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

Why is the Medicaid comparison limited to Rhode Island 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. Rhode Island (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.

St. Mary's Home For Children (NPI 1770698011)

Field	Value
Entity Type	Organization
Organization	St. Mary's Home For Children
Address	420 Fruit Hill Ave
City	North Providence
State	RI
ZIP	02911
Taxonomy	Emotionally Disturbed Childrens' Residential Treatment Facility
NPI Enumerated	August 19, 2006

Payer Source	Total Paid
Medicaid	$19.7M
Medicare	$0

Key Findings

ST. MARY'S HOME FOR CHILDREN reports no Medicare billing on file and $19.7M in lifetime Medicaid revenue, making Medicaid the de facto sole public payer supporting this entity’s billed services. This effectively single-payer profile should orient analyst focus toward Medicaid policy, rate-setting, and authorization trends rather than Medicare dynamics.

Medicaid revenue is extremely concentrated: the precomputed top 3 Medicaid codes account for 100.0% of the provider's Medicaid revenue, and H0019 alone is reported as $19.7M in revenue across 1.5K claims with a $12928 avg paid/claim. This concentration indicates the provider’s financial picture is driven almost entirely by long-term residential behavioral-health per-diem billing rather than a diversified mix of service codes.

The dominant code, H0019, denotes behavioral health long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), billed without room and board on a per-diem basis. Combined with the provider taxonomy (Emotionally Disturbed Children's Residential Treatment Facility), the code mix signals an operational focus on multi-week or multi-month therapeutic residential treatment for children and adolescents rather than short-term outpatient or acute medical care.

In-state competitive standing for H0019 is middle-of-the-pack: the code ranks #13 of 25 providers (50th percentile) in the state and is described as typical, unremarkable volume for this code. That rank suggests ST. MARY'S is a modest, established participant in Rhode Island’s residential behavioral-health market but not a dominant provider for this service line.

The reported $12928 avg paid/claim for H0019 is large on a per-claim basis and is consistent with per-diem billing for extended stays implied by the code description; this pattern reflects revenue realized through bundled daily treatment rates rather than high-volume, low-paid outpatient encounters. Analysts should interpret per-claim magnitude as an indicator of prolonged service episodes driving each claim rather than single-visit intensity.

With an NPI enumerated on 2006-08-19 (~20 years ago), the facility shows long-standing enrollment in federal provider registries, supporting continuity of operations and an established presence in the state behavioral-health ecosystem. Tenure of roughly two decades increases the likelihood that existing payer relationships and authorization workflows are mature.

The near-total reliance on a single Medicaid code creates operational and reimbursement risk: any change to Medicaid per-diem rates, prior-auth requirements, or policy definitions for H0019 would materially affect this provider’s revenue stream. Payer and network managers should prioritize monitoring of H0019 policy updates, utilization management, and state reimbursement decisions when assessing financial exposure.

For contracting and network strategy, the middle percentile rank and concentrated revenue base imply limited statewide negotiating leverage but stable service supply in the residential children’s behavioral-health segment. Payers seeking capacity in long-term residential treatment may view ST. MARY'S as a standard, established option, while larger network decisions should account for its single-service concentration and sensitivity to H0019 reimbursement changes.

Medicaid: Complete Services Breakdown

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

1 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	1,530	$12,930	$19.7M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Rhode Island Distribution

St. Mary's Home For Children — 0 of 1 code billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Rhode Island

Full comparison — all codes billed, vs. Rhode Island median

1 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	13	30	1,530	$360	$9.7M

Nearby Providers

Other providers in the same ZIP code as St. Mary's Home For Children, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alpha Surgical, Inc.	RI	Durable Medical Equipment & Medical Supplies	$0	$1.7M
Tri-town Economic Opportunity Committee	RI	Case Management Agency	$0	$320.5K
Peter Deblasio	RI	Ophthalmology Physician	$106.2K	$2.5K
Frank D'alessandro	RI	Endocrinology, Diabetes & Metabolism Physician	$52.3K	$26.6K
Alexandra Winnes	RI	Physical Therapist	$70.9K	$0
Victoria Ramos	RI	Physical Therapist	$65K	$0

St. Mary's Home For Children — Billing Profile & Reimbursement Data

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St. Mary's Home For Children — 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