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

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

Pendleton House (NPI 1972758373)

Field	Value
Entity Type	Organization
Organization	Pendleton House
Address	2585 Westgate
City	Pendleton
State	OR
ZIP	97801
Taxonomy	Mental Illness Community Based Residential Treatment Facility
NPI Enumerated	November 26, 2008

Payer Source	Total Paid
Medicaid	$17.9M
Medicare	$0

Key Findings

PENDLETON HOUSE reports $17.9M in lifetime Medicaid revenue and has no Medicare billing on file, making it effectively a Medicaid-focused provider rather than a dual-payer operation. This single-payer concentration means its financial performance and utilization profile will be driven almost entirely by Medicaid policies and rates.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 97.4% of the provider's total Medicaid revenue. Those three codes are T1020, H2013, and H2014, which together create material exposure if reimbursement or utilization patterns for these service lines change.

The code mix (T1020 personal care services per diem; H2013 psychiatric health facility service per diem; H2014 skills training and development per 15 minutes) indicates an operation oriented toward community-based residential and psychiatric per-diem services with a substantial component of billed skills-training encounters. This pattern is consistent with the provider taxonomy as a Mental Illness Community Based Residential Treatment Facility and suggests care is delivered in a residential, programmatic model rather than through episodic outpatient medical visits.

T1020 is the dominant revenue driver: 2.4K claims, $6037 avg paid/claim, $14.2M revenue (79.5% of this provider's total Medicaid revenue). T1020 ranks #16 of 44 in-state (65th percentile) and is characterized as typical, unremarkable volume statewide, indicating PENDLETON HOUSE captures a meaningful share of per-diem personal care revenue without being an outlier.

H2014 shows very high claim volume but lower unit payment: 9.2K claims, $172 avg paid/claim, $1.6M revenue (8.9% of this provider's total Medicaid revenue). H2014 ranks #20 of 115 in-state (83rd percentile) and is labeled typical, unremarkable volume, suggesting the provider delivers frequent, short-duration skills training sessions that collectively represent a notable programmatic activity.

H2013 contributes a similar dollar amount to H2014 but with far fewer claims and a much higher avg paid/claim: 1K claims, $1546 avg paid/claim, $1.6M revenue (9.0% of this provider's total Medicaid revenue). H2013 ranks #12 of 22 in-state (48th percentile) and is described as typical, unremarkable volume, consistent with per-diem psychiatric facility billing at a midpack statewide position.

Smaller-coded services (for example H0004, H2032, and outpatient E/M such as 99214/99213) account for a trivial share of revenue; H2032 generates $190K (1.1% of Medicaid revenue) on 4.2K claims and ranks #5 of 29 in-state (86th percentile) but is still labeled typical, unremarkable volume. The presence of these auxiliary codes indicates ancillary therapy and counseling services are billed, but they are not material to the provider's overall Medicaid revenue profile.

The provider's NPI was enumerated on 2008-11-26 (~18 years ago), indicating it is an established entity in the market; paired with the concentrated, Medicaid-centric revenue mix, this tenure suggests an established business model centered on residential and programmatic mental health services rather than recent pivoting into new payer markets.

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
T1020	Personal care services, per diem, 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…	2,350	$6,040	$14.2M
H2013	Psychiatric health facility service, per diem	1,050	$1,550	$1.6M
H2014	Skills training and development, per 15 minutes	9,190	$170	$1.6M
H0004	Behavioral health counseling and therapy, per 15 minutes	1,980	$140	$271.7K
H2032	Activity therapy, per 15 minutes	4,220	$50	$190K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	120	$60	$6.7K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	50	$40	$1.8K
T1016	Case management, each 15 minutes	30	$40	$1.5K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	20	$90	$1.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Pendleton House — 0 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1020	Personal care services, per diem, 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…	16	40	1,330	$1,170	$6.4M
H2013	Psychiatric health facility service, per diem	12	20	1,290	$520	$2.4M
H0004	Behavioral health counseling and therapy, per 15 minutes	123	270	1,660	$90	$681K
H2014	Skills training and development, per 15 minutes	20	120	1,010	$40	$323.2K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	1,117	1,500	650	$70	$312.4K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	1,350	1,590	590	$50	$236.5K
H2032	Activity therapy, per 15 minutes	5	30	650	$60	$151.5K
T1016	Case management, each 15 minutes	186	210	410	$50	$126.4K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	84	90	120	$70	$42.2K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Interpath Laboratory, Inc.	OR	Clinical Medical Laboratory	$7.8M	$70M
Commonspirit Oregon	OR	Critical Access Hospital	$0	$13.7M
Eastern Oregon Alcoholism Foundation	OR	Substance Abuse Rehabilitation Facility	$0	$9.9M
Yellowhawk Tribal Health Center	OR	Clinic/Center	$0	$5.1M
Jeffrey Kobernik	OR	General Practice Dentistry	$0	$1.9M
City Of Pendleton	OR	Land Ambulance	$529K	$1.1M
Umatilla River Emergency Physicians LLC	OR	Emergency Medicine Physician	$0	$1.5M
Joshua Garren	OR	Radiation Oncology Physician	$1.3M	$0
Case Ketting	OR	Radiation Oncology Physician	$325.1K	$0
Terrol Marshall	OR	Podiatrist	$209.8K	$0

Pendleton House — Billing Profile & Reimbursement Data

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Pendleton House — 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