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

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

Commonwealth Of Massachusetts (NPI 1750504064)

Field	Value
Entity Type	Organization
Organization	Commonwealth Of Massachusetts
Address	14 Mechanic St
City	Southbridge
State	MA
ZIP	01550
Taxonomy	Case Management Agency
NPI Enumerated	April 11, 2007

Payer Source	Total Paid
Medicaid	$1.3B
Medicare	$0

Key Findings

This entity is effectively a single-payer Medicaid operator: there is no Medicare billing on file and total Medicaid revenue is $1.35B, indicating the organization’s financial scale is driven entirely by Medicaid payments rather than dual Medicare/Medicaid mix. Analysts should treat this profile as a Medicaid-centric footprint when modeling payer risk or network exposure.

Medicaid revenue is highly concentrated: the precomputed top 3 codes account for 94.2% of this provider's total Medicaid revenue, with T2016 generating $1.22B (90.3%), T2003 generating $32.1M (2.4%), and T2023 generating $20.4M (1.5%). This concentration means financial performance is very sensitive to reimbursement or utilization changes for those three codes.

The provider’s dominant revenue driver is T2016 (Habilitation, residential, waiver; per diem), which produced $1.22B from 79.3K claims at an average paid/claim of $15363 and ranks #2 of 25 providers in-state (96th percentile). That mix reflects a core operation centered on residential habilitation/waiver services paid on a per-diem basis, implying a sizable residential bed footprint or contracted residential habilitation capacity.

T2003 (Non-emergency transportation; encounter/trip) shows extremely high utilization with 1.2M claims and $32.1M revenue at $26 avg paid/claim, and it ranks #1 of 245 providers in-state (100th percentile; extreme outlier). This combination of very high claim volume and top statewide rank indicates the provider either manages a large in-house non-emergency transportation network or serves as a major transportation vendor for many enrollees.

Targeted case management is a material service line as well: T2023 (per month) has 60.3K claims, $20.4M revenue at $339 avg paid/claim and ranks #2 of 70 providers in-state (99th percentile). The monthly case management billing pattern confirms a substantive care coordination and case management program consistent with the Case Management Agency taxonomy.

Beyond the top three, the provider reports measurable revenue across community support and day programs—examples include S5100 ($15.8M, 67.6K claims; ranks #16 of 189 in-state, 92th percentile), H2015 ($14.2M; ranks #25 of 147, 84th percentile), S5125 ($14.1M; ranks #3 of 40, 95th percentile), and H2023 ($12.5M; ranks #1 of 23, 100th percentile). These mid-tier lines show the organization operates a broad set of waiver and community-based services (day care, attendant care, supported employment), indicating diversified service offerings beyond residential habilitation.

The provider occupies top-tier competitive positions on multiple Medicaid codes across the state: examples include T2003 at #1 of 245 (100th percentile; extreme outlier), T2016 at #2 of 25 (96th percentile), T2023 at #2 of 70 (99th percentile), and H2023 at #1 of 23 (100th percentile). Collectively, those ranks portray a major statewide player in transportation, residential habilitation, case management, and supported employment services rather than a niche or low-volume provider.

This NPI has an established tenure: it was enumerated on 2007-04-11 (~19 years ago), indicating long-standing enrollment in the program and likely established operational relationships with Massachusetts Medicaid administration and managed care plans. Tenure combined with the revenue and rank profile suggests stability and scale in the provider’s Medicaid operations.

Medicaid: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	79,350	$15,360	$1.2B
T2003	Non-emergency transportation; encounter/trip	1,233,510	$30	$32.1M
T2023	Targeted case management; per month	60,300	$340	$20.4M
S5100	Day care services, adult; per 15 minutes	67,570	$230	$15.8M
H2015	Comprehensive community support services, per 15 minutes	50,720	$280	$14.2M
S5125	Attendant care services; per 15 minutes	42,860	$330	$14.1M
H2023	Supported employment, per 15 minutes	63,500	$200	$12.5M
T2021	Day habilitation, waiver; per 15 minutes	29,810	$310	$9.2M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	1,140	$6,360	$7.3M
T2019	Habilitation, supported employment, waiver; per 15 minutes	20,860	$140	$2.8M

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Commonwealth Of Massachusetts — 5 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

16 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	2	30	29,930	$10,070	$358.9M
T2025	Waiver services; not otherwise specified (nos)	8	10	230	$160	$86.5M
T2023	Targeted case management; per month	2	70	8,210	$510	$8.6M
H2023	Supported employment, per 15 minutes	1	20	28,450	$190	$5.6M
H2015	Comprehensive community support services, per 15 minutes	25	150	7,770	$140	$4.8M
S5125	Attendant care services; per 15 minutes	3	40	3,390	$300	$4.7M
T2021	Day habilitation, waiver; per 15 minutes	6	20	20,590	$210	$4.5M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	1	10	320	$6,480	$3.3M
S5100	Day care services, adult; per 15 minutes	16	190	2,000	$230	$3.1M
T2019	Habilitation, supported employment, waiver; per 15 minutes	17	20	24,690	$120	$3.1M

Showing 1–10 of 16

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Umass Memorial Health-harrington Hospital Inc	MA	General Acute Care Hospital	$0	$71.3M
Rmg Home Care, Inc	MA	Home Health Agency	$0	$12.8M
Rmg Adult Day Health Centers, LLC	MA	Adult Day Care Clinic/Center	$0	$12.2M
Southern Worcester County Arc Inc	MA	Developmentally Disabled Services Day Training Agency	$0	$11.3M
Renaissance Primary Care, LLC	MA	Internal Medicine Physician	$0	$11.3M
Harrington Physician Services Inc	MA	Family Medicine Physician	$0	$9.1M
People First Gafc LLC	MA	Adult Care Home Facility	$0	$8.8M
Hugh Cooper	MA	Ophthalmology Physician	$286K	$204K
Craig Goldberg	MA	Family Medicine Physician	$68.1K	$104.1K
Young-ho Oh	MA	Orthopaedic Surgery Physician	$117.8K	$13.8K

Commonwealth Of Massachusetts — Billing Profile & Reimbursement Data

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Commonwealth Of Massachusetts — 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