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 1851422661)

Field	Value
Entity Type	Organization
Organization	Commonwealth Of Massachusetts
Address	465 Waverly Oaks Road
City	Waltham
State	MA
ZIP	02452
Taxonomy	Case Management Agency
NPI Enumerated	March 7, 2007

Payer Source	Total Paid
Medicaid	$298.4M
Medicare	$0

Key Findings

This entity is effectively a Medicaid-focused operator: it has no Medicare billing on file and reports $298.4M in lifetime Medicaid revenue, making Medicaid the sole material payer reflected in the billing data. The absence of Medicare activity indicates the provider’s operations and reimbursement exposure are concentrated entirely within Medicaid program rules and rates.

Revenue is highly concentrated in a very small set of services: the precomputed top three Medicaid codes account for 93.8% of this provider’s total Medicaid revenue. That concentration creates dependency on a few program lines and suggests that changes to reimbursement or authorization for those codes would materially affect overall revenue.

T2016 (Habilitation, residential, waiver; per diem) is the dominant revenue driver, with 27.9K claims, an average paid per claim of $8693, and $242.2M in revenue (81.2% of this provider’s total Medicaid revenue). Despite generating the bulk of revenue, this provider ranks #16 of 25 in-state (38th percentile), described as typical, unremarkable volume for this code, implying a high-dollar service mix rather than exceptional market share in residential habilitation.

S5100 (Day care services, adult; per 15 minutes) is the provider’s second major line with 73.9K claims, $331 avg paid/claim, and $24.5M in revenue (8.2% of this provider’s total Medicaid revenue). The provider ranks #11 of 189 in-state (95th percentile) for S5100 and is labeled notably above typical state volume, indicating a comparatively strong competitive position in adult day care services relative to peers.

H2015 (Comprehensive community support services, per 15 minutes) contributes $13.1M (4.4% of Medicaid revenue) from 15.1K claims at $871 avg paid/claim, and the provider ranks #63 of 147 in-state (58th percentile). This middling percentile and the characterization of typical, unremarkable volume suggest the provider participates in community support services at an average level relative to peers rather than as a market leader.

Operational profile implied by the code mix points to residential habilitation and community-based behavioral/developmental support as the core business lines: large per-diem habilitation payments (T2016) combined with high-volume adult day care (S5100) and billed community support (H2015) indicate a provider network focused on waiver-based residential and day services. The presence of per diem and per-15-minute codes suggests ongoing, facility-based or daylong support models rather than episodic outpatient care.

Competitive standing is mixed across service lines: the provider is a major outlier in S5100 (95th percentile, among the top in-state performers for adult day care), but only a modest participant for T2016 (38th percentile) despite that code producing the majority of its revenue. This pattern implies strong niche positioning in day services but only average market penetration in residential habilitation compared with in-state peers.

The provider has an established operating history, with an NPI enumerated on 2007-03-07 (~19 years ago), which supports the likelihood that its current concentration and competitive positions are the result of sustained service strategies rather than recent entry. Given the heavy reliance on a single code (T2016, 81.2% of Medicaid revenue) and top-three concentration (93.8%), strategic or policy shifts affecting waiver per-diem payments would present a material financial sensitivity for this provider.

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
T2016	Habilitation, residential, waiver; per diem	27,860	$8,690	$242.2M
S5100	Day care services, adult; per 15 minutes	73,930	$330	$24.5M
H2015	Comprehensive community support services, per 15 minutes	15,080	$870	$13.1M
T2023	Targeted case management; per month	27,340	$340	$9.3M
T2003	Non-emergency transportation; encounter/trip	160,400	$30	$4.7M
T2021	Day habilitation, waiver; per 15 minutes	10,440	$210	$2.2M
H2023	Supported employment, per 15 minutes	9,300	$170	$1.5M
T2019	Habilitation, supported employment, waiver; per 15 minutes	9,910	$90	$931.4K

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 — 0 of 8 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

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	16	30	29,930	$10,070	$358.9M
T2023	Targeted case management; per month	21	70	8,210	$510	$8.6M
H2023	Supported employment, per 15 minutes	21	20	28,450	$190	$5.6M
H2015	Comprehensive community support services, per 15 minutes	63	150	7,770	$140	$4.8M
T2021	Day habilitation, waiver; per 15 minutes	20	20	20,590	$210	$4.5M
S5100	Day care services, adult; per 15 minutes	11	190	2,000	$230	$3.1M
T2019	Habilitation, supported employment, waiver; per 15 minutes	23	20	24,690	$120	$3.1M
T2003	Non-emergency transportation; encounter/trip	24	250	40,490	$30	$2.2M

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
Rainbow Adhc Of Waltham	MA	Adult Day Care Clinic/Center	$0	$17.1M
Priscilla Nwachukwu	MA	Adult Health Nurse Practitioner	$61.4K	$0
Alicia Longani	MA	Medical Physician Assistant	$46K	$0

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