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

Why is the Medicaid comparison limited to South 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. South 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.

Every Citizen Counts Organization (NPI 1659420073)

Field	Value
Entity Type	Organization
Organization	Every Citizen Counts Organization
Address	706 Sw 7th St
City	Madison
State	SD
ZIP	57042
Taxonomy	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NPI Enumerated	January 9, 2007

Payer Source	Total Paid
Medicaid	$20.7M
Medicare	$0

Key Findings

This provider is effectively single‑payer: Medicare revenue is none (no Medicare billing on file) while reported Medicaid revenue totals $20.7M. The absence of Medicare billing indicates that the organization’s entire reported public reimbursement footprint in the available data is driven by Medicaid activity.

Revenue concentration is high: the precomputed top 3 Medicaid codes account for 93.5% of this provider’s total Medicaid revenue. Those three codes are T2016, T2020, and S0281, which together dominate the reported $20.7M Medicaid footprint.

Operationally, the code mix points to a community‑based I/DD habilitation provider focused on residential and day habilitation plus care coordination. T2016 is a residential habilitation per‑diem (T2016 – Habilitation, residential, waiver; per diem) and T2020 is day habilitation (T2020 – Day habilitation, waiver; per diem), while S0281 (Medical home program, comprehensive care coordination and planning, maintenance of plan) reflects active care‑coordination and service planning.

T2016 is the single largest revenue driver: 3.6K claims, $3888 avg paid/claim, $14.1M revenue and 68.2% of this provider’s total Medicaid revenue. Despite producing the majority of this provider’s Medicaid dollars, the provider ranks #16 of 21 in‑state for T2016 (25th percentile; typical, unremarkable volume for this code), which suggests the provider’s residential habilitation business is locally meaningful but not a statewide leader.

T2020 and S0281 make up the next largest shares: T2020 has 3.7K claims, $1024 avg paid/claim, $3.8M revenue (18.4% of Medicaid revenue) and ranks #18 of 20 in‑state (11th percentile; typical, unremarkable volume), while S0281 has 3.3K claims, $437 avg paid/claim, $1.4M revenue (6.9% of Medicaid revenue) and ranks #15 of 21 (30th percentile; typical, unremarkable volume). These positions show meaningful service delivery in day habilitation and care coordination, but not top‑tier market share within the state for either line.

The provider’s claim‑level profile shows a mix of high per‑claim residential revenue and a substantial volume of lower‑paid supplies and ancillary waiver codes. For example, T2016 averages $3888 per claim versus T2028 (Specialized supply, not otherwise specified, waiver) at 2.9K claims, $55 avg paid/claim, $157K revenue and a #10 of 33 in‑state rank (72th percentile; typical, unremarkable volume), indicating that supplies are high in claim count but low in revenue contribution.

Competitive standing across its top codes is modest: rankings such as #16 of 21 (25th percentile) for T2016, #18 of 20 (11th percentile) for T2020, and #15 of 21 (30th percentile) for S0281 indicate this provider is not a dominant statewide participant for those services. In other words, while these codes drive most of the provider’s revenue, the provider sits in the lower‑to‑mid percentiles among in‑state peers rather than at the top.

The provider has a long tenure in the NPI registry, enumerated on 2007-01-09 (~19 years ago), which suggests an established presence in its service market and a sustained Medicaid revenue stream totaling $20.7M over the reported lifetime. This longevity combined with the concentrated code mix supports the view of a specialized, Medicaid‑focused habilitation provider with stable operations.

Medicaid: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	3,630	$3,890	$14.1M
T2020	Day habilitation, waiver; per diem	3,710	$1,020	$3.8M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	3,290	$440	$1.4M
T2025	Waiver services; not otherwise specified (nos)	3,380	$250	$852K
T2014	Habilitation, prevocational, waiver; per diem	400	$400	$162K
T2018	Habilitation, supported employment, waiver; per diem	780	$200	$158.7K
T2028	Specialized supply, not otherwise specified, waiver	2,850	$60	$157K
T2019	Habilitation, supported employment, waiver; per 15 minutes	30	$650	$21.5K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Every Citizen Counts Organization — 0 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

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

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	16	20	6,880	$1,660	$31.6M
T2020	Day habilitation, waiver; per diem	18	20	7,340	$500	$8.9M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	15	20	6,090	$420	$3M
T2025	Waiver services; not otherwise specified (nos)	13	20	5,410	$180	$1.9M
T2018	Habilitation, supported employment, waiver; per diem	12	20	1,510	$80	$433.9K
T2014	Habilitation, prevocational, waiver; per diem	14	20	1,210	$130	$410.3K
T2019	Habilitation, supported employment, waiver; per 15 minutes	15	20	480	$90	$288.6K
T2028	Specialized supply, not otherwise specified, waiver	10	30	910	$50	$169.8K

Nearby Providers

Other providers in the same ZIP code as Every Citizen Counts Organization, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Madison Community Hospital	SD	Critical Access Hospital	$0	$1M
Eyecare Center Of Madison Prof LLC	SD	Optometrist	$0	$244.1K
Inter-lakes Community Action Partnership	SD	Voluntary or Charitable Agency	$0	$192.5K
Sanford Medical Center	SD	Community/Retail Pharmacy	$119.8K	$290
Madison Central School District	SD	Local Education Agency (LEA)	$0	$87K
Kevin M. Donlin, D.m.d., P.C.	SD	General Practice Dentistry	$0	$82K
Jason Evans	SD	Neurology Chiropractor	$60.8K	$0
Madison Family Dental Prof LLC	SD	General Practice Dentistry	$0	$51.8K
Ben Liscano	SD	Family Medicine Physician	$42.7K	$0
Avera Home Medical Equipment, LLC	SD	Durable Medical Equipment & Medical Supplies	$0	$41.4K

Every Citizen Counts Organization — Billing Profile & Reimbursement Data

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Every Citizen Counts Organization — Billing Profile & Reimbursement Data

Sign up for Every Citizen Counts Organization — 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