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

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

Ohi (NPI 1720153836)

Field	Value
Entity Type	Organization
Organization	Ohi
Address	203 Maine Ave
City	Bangor
State	ME
ZIP	04401
Taxonomy	Mental Illness Community Based Residential Treatment Facility
NPI Enumerated	November 22, 2006

Payer Source	Total Paid
Medicaid	$39.6M
Medicare	$0

Key Findings

OHI is a Mental Illness Community Based Residential Treatment Facility based in BANGOR, ME with an NPI enumerated on 2006-11-22 (~20 years ago), indicating long-standing enrollment in federal payer systems and an established operational presence in the state. The provider taxonomy and tenure support interpretation of its billing as coming from an established residential behavioral health program rather than a recently formed operation.

The provider reports no Medicare billing on file and $39.6M in lifetime Medicaid revenue, making it effectively a single-payer Medicaid operation in the available claims data rather than a mixed Medicare/Medicaid outpatient or institutional biller. This concentration of payer exposure means revenue performance will be highly sensitive to Medicaid rates and policy changes.

Revenue concentration is extremely narrow: the precomputed top 3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with H0019 representing $29.4M (74.3% of this provider's total Medicaid revenue) and T1020 representing $10.2M (25.7% of this provider's total Medicaid revenue). This indicates virtually all Medicaid income is derived from a small set of per-diem residential and personal-care service lines.

Code-level service implications: H0019 (long-term residential, non-medical per diem, without room and board) signals that OHI operates long‑stay residential behavioral health programming rather than short-term acute treatment, while T1020 (personal care services, per diem as part of an individualized plan) indicates parallel delivery of daily personal-care support tied to clients' treatment plans. Together these codes describe a program model focused on daily, facility-based supports rather than episodic clinical procedures or medical specialty services.

Claims volume and unit economics underline how revenue is driven: H0019 shows 88.6K claims at $332 avg paid/claim and T1020 shows 89.2K claims at $114 avg paid/claim, meaning similar claim counts but substantially different per-claim payments which explain the revenue split between the two codes. The pattern suggests operational scale in daily per-diem delivery where higher unit rates for residential per diems drive the majority of Medicaid revenue.

Competitive standing for H0019 is mid-to-upper statewide: H0019 ranks #6 of 28 providers in-state (81th percentile; typical, unremarkable volume), which positions OHI as a solid participant but not a statewide dominant provider for long-term residential behavioral health. The dataset labels H0019 activity as "typical, unremarkable volume," implying presence without being an outlier.

Competitive standing for T1020 is comparatively stronger: T1020 ranks #3 of 21 providers in-state (90th percentile; typical, unremarkable volume), indicating OHI is among the higher-volume in-state providers for personal care per diems while still characterized as "typical, unremarkable volume." This suggests a leading role in delivering per-diem personal care within the state's Medicaid network.

The extreme concentration of Medicaid revenue in a narrow set of per-diem residential and personal-care codes (100.0% from the top codes) creates both operational clarity and risk: OHI appears specialized and scaled to a specific residential service model, which can support efficient, repeatable service delivery but also leaves the provider exposed to any Medicaid rate, coding, or policy changes that affect H0019 or T1020.

Medicaid: Complete Services Breakdown

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

2 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	88,620	$330	$29.4M
T1020	Personal care services, per diem, 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…	89,160	$110	$10.2M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Ohi — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

2 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	6	30	13,990	$560	$23.9M
T1020	Personal care services, per diem, 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…	3	20	8,350	$340	$9.2M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Eastern Maine Medical Center	ME	General Acute Care Hospital	$0	$159.3M
Creative Options, LLC	ME	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$78.7M
Mas Medical Staffing Corporation	ME	Community/Behavioral Health Agency	$0	$62.5M
Ohi	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$61.9M
St. Joseph Hospital	ME	General Acute Care Hospital	$0	$38.8M
Mert Enterprises, Inc.	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$36.3M
Penobscot Community Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$27.3M
Amicus	ME	Developmentally Disabled Services Day Training Agency	$0	$26.1M
Branches, LLC	ME	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$25.4M
Lifeflight Of Maine, LLC	ME	Air Ambulance	$2.4M	$19.8M

Ohi — Billing Profile & Reimbursement Data

Sign up for Ohi — Billing Profile & Reimbursement Data policy alerts

Ohi — Billing Profile & Reimbursement Data

Sign up for Ohi — 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