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

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

Elmhurst, Inc (NPI 1891876751)

Field	Value
Entity Type	Organization
Organization	Elmhurst, Inc
Address	400 Centre St
City	Bath
State	ME
ZIP	04530
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	October 18, 2006

Payer Source	Total Paid
Medicaid	$23.7M
Medicare	$0

Key Findings

ELMHURST, INC is effectively a Medicaid-focused provider: there is no Medicare billing on file and the provider reports $23.7M in lifetime Medicaid revenue, indicating a near-exclusive reliance on Medicaid as the revenue stream. The NPI was enumerated on 2006-10-18 (~20 years ago), so this billing footprint reflects a long-tenured operation concentrated in state waiver services.

Revenue is highly concentrated in a very small set of waiver and case-management codes: the precomputed top three Medicaid codes account for 100.0% of the provider's total Medicaid revenue, led by T2016 ($17.7M revenue, 74.9% of this provider's total Medicaid revenue), followed by T2021 ($4.6M revenue, 19.5%) and G9012 ($1.3M revenue, 5.6%). This concentration implies that changes to reimbursement, eligibility, or program rules for these specific codes would materially affect the provider's financials.

The code mix signals a service model built around waiver-based habilitation and associated case management: T2016 (Habilitation, residential, waiver; per diem) and T2021 (Day habilitation, waiver; per 15 minutes) together drive virtually all revenue, while G9012 (Other specified case management service not elsewhere classified) provides supplemental revenue. Operationally this pattern is consistent with an organization operating residential habilitation settings and day habilitation programs supported by case management for waiver populations.

Payment-per-claim patterns show T2016 as the dominant revenue engine by dollar intensity: T2016 has 2.4K claims with an average paid/claim of $7420, while T2021 has 3.4K claims with $1352 avg paid/claim and G9012 has 5.4K claims with $245 avg paid/claim. These figures highlight that per-diem residential payments (T2016) are the primary source of dollars despite T2021 and G9012 carrying higher claim counts in some cases.

Statewide competitive standing is modest rather than dominant: for its top revenue codes the provider ranks #58 of 75 providers in-state for T2016 (23th percentile; typical, unremarkable volume for this code), #59 of 72 for T2021 (18th percentile; typical, unremarkable volume), and #39 of 50 for G9012 (22th percentile; typical, unremarkable volume). These rank/percentile positions indicate the provider is a routine participant in Maine's waiver services market but not a leading statewide operator for these billing categories.

There is limited activity outside the three main codes: T2017 appears only as a very small activity line with 19 claims generating $6.9K revenue (0.0% of total Medicaid revenue) and ranks #34 of 34 providers in-state (0th percentile; typical, unremarkable volume for this code). This confirms the provider's offering is narrowly focused and that ancillary service lines are immaterial to overall revenue.

From a payer-mix and risk perspective, the absence of Medicare billing combined with the fact that a single code (T2016) represents $17.7M (74.9%) of $23.7M total Medicaid revenue creates concentrated exposure to Medicaid waiver payment policies and utilization changes. Analysts evaluating downstream contract negotiations or network participation should treat waiver program reimbursement stability as a critical factor for this provider's financial resilience.

Medicaid: Complete Services Breakdown

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

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	2,390	$7,420	$17.7M
T2021	Day habilitation, waiver; per 15 minutes	3,420	$1,350	$4.6M
G9012	Other specified case management service not elsewhere classified	5,380	$250	$1.3M
T2017	Habilitation, residential, waiver; 15 minutes	20	$360	$6.9K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Elmhurst, Inc — 0 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

4 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	58	80	7,300	$1,670	$30.8M
T2021	Day habilitation, waiver; per 15 minutes	59	70	13,340	$200	$5.1M
G9012	Other specified case management service not elsewhere classified	39	50	25,820	$80	$3M
T2017	Habilitation, residential, waiver; 15 minutes	34	30	8,960	$260	$3M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pine Tree Society Inc	ME	Voluntary or Charitable Agency	$0	$17.8M
City Of Bath	ME	Land Ambulance	$157.5K	$996K
Bio-medical Applications Of Maine, Inc.	ME	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$991.1K
Michelle Roberts	ME	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$965.8K
Saskia Cooper	ME	Rheumatology Physician	$119.5K	$0
Walgreen Eastern Co Inc	ME	Pharmacy	$118.6K	$0
Cvs State Capital LLC	ME	Pharmacy	$115.2K	$0
Alice Shea	ME	Diagnostic Radiology Physician	$79.8K	$0
Benjamin Herman	ME	Internal Medicine Physician	$49.7K	$0
Matthew Perkowski	ME	Physical Medicine & Rehabilitation Physician	$46.5K	$0

Elmhurst, Inc — Billing Profile & Reimbursement Data

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Elmhurst, Inc — 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