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

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

Gem State Developmental Center LLC (NPI 1760523062)

Field	Value
Entity Type	Organization
Organization	Gem State Developmental Center LLC
Address	818 Nw 15th St
City	Meridian
State	ID
ZIP	83642
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	February 9, 2007

Payer Source	Total Paid
Medicaid	$9.1M
Medicare	$0

Key Findings

This provider is effectively single-payer: there is no Medicare billing on file and all reported payment activity is Medicaid-based, with total Medicaid revenue of $9.1M. The absence of Medicare claims indicates payer exposure and contracting are concentrated entirely in Medicaid programs rather than split across Medicare/Medicaid lines.

Revenue is highly concentrated in a small set of Medicaid codes: the top three codes (H2032, H0004, 97537) account for 78.3% of the provider’s Medicaid revenue. Those three codes individually generated $3.5M (38.5%), $2.5M (27.3%), and $1.1M (12.6%) respectively, and collectively form the core of the provider’s financial profile.

The code mix indicates an operational focus on developmental-disability and community-based rehabilitation services: H2032 (Activity therapy, per 15 minutes) is the single largest revenue driver, H0004 (Behavioral health counseling and therapy, per 15 minutes) is the next largest, and 97537 (community work reintegration training, per 15 minutes) represents structured, time-based rehabilitation and community reintegration work. This combination aligns with a Developmentally Disabled Services Day Training Agency model emphasizing activity therapy, behavioral counseling, and vocational/community reintegration training.

Competitive standing is mixed across leading codes: H2032 generated 63.7K claims and $3.5M in revenue and ranks #6 of 41 providers in-state (88th percentile), H0004 generated 13.4K claims and $2.5M and ranks #36 of 157 (78th percentile), and 97537 generated 54.5K claims and $1.1M and ranks #14 of 41 (68th percentile). Notably, each of these top codes is described as “typical, unremarkable volume for this code,” suggesting that while the provider sits in upper state percentiles for some services, its volumes remain within expected statewide patterns rather than being extreme outliers.

Several complementary service lines contribute meaningful but smaller shares of Medicaid revenue: H2015 produced $611.7K (6.7%) and ranks #6 of 45 in-state (89th percentile), and S5100 produced $556.5K (6.1%) and ranks #6 of 37 (86th percentile). These positions indicate the provider also holds relatively strong statewide placement for comprehensive community support services and adult day care, reinforcing a day-program/community-support business model.

Other billed codes show more modest or below-median participation: H2019 ($338.1K, 3.7%) ranks #35 of 60 (42th percentile) and is labeled typical; H0005 ($290.1K, 3.2%) ranks #26 of 81 (69th percentile) and 96152 ($176.3K, 1.9%) ranks #52 of 73 (29th percentile). These lower percentiles and revenue shares suggest these services are secondary components of the provider’s portfolio rather than primary revenue drivers.

The provider has an established operational history, with an NPI enumerated/registered on 2007-02-09 (~19 years ago), which indicates long-tenured local presence and may support stable networks and institutional knowledge relevant to payer contracting and utilization review.

High concentration in the top three Medicaid codes (78.3% of Medicaid revenue) creates revenue vulnerability to reimbursement or policy changes affecting H2032, H0004, or 97537; payers and analysts should monitor utilization trends, unit rates (reported averages: $55 for H2032, $185 for H0004, $21 for 97537), and state policy changes that could materially affect the provider’s revenue base.

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
H2032	Activity therapy, per 15 minutes	63,680	$60	$3.5M
H0004	Behavioral health counseling and therapy, per 15 minutes	13,440	$190	$2.5M
97537	In this procedure, the provider works one on one with a patient to provide community work reintegration training. The training helps the injured or ill patient to return to employment and the…	54,540	$20	$1.1M
H2015	Comprehensive community support services, per 15 minutes	12,000	$50	$611.7K
S5100	Day care services, adult; per 15 minutes	34,780	$20	$556.5K
H2019	Therapeutic behavioral services, per 15 minutes	2,600	$130	$338.1K
H0005	Alcohol and/or drug services; group counseling by a clinician	4,400	$70	$290.1K
96152	N/A	1,150	$150	$176.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Gem State Developmental Center LLC — 0 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0004	Behavioral health counseling and therapy, per 15 minutes	36	160	4,020	$140	$1.6M
H2032	Activity therapy, per 15 minutes	6	40	19,190	$50	$1.6M
97537	In this procedure, the provider works one on one with a patient to provide community work reintegration training. The training helps the injured or ill patient to return to employment and the…	14	40	30,150	$20	$1.2M
H2019	Therapeutic behavioral services, per 15 minutes	35	60	2,960	$120	$609.8K
96152	N/A	52	70	2,270	$80	$608.8K
S5100	Day care services, adult; per 15 minutes	6	40	9,710	$30	$577.7K
H2015	Comprehensive community support services, per 15 minutes	6	50	2,960	$100	$570.3K
H0005	Alcohol and/or drug services; group counseling by a clinician	26	80	2,240	$50	$257.3K

Nearby Providers

Other providers in the same ZIP code as Gem State Developmental Center LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Norco, Inc.	ID	Durable Medical Equipment & Medical Supplies	$0	$41M
Joint School District No. 2	ID	Local Education Agency (LEA)	$0	$34.2M
Chatterbox Speech & Language Center	ID	Speech-Language Pathologist	$0	$10.6M
St. Fillan's, LLC	ID	In Home Supportive Care Agency	$0	$10.5M
Southern Idaho Health Partners LLC	ID	General Practice Physician	$0	$9.2M
Addus Healthcare, Inc.	ID	In Home Supportive Care Agency	$0	$6.1M
Northwest Neurobehavioral Health, LLC	ID	Clinical Social Worker	$0	$5.2M
Idaho Pediatric Therapy Clinic PLLC	ID	Physical Therapist	$0	$3.1M
Cpapnow Inc	ID	Durable Medical Equipment & Medical Supplies	$0	$3.1M
Slh Hti West Manager, LLC	ID	Assisted Living Facility	$0	$2.9M

Gem State Developmental Center LLC — Billing Profile & Reimbursement Data

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Gem State Developmental Center 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