.9M across 41.2K claims at a $71 avg paid/claim. Combined with the facility’s Speech-Language Pathologist taxonomy and its name, the code mix suggests core clinical activity is direct pediatric communication and functional therapy rather than broad medical specialties.

RED DOOR is a dominant statewide outlier for its two leading codes: 92507 ranks #2 of 61 providers in-state (98th percentile; extreme outlier) and 97530 ranks #3 of 67 providers in-state (97th percentile; extreme outlier). These ranks indicate the provider operates at volumes far above typical state peers for those services, signaling a major competitive position in those specific therapy markets.

By contrast, ancillary codes generate minimal revenue and reflect a narrower service footprint: 97110 accounted for $240.2K (6.2K claims, $39 avg paid/claim) and ranks #4 of 32 providers in-state (90th percentile; typical, unremarkable volume), while 90834, 97112, and 92526 together represent only small fractions of Medicaid revenue. This distribution underscores a business model focused on a few high-volume therapy codes rather than a broad mix of behavioral or medical services.

Financial intensity per encounter for the top codes is moderate: both 97530 and 92507 report a $71 avg paid/claim while 97110 reports a $39 avg paid/claim, indicating reimbursement rates per unit are similar across the two primary therapy streams and lower for therapeutic exercise. Analysts should consider how encounter volume, rather than higher unit pricing, is driving overall revenue.

Tenure and registry history support a stable presence in the market: the provider’s NPI was enumerated on 2006-11-02 (~20 years ago), suggesting long-term operation and an established referral or contracting footprint in its service area. That longevity combined with concentrated high-volume billing for a narrow set of codes increases sensitivity to policy or rate changes affecting those codes.

From a risk and opportunity perspective, the business is highly exposed to utilization shifts in a small number of services: with 98.8% of Medicaid revenue tied to the top three codes, any changes in coverage, prior authorization, or utilization management for 97530 or 92507 would materially impact revenue. Conversely, payers or partners seeking to affect pediatric therapy capacity in-state would find RED DOOR is a consequential counterparty for those service 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
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	41,180	$70	$2.9M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	33,960	$70	$2.4M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	6,160	$40	$240.2K
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…	660	$60	$42.5K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	560	$40	$21.8K
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	30	$90	$2.7K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Dakota Distribution

Red Door Pediatric Therapy, Inc — 2 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Dakota

Full comparison — all codes billed, vs. North Dakota median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	3	70	1,950	$60	$387K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	2	60	1,860	$60	$348.7K
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…	31	80	400	$80	$133.6K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	8	10	840	$30	$95.6K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	4	30	360	$30	$94.6K
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	5	10	190	$50	$17.8K

Nearby Providers

Other providers in the same ZIP code as Red Door Pediatric Therapy, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Options For Residential And Employment Services, Inc	ND	Case Manager/Care Coordinator	$0	$84.4M
Metro Area Ambulance Service, Inc	ND	Land Ambulance	$1.5M	$11.7M
New Freedom Center	ND	Substance Abuse Rehabilitation Facility	$0	$4.5M
Bismarck Surgical Associates, LLC	ND	Ambulatory Surgical Clinic/Center	$2.2M	$0
Maple View Ii East Inc	ND	Alzheimer Center (Dementia Center)	$0	$1.7M
Good Road Recovery Center	ND	Substance Abuse Rehabilitation Facility	$0	$1.1M
Bismarck Transportation Services	ND	Taxi	$0	$1.1M
Daniel J. Keith, Dds, Ms, PC	ND	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$1.1M
Sanford Healthcare Accessories, LLC	ND	Durable Medical Equipment & Medical Supplies	$0	$1.1M
Pathology Consultants, PC	ND	Anatomic Pathology & Clinical Pathology Physician	$0	$1M

Red Door Pediatric Therapy, Inc — Billing Profile & Reimbursement Data

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Red Door Pediatric Therapy, 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