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.

Community Innovations (NPI 1912099623)

Field	Value
Entity Type	Organization
Organization	Community Innovations
Address	801 Wilson St
City	Whiteville
State	NC
ZIP	28472
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	September 29, 2006

Payer Source	Total Paid
Medicaid	$73.8M
Medicare	$0

Key Findings

COMPREHENSIVE MEDICAID DEPENDENCE: COMMUNITY INNOVATIONS has no Medicare billing on file and reports $73.8M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid) provider in available claims data. This concentration means analyses of its business mix and competitive position should focus on Medicaid waiver and community support services rather than Medicare patient flows.

HEAVY REVENUE CONCENTRATION IN THREE HABILITATION CODES: The provider’s top three Medicaid codes—T2013 ($16.5M, 22.4%), T2020 ($16.1M, 21.8%), and T2014 ($10.3M, 13.9%)—together account for 58.1% of its total Medicaid revenue. That level of concentration indicates a reliance on habilitation and day-program services for the majority of billed revenue and makes those codes primary levers for any payer negotiations or utilization reviews.

SERVICE-LINE PROFILE: The dominant codes are habilitation and day habilitation services (T2013, T2020, T2014) with mix across per-hour, per-diem, and per-15-minute billing units, signaling a portfolio of intensive waiver-based supports—day programs, prevocational training, and individualized habilitation. Secondary codes such as T2021, H2016, H2015, and T2012 further show the organization delivers structured day/prevocational programming plus ongoing community support services rather than primarily outpatient medical care.

CLAIM VOLUME AND UNIT-PRICE SIGNALS: High claim counts and modest per-claim payments characterize the operation—T2013 has 100.5K claims at $164 avg paid/claim, T2020 has 91.4K claims at $176 avg paid/claim, and T2014 has 67.7K claims at $152 avg paid/claim—indicating large-scale, labor-intensive service delivery with revenue driven by volume rather than high per-claim reimbursements. Those volumes imply substantial operational throughput and staffing requirements to sustain day habilitation and hourly habilitation programs.

COMPETITIVE STANDING: COMMUNITY INNOVATIONS is a major in-state provider for select service lines but not uniformly dominant across all codes. It ranks #4 of 48 for T2020 (94th percentile; notably above typical state volume) and #2 of 17 for T2014 (94th percentile; labeled typical, unremarkable volume), while its T2013 activity sits at #28 of 185 (85th percentile; typical, unremarkable volume), showing market leadership in specific day-habilitation segments but only a modest footprint in others.

SECONDARY REVENUE STREAMS: Beyond the top three codes, the provider reports meaningful revenue in related community supports—T2021 $9.7M (13.1%), H2016 $9.3M (12.6%), T2012 $5.9M (8.0%), H2015 $4M (5.5%), S5150 $1M (1.4%), and H2025 $951.5K (1.3%). These secondary codes demonstrate a diversified set of waiver and support offerings (per-diem, per-15-minute, and respite care) that supplement the core day/ habilitation revenue base.

TENURE AND MARKET PRESENCE: The NPI was enumerated on 2006-09-29 (~20 years ago), indicating an established operating history in the state’s Medicaid space; this longevity, combined with multi-code billing and high claim volumes, supports the characterization of an experienced regional provider of waiver habilitation services.

IMPLICATIONS FOR PAYERS AND ANALYSTS: Given that 58.1% of Medicaid revenue is concentrated in three habilitation/day-program codes and that T2020 shows notably above-typical state volume, payers should prioritize utilization, compliance, and rate-review workstreams on day habilitation and prevocational service lines. Contracting or network decisions should recognize the provider as a key supplier for waiver-based day services in its market while noting it is not a broad-spectrum Medicare/MAP provider.

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2013	Habilitation, educational, waiver; per hour	100,540	$160	$16.5M
T2020	Day habilitation, waiver; per diem	91,450	$180	$16.1M
T2014	Habilitation, prevocational, waiver; per diem	67,670	$150	$10.3M
T2021	Day habilitation, waiver; per 15 minutes	72,720	$130	$9.7M
H2016	Comprehensive community support services, per diem	48,570	$190	$9.3M
T2012	Habilitation, educational; waiver, per diem	29,580	$200	$5.9M
H2015	Comprehensive community support services, per 15 minutes	37,790	$110	$4M
S5150	Unskilled respite care, not hospice; per 15 minutes	10,830	$90	$1M
H2025	Ongoing support to maintain employment, per 15 minutes	7,930	$120	$951.5K

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

Community Innovations — 0 of 9 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

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2013	Habilitation, educational, waiver; per hour	28	190	29,090	$150	$9.1M
H2016	Comprehensive community support services, per diem	19	70	28,040	$220	$8.2M
T2020	Day habilitation, waiver; per diem	4	50	22,570	$180	$6.2M
T2012	Habilitation, educational; waiver, per diem	37	110	21,340	$180	$6.1M
T2021	Day habilitation, waiver; per 15 minutes	18	200	25,740	$130	$4.6M
T2014	Habilitation, prevocational, waiver; per diem	2	20	16,540	$150	$4.2M
H2015	Comprehensive community support services, per 15 minutes	37	250	10,060	$130	$2.4M
H2025	Ongoing support to maintain employment, per 15 minutes	26	60	6,380	$120	$1.3M
S5150	Unskilled respite care, not hospice; per 15 minutes	55	170	4,310	$80	$958.4K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carolinas Home Care Agency, Inc.	NC	Community/Behavioral Health Agency	$0	$45.9M
Advantage Behavioral Healthcare Inc.	NC	Mental Health Counselor	$0	$20.1M
Columbus Regional Healthcare System	NC	General Acute Care Hospital	$0	$17.2M
Homecare Management Corporation	NC	Community/Behavioral Health Agency	$0	$16.8M
Interim Healthcare Of The Eastern Carolinas, Inc	NC	In Home Supportive Care Agency	$0	$10.9M
Rachel Tedesco	NC	Nurse Practitioner	$5.7M	$0
Jeffrey Coury	NC	Facial Plastic Surgery Physician	$508.5K	$0
Rene Bermudez	NC	MOHS-Micrographic Surgery Physician	$460.6K	$0
David Sutton	NC	Ophthalmology Physician	$437.5K	$6.7K
Columbus County Ems, Inc	NC	Land Ambulance	$327.6K	$110.8K

Community Innovations — Billing Profile & Reimbursement Data

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Community Innovations — 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