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

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

Pride In North Carolina, LLC (NPI 1760420186)

Field	Value
Entity Type	Organization
Organization	Pride In North Carolina, LLC
Address	231 Commerce St
City	Greenville
State	NC
ZIP	27858
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	June 4, 2006

Payer Source	Total Paid
Medicaid	$98.2M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file while Medicaid accounts for the provider’s entire lifetime revenue of $98.2M. The absence of Medicare activity indicates the organization’s revenue and operations are concentrated in the Medicaid population rather than a mixed Medicare/Medicaid model.

Revenue concentration is very high: the top three Medicaid codes (H2022, 90837, H2017) together account for 83.3% of the provider’s total Medicaid revenue. In particular H2022 alone represents $63.1M (64.3% of Medicaid revenue), making the business highly dependent on one service line.

The code mix points to a community behavioral health operating model focused on programmatic, per‑diem and time‑based services: H2022 (community‑based wrap‑around services, per diem), H2017 (psychosocial rehabilitation, per 15 minutes) and 90837 (psychotherapy, 53+ minutes) are the top revenue drivers. This combination suggests large, ongoing care programs and intensive psychotherapy capacity rather than episodic specialty procedures.

Claim volumes reinforce an operational scale built around high throughput and recurring services: H2022 shows 246.5K claims at $256 avg paid/claim, 90837 shows 144.4K claims at $82 avg paid/claim, and H2017 shows 108.8K claims at $63 avg paid/claim. These claim counts are consistent with per‑diem and 15‑minute billing structures that drive sustained revenue flows across many encounters.

The provider is a dominant statewide player on multiple core Medicaid codes: H2022 ranks #1 of 216 providers in‑state (100th percentile; extreme outlier), H2017 ranks #1 of 142 (100th percentile; extreme outlier), and 90837 ranks #2 of 1709 (100th percentile; extreme outlier). Several other codes (e.g., 99205 at #1 of 363 and 90791 at 99th percentile) further indicate unusually high activity relative to state peers.

Beyond programmatic services, the provider also bills substantial office E/M and evaluation codes, indicating integrated clinical assessment capacity: 99214 has 37.6K claims and $2.9M revenue (rank #71 of 4404, 98th percentile) while 99205 has 4.2K claims and $560.9K revenue (rank #1 of 363, 100th percentile). This mix suggests the organization combines community wrap‑around and rehab programming with significant clinician‑delivered evaluation and psychotherapy services.

The NPI tenure shows long‑standing presence: the NPI was enumerated on 2006-06-04 (~20 years ago). That longevity, paired with sustained high Medicaid billing, indicates an established provider footprint in the state behavioral health market.

Concentration risk is material given the reliance on a small set of Medicaid codes: H2022 alone is 64.3% of Medicaid revenue and the top three codes together are 83.3% of revenue, so changes in Medicaid policy, reimbursement or program eligibility for those services would have outsized impact. Offsetting this concentration is some service breadth (psychotherapy codes 90837/90834/90832, psychosocial rehab H2017, community support H2015, and modest telehealth Q3014 activity at 4.1K claims for $86.3K), but those sources are much smaller individually than H2022.

Medicaid: Complete Services Breakdown

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2022	Community-based wrap-around services, per diem	246,540	$260	$63.1M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	144,440	$80	$11.8M
H2017	Psychosocial rehabilitation services, per 15 minutes	108,760	$60	$6.9M
H2015	Comprehensive community support services, per 15 minutes	40,210	$170	$6.8M
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	37,590	$80	$2.9M
H0032	Mental health service plan development by non-physician	3,020	$490	$1.5M
T2021	Day habilitation, waiver; per 15 minutes	12,050	$110	$1.3M
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…	13,400	$50	$723.7K
90832	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…	15,630	$40	$641K
H2012	Behavioral health day treatment, per hour	4,180	$150	$614.9K

Showing 1–10 of 26

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Pride In North Carolina, LLC — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

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

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2021	Day habilitation, waiver; per 15 minutes	137	200	25,740	$130	$4.6M
H2022	Community-based wrap-around services, per diem	1	220	3,330	$290	$3.3M
H2015	Comprehensive community support services, per 15 minutes	35	250	10,060	$130	$2.4M
H2017	Psychosocial rehabilitation services, per 15 minutes	1	140	17,630	$80	$1.8M
H2012	Behavioral health day treatment, per hour	41	90	4,080	$180	$1.7M
H0038	Self‑help/peer services, per 15 minutes	184	310	2,820	$120	$1.3M
T1017	Targeted case management, each 15 minutes	143	220	1,700	$150	$1.3M
H0032	Mental health service plan development by non-physician	5	20	1,310	$420	$783.1K
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	134	170	1,880	$90	$481.7K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	2	1,710	810	$80	$274.5K

Showing 1–10 of 26

Nearby Providers

Other providers in the same ZIP code as Pride In North Carolina, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pinnacle Home Care, Inc.	NC	Developmentally Disabled Services Day Training Agency	$0	$59.3M
East Carolina University	NC	Internal Medicine Physician	$0	$53.7M
Easter Seals Ucp Nc & Va, Inc.	NC	Community/Behavioral Health Agency	$0	$38.8M
Maxim Healthcare Services, Inc.	NC	Home Health Agency	$0	$35M
Pathways To Life, Inc	NC	Community/Behavioral Health Agency	$0	$30.4M
Behavioral Framework Nc LLC	NC	Behavior Analyst	$0	$29.4M
Venture Rehabilitation Group	NC	Speech-Language Pathologist	$0	$16M
At Home Personal Care Services,inc. Of North Carolina	NC	Home Health Agency	$0	$14.5M
East Carolina Home Care	NC	In Home Supportive Care Agency	$0	$14.5M
Carolina Therapy Connection, PC	NC	Pediatric Occupational Therapist	$0	$12.5M

Pride In North Carolina, LLC — Billing Profile & Reimbursement Data

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Pride In North Carolina, LLC — 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