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.

Primary Health Choice, Inc. (NPI 1851539126)

Field	Value
Entity Type	Organization
Organization	Primary Health Choice, Inc.
Address	4701 Fayetteville Rd
City	Lumberton
State	NC
ZIP	28358
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	January 26, 2009

Payer Source	Total Paid
Medicaid	$93.3M
Medicare	$0

Key Findings

PRIMARY HEALTH CHOICE, INC. is a community/behavioral health agency based in Lumberton, NC that has been NPI-enumerated since 2009-01-26 (~17 years ago). Its billed activity is overwhelmingly Medicaid-centric with Total Medicaid revenue of $93.3M and no Medicare billing on file, making it effectively a single-payer (Medicaid) operation in the claims data provided.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes account for 98.1% of this provider's total Medicaid revenue. The dominant codes are T2013 (70.4% of Medicaid revenue), T2012 (22.5%), and S5150 (5.2%), indicating a narrow set of services drive nearly all reported receipts.

The code mix points to a waiver/habilitation-focused business model: T2013 (Habilitation, educational, waiver; per hour) and T2012 (Habilitation, educational; waiver, per diem) together make up the great majority of revenue, which implies the organization primarily delivers long‑duration community habilitation and waiver services rather than typical Medicare-covered medical or acute care. S5150 (Unskilled respite care, not hospice; per 15 minutes) as the third-largest code confirms additional emphasis on caregiver respite and support services within the waiver population.

PRIMARY HEALTH CHOICE is a dominant statewide provider for its top habilitation code: T2013 generated $65.7M in revenue, 379.5K claims at $173 avg paid/claim, and ranks #4 of 185 providers in-state (98th percentile; described as an extreme outlier and far above typical state volume). T2012 also shows outsized scale with $21M in revenue, 120K claims at $175 avg paid/claim, ranking #7 of 110 providers in-state (94th percentile; notably above typical state volume).

S5150 (65.7K claims, $74 avg paid/claim, $4.9M revenue) ranks #5 of 168 providers in-state (98th percentile; notably above typical state volume), reinforcing that this provider is among the very largest state-level suppliers of respite care in addition to habilitation. Those three codes together place the organization in a concentrated leadership position for waiver-related community services within North Carolina.

A range of other Medicaid codes are present but are de minimis relative to the top three: examples include S5125 (3.7K claims, $173 avg, $640.1K revenue, 0.7% of total — rank #298 of 399, typical volume), 99509 (3K claims, $170 avg, $515.3K revenue, 0.6% — rank #1197 of 1450, typical volume), and H2022 (1.3K claims, $281 avg, $364.5K revenue, 0.4% — rank #144 of 216, typical volume). These smaller lines (and other listed codes such as H2015, T1019, and Q3014) indicate ancillary services are billed but constitute only a tiny share of overall Medicaid revenue.

From a payer‑mix and business risk perspective, the absence of Medicare billing combined with extreme concentration in a few waiver/habilitation codes implies revenue sensitivity to state Medicaid policy, waiver eligibility, and reimbursement changes; any material change to rates or authorization rules for T2013 or T2012 could have outsized impact on the organization's financial base. Analysts should treat the provider as highly specialized in Medicaid waiver habilitation and respite services rather than a diversified multi‑payer health services provider.

Medicaid: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2013	Habilitation, educational, waiver; per hour	379,490	$170	$65.7M
T2012	Habilitation, educational; waiver, per diem	119,990	$180	$21M
S5150	Unskilled respite care, not hospice; per 15 minutes	65,670	$70	$4.9M
S5125	Attendant care services; per 15 minutes	3,700	$170	$640.1K
99509	A home health provider, such as a registered nurse, or a non nursing practitioner, visits a patient to provide help with activities of daily living, or ADLs, and self care.	3,030	$170	$515.3K
H2022	Community-based wrap-around services, per diem	1,300	$280	$364.5K
H2015	Comprehensive community support services, per 15 minutes	920	$150	$142K
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	280	$170	$47.6K
T1017	Targeted case management, each 15 minutes	110	$340	$37.5K
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…	150	$70	$10.2K

Showing 1–10 of 13

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

Primary Health Choice, Inc. — 2 of 13 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

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2013	Habilitation, educational, waiver; per hour	4	190	29,090	$150	$9.1M
T2012	Habilitation, educational; waiver, per diem	7	110	21,340	$180	$6.1M
H2022	Community-based wrap-around services, per diem	144	220	3,330	$290	$3.3M
S5125	Attendant care services; per 15 minutes	298	400	15,030	$100	$3M
H2015	Comprehensive community support services, per 15 minutes	219	250	10,060	$130	$2.4M
99509	A home health provider, such as a registered nurse, or a non nursing practitioner, visits a patient to provide help with activities of daily living, or ADLs, and self care.	1,197	1,450	23,320	$50	$2.3M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	65	80	2,380	$160	$1.8M
T1017	Targeted case management, each 15 minutes	198	220	1,700	$150	$1.3M
H0045	Respite care services, not in the home, per diem	82	80	4,450	$100	$993.7K
S5150	Unskilled respite care, not hospice; per 15 minutes	5	170	4,310	$80	$958.4K

Showing 1–10 of 13

Nearby Providers

Other providers in the same ZIP code as Primary Health Choice, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Health Of Carolina, PA	NC	Pediatrics Physician	$0	$90.4M
A Primary Choice, Inc.	NC	In Home Supportive Care Agency	$0	$71.2M
Southeastern Regional Medical Center	NC	General Acute Care Hospital	$0	$28.8M
Southeastern Integrated Care	NC	Family Medicine Physician	$0	$23.9M
Charles Graham	NC	Personal Care Attendant	$0	$23.9M
Speech Solutions Inc	NC	Speech-Language Pathologist	$0	$19.2M
Stephens Outreach Center, Inc	NC	Community/Behavioral Health Agency	$0	$17.4M
A Primary Choice	NC	In Home Supportive Care Agency	$0	$15.6M
Premier Behavioral Services Inc	NC	Community/Behavioral Health Agency	$0	$14.6M
Aaa Homecare	NC	Home Health Agency	$0	$12M

Primary Health Choice, Inc. — Billing Profile & Reimbursement Data

Sign up for Primary Health Choice, Inc. — Billing Profile & Reimbursement Data policy alerts

Primary Health Choice, Inc. — Billing Profile & Reimbursement Data

Sign up for Primary Health Choice, Inc. — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References