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

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

National Mentor Healthcare, LLC (NPI 1952989212)

Field	Value
Entity Type	Organization
Organization	National Mentor Healthcare, LLC
Address	450 Parkway Ste 200
City	Broomall
State	PA
ZIP	19008
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	March 30, 2021

Payer Source	Total Paid
Medicaid	$44.7M
Medicare	$0

Key Findings

NATIONAL MENTOR HEALTHCARE, LLC has been NPI-enumerated since 2021-03-30 (~5 years ago) and reports $44.7M in lifetime Medicaid revenue with none in Medicare billing on file; this makes the organization effectively a Medicaid-focused operator rather than a dual-payer provider. The absence of Medicare activity means analyses of scale, competitive posture, and reimbursement risk should be framed against Medicaid performance and state-level peers.

Revenue is highly concentrated in a small set of Medicaid service lines: the precomputed top three Medicaid codes account for 67.7% of the provider’s total Medicaid revenue. Those top-driving codes are 97153 ($15.8M revenue, 35.4% of total Medicaid revenue), H2021 ($7.4M revenue, 16.5% of total Medicaid revenue), and 97155 ($7.1M revenue, 15.8% of total Medicaid revenue), indicating a narrow set of services delivering the majority of dollars.

The code mix and volumes indicate an operational focus on applied behavior analysis (ABA) and community-based behavioral health services—particularly technician-delivered adaptive behavior treatments and supervisory/clinical oversight. High-volume, technician-focused codes such as 97153 (75.2K claims, $210 avg paid/claim) alongside supervisory/clinician codes such as 97155 (33.6K claims, $210 avg paid/claim) and H2021 (44.7K claims, $165 avg paid/claim) point to a labor-intensive delivery model that relies on large numbers of technician encounters plus professional supervision and wrap-around services.

Operational scale is reflected in claim counts and average payments: 97153 posted 75.2K claims and $15.8M revenue while 97155 posted 33.6K claims and $7.1M revenue, signaling both high throughput and substantial per-claim reimbursement for these ABA services. The combination of high claim volume and meaningful avg paid/claim values suggests significant investments in front-line technician staffing and billing capacity to support ongoing service delivery.

Against in-state peers, this provider is a major Medicaid participant for several high-revenue codes: 97153 ranks #9 of 145 providers in-state (94th percentile) and 97155 ranks #7 of 151 providers in-state (96th percentile), both labeled as notably above typical state volume. H2021 ranks #20 of 218 providers in-state (91th percentile) and H0032 ranks #15 of 209 providers in-state (93th percentile), further indicating the provider is well above median state activity for community wrap-around and mental health service plan development.

Some specialized activities show outsized relative standing despite smaller absolute revenue: H0031 (2.1K claims, $87.4K revenue) ranks #3 of 105 providers in-state (98th percentile) and is described as notably above typical state volume, implying the organization has a strong assessment/case-finding capability relative to peers even though assessments represent a small share of total Medicaid revenue. This concentrated assessment presence may support the high volumes in downstream ABA and treatment codes.

The provider maintains additional, but smaller, revenue streams beyond the top three codes that diversify service offerings: 97154 generated $3.3M (7.5% of total Medicaid revenue) and 97151 generated $2.1M (4.7% of total Medicaid revenue), while codes such as H2019, 97156, and 90791 contribute smaller shares. This mix shows the organization delivers both individual and group adaptive behavior treatments, assessments, caregiver training, and therapeutic behavioral services—helpful context for contract negotiations and program planning because revenues are concentrated but not monocultural.

From a contracting and strategic perspective, the provider’s Medicaid concentration and strong state percentile placements for core ABA and community-behavioral codes mean network inclusion and Medicaid-rate discussions should prioritize 97153, 97155, and H2021 performance metrics. Given there is no Medicare billing on file, payer engagement strategy, utilization reviews, and competitive benchmarking should be anchored to Medicaid programs, state-level peer comparisons, and capacity for technician-delivered services and supervisory clinical oversight.

Medicaid: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	75,250	$210	$15.8M
H2021	Community-based wrap-around services, per 15 minutes	44,660	$170	$7.4M
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	33,610	$210	$7.1M
H0032	Mental health service plan development by non-physician	36,840	$180	$6.6M
97154	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	21,450	$160	$3.3M
97151	The provider, a physician or other qualified healthcare professional, identifies the adaptive or maladaptive behavior of the patient by administering several different types of tests in person; he…	10,910	$190	$2.1M
H2019	Therapeutic behavioral services, per 15 minutes	14,680	$120	$1.8M
97156	The provider discusses a patient’s adaptive behavior treatment face–to–face with the guardian(s) or caregiver(s), with or without the patient present. Report this code for each 15 minutes that the…	3,700	$120	$436K
H0031	Mental health assessment, by non-physician	2,080	$40	$87.4K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	680	$80	$52.6K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

National Mentor Healthcare, LLC — 2 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	9	150	8,280	$220	$4.1M
97154	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	4	20	1,780	$210	$2.6M
H2021	Community-based wrap-around services, per 15 minutes	20	220	3,810	$100	$1.5M
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	7	150	2,770	$200	$1.4M
H0032	Mental health service plan development by non-physician	15	210	3,020	$130	$1.3M
H2014	Skills training and development, per 15 minutes	9	20	370	$140	$1M
H2019	Therapeutic behavioral services, per 15 minutes	28	180	3,510	$80	$685K
97151	The provider, a physician or other qualified healthcare professional, identifies the adaptive or maladaptive behavior of the patient by administering several different types of tests in person; he…	8	120	1,330	$180	$557.5K
97158	The provider administers adaptive behavior treatment to multiple patients in a social skills group. Report this code for each 15 minutes that the provider spends face–to–face with multiple patients…	5	10	280	$230	$456.1K
97156	The provider discusses a patient’s adaptive behavior treatment face–to–face with the guardian(s) or caregiver(s), with or without the patient present. Report this code for each 15 minutes that the…	12	100	530	$120	$196.1K

Showing 1–10 of 12

Related Providers

Other providers that share a Tax Identification Number (TIN) with National Mentor Healthcare, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
National Mentor Healthcare LLC	PA	Community/Behavioral Health Agency	$0	$31.6M

Nearby Providers

Other providers in the same ZIP code as National Mentor Healthcare, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Connectamerica.com,llc	PA	Emergency Response System Companies	$0	$20.9M
Bayada Home Health Care, Inc.	PA	Home Health Agency	$0	$17.3M
Accucare Home Nursing, Inc.	PA	Home Health Agency	$0	$10.4M
Robert Roush	PA	Hematology & Oncology Physician	$1.5M	$0
John Sprandio	PA	Medical Oncology Physician	$1.3M	$0
John Sprandio	PA	Hematology & Oncology Physician	$1.1M	$0
Marple Township Ambulance Corp	PA	Land Ambulance	$470.4K	$243.4K
Alexander Deak	PA	Hematology & Oncology Physician	$397.8K	$0
Isabella Tembe	PA	Family Nurse Practitioner	$304.9K	$14K
Matthew Hillis	PA	Clinical Cardiac Electrophysiology Physician	$266.7K	$0

National Mentor Healthcare, LLC — Billing Profile & Reimbursement Data

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National Mentor Healthcare, LLC — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References