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

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

Premium Care Usa LLC (NPI 1679941181)

Field	Value
Entity Type	Organization
Organization	Premium Care Usa LLC
Address	10300 Eaton Pl Ste 260
City	Fairfax
State	VA
ZIP	22030
Taxonomy	In Home Supportive Care Agency
NPI Enumerated	September 14, 2015

Payer Source	Total Paid
Medicaid	$47.9M
Medicare	$0

Key Findings

This provider is effectively single-payer at scale: there is no Medicare billing on file and lifetime Medicaid revenue is $47.9M, indicating primary dependence on Medicaid for all reported public-payer activity. The NPI was enumerated 2015-09-14 (~11 years ago), so the operation has been active long enough to build sustained Medicaid volume.

Revenue is highly concentrated: the top three Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with T1019 representing $43M (89.8%), T1005 $4.7M (9.9%), and G2021 $161.4K (0.3%). This level of concentration means changes to reimbursement or utilization for any of these codes — especially T1019 — would materially affect overall revenue.

The code mix and unit metrics identify a labor‑intensive in‑home personal care model: T1019 (personal care services, per 15 minutes) drives the business with 222.8K claims at $193 avg paid/claim and $43M revenue, while T1005 (respite care services, up to 15 minutes) contributes 58.4K claims at $81 avg paid/claim and $4.7M revenue. These volumes and per‑15‑minute billing patterns align with an agency that delivers frequent, short‑interval direct care visits (home aides/respite providers) rather than episodic clinical services.

Competitive standing in the Virginia Medicaid market is strong for core service lines: T1019 ranks #12 of 758 providers in-state (99th percentile; notably above typical state volume for this code) and T1005 ranks #10 of 574 providers in-state (98th percentile; notably above typical state volume for this code). Those rankings indicate the provider is a major in‑state player for personal care and respite service delivery.

G2021 represents a marginal and relatively routine revenue stream for this entity: 165 claims, $978 avg paid/claim, $161.4K revenue (0.3% of Medicaid revenue) and it ranks #20 of 293 providers in-state (93th percentile; typical, unremarkable volume for this code). This suggests any advanced or ancillary tip-based payments are not a primary business driver compared with the high-volume personal care codes.

Operational and financial risk considerations follow from the observed profile: dependence on per‑15‑minute Medicaid codes (T1019 and T1005) means the organization’s revenue is sensitive to changes in per‑unit rates, documentation requirements, or utilization patterns for short‑interval home services. The large claim counts (222.8K and 58.4K) imply significant workforce and scheduling scale, which could create fixed labor and administrative overhead pressures if utilization declines.

The combination of a decade of enrollment, very high claim volumes for per‑15‑minute personal care, and top‑percentile in‑state rankings suggests the provider has established operational capacity and market penetration in Virginia’s Medicaid personal care/respite segment. Given the single‑payer concentration and dominance in a narrow set of service codes, strategic or regulatory shifts in Medicaid policy for home supportive care would be the primary drivers of future revenue variability for this entity.

Medicaid: Complete Services Breakdown

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

3 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…	222,770	$190	$43M
T1005	Respite care services, up to 15 minutes	58,390	$80	$4.7M
G2021	Health care practitioners rendering treatment in place (tip)	170	$980	$161.4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Premium Care Usa LLC — 2 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	12	760	17,620	$150	$5.5M
T1005	Respite care services, up to 15 minutes	10	570	4,400	$80	$831.8K
G2021	Health care practitioners rendering treatment in place (tip)	20	290	40	$790	$56.7K

Nearby Providers

Other providers in the same ZIP code as Premium Care Usa LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sunrise Community Of Virginia, Inc.	VA	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$51.3M
Chimes Virginia, Inc.	VA	Intellectual & Developmental Disabilities Psychologist	$0	$35.5M
Nova Home Health Care, LLC	VA	Home Health Agency	$0	$35.3M
Mental Health Services En Espanol LLC	VA	Assistant Behavior Analyst	$0	$22.9M
Kahak Va, Inc.	VA	Home Health Agency	$0	$22.2M
Director Of Finance-county Of Fairfax Va	VA	Early Intervention Provider Agency	$0	$19.9M
Sagun Home Care Inc	VA	Home Health Agency	$0	$18.8M
Alliance Nurses For Home Health And Wellness, L.L.C.	VA	Home Health Agency	$0	$16.4M
Pediatric Services Of America, LLC	VA	Nursing Care Agency	$0	$12.1M
Nirmal Enterprises	VA	Home Health Agency	$0	$10.2M

Premium Care Usa LLC — Billing Profile & Reimbursement Data

Sign up for Premium Care Usa LLC — Billing Profile & Reimbursement Data policy alerts

Premium Care Usa LLC — Billing Profile & Reimbursement Data

Sign up for Premium Care Usa LLC — 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