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

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

Mainstream Living, Inc. (NPI 1992886881)

Field	Value
Entity Type	Organization
Organization	Mainstream Living, Inc.
Address	2012 E 13th St
City	Ames
State	IA
ZIP	50010
Taxonomy	Social Worker
NPI Enumerated	October 18, 2006

Payer Source	Total Paid
Medicaid	$134.3M
Medicare	$0

Key Findings

MAINSTREAM LIVING, INC. is effectively a Medicaid-focused provider: there is no Medicare billing on file and the provider reports $134.3M in lifetime Medicaid revenue, indicating a single-payer operational footprint concentrated in state Medicaid programs. This payer mix suggests its service model and revenue depend almost entirely on Medicaid reimbursement streams rather than Medicare.

Revenue is highly concentrated in a very small set of service lines — the precomputed top three Medicaid codes account for 96.4% of the provider's total Medicaid revenue. In particular, H2016, S5136, and T2020 together drive the vast majority of billing and should be the primary focus for any reimbursement or utilization analysis.

H2016 is the dominant revenue driver: 46.4K claims at an average paid/claim of $1988 produced $92.1M in revenue, representing 68.6% of this provider's total Medicaid revenue. That mix implies MAINSTREAM LIVING operates primarily as a comprehensive community support services provider on a per-diem basis, with a business model centered on paid daily supports rather than short, episodic encounters.

S5136 is the second-largest contributor with 8.1K claims, a $3950 avg paid/claim, and $32.1M in revenue (23.9% of total Medicaid revenue); the pattern indicates significant delivery of companion care (IADL/ADL) on a per-diem basis. Although S5136 represents a large share of dollars, its in-state rank (#45 of 82, 46th percentile) is described as typical and unremarkable volume, so the provider’s dollar concentration here reflects scale more than unusually high per-code intensity relative to peers.

T2020 (32.8K claims, $158 avg paid/claim, $5.2M revenue, 3.9% of Medicaid revenue) shows the provider also bills day habilitation (waiver) services as a meaningful but much smaller revenue stream. T2020 ranks #26 of 101 in-state (75th percentile) and is labeled typical, indicating MAINSTREAM LIVING participates in day habilitation at a modestly above-median level but not as a statewide leader.

Secondary service lines (H2015, H2023, H0037, T2021) collectively represent minimal revenue relative to the top three, with H2015 contributing $3M (23K claims, $132 avg paid/claim) and ranking #14 of 95 (86th percentile), and H2023 contributing $973.6K and ranking #7 of 29 (79th percentile). All of these codes are characterized as typical, unremarkable volume for their respective statewide peer groups, which suggests the provider’s service mix beyond the top three is consistent with standard community behavioral and habilitation providers rather than outlier specialization.

Competitive standing is mixed: MAINSTREAM LIVING is a major dollar generator within its own Medicaid billing profile because H2016 accounts for $92.1M (68.6% of its Medicaid revenue), but rank/percentile information (for example, H2016 at #40 of 176, 78th percentile) consistently describes its volumes as typical or unremarkable relative to statewide peers. In short, the organization is a significant Medicaid revenue holder at the account level but not an unusually dominant outlier on per-code market-share metrics.

The provider has long-tenured enrollment: the NPI was enumerated on 2006-10-18 (approximately 20 years ago), indicating an established presence in the market and likely institutional continuity in delivering community support, companion care, and day habilitation services. That tenure, coupled with high Medicaid concentration, suggests stability in its Medicaid-facing business model but also exposure to any state-level Medicaid policy or rate changes that affect per-diem reimbursement lines.

Medicaid: Complete Services Breakdown

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

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2016	Comprehensive community support services, per diem	46,350	$1,990	$92.1M
S5136	Companion care, adult (e.g., iadl/adl); per diem	8,130	$3,950	$32.1M
T2020	Day habilitation, waiver; per diem	32,840	$160	$5.2M
H2015	Comprehensive community support services, per 15 minutes	23,040	$130	$3M
H2023	Supported employment, per 15 minutes	18,720	$50	$973.6K
H0037	Community psychiatric supportive treatment program, per diem	2,490	$260	$645.9K
T2021	Day habilitation, waiver; per 15 minutes	5,740	$30	$195.2K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

Mainstream Living, Inc. — 0 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

7 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5136	Companion care, adult (e.g., iadl/adl); per diem	45	80	9,410	$490	$17.9M
H2016	Comprehensive community support services, per diem	40	180	10,790	$390	$15.2M
T2020	Day habilitation, waiver; per diem	26	100	10,960	$110	$3M
H2015	Comprehensive community support services, per 15 minutes	14	100	4,130	$160	$1.9M
H0037	Community psychiatric supportive treatment program, per diem	10	30	1,050	$210	$800.8K
H2023	Supported employment, per 15 minutes	7	30	4,810	$60	$542.5K
T2021	Day habilitation, waiver; per 15 minutes	35	100	2,780	$60	$386.9K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mcfarland Clinic PC	IA	Multi-Specialty Clinic/Center	$0	$26.7M
Youth And Shelter Services, Inc.	IA	Counselor	$0	$11.4M
Mary Greeley Medical Center	IA	General Acute Care Hospital	$0	$9.1M
Mary Greeley Medical Center	IA	Land Ambulance	$0	$4.4M
Venkatesh Rudrapatna	IA	Hematology & Oncology Physician	$3.4M	$0
Sreenath Kodali	IA	Hematology & Oncology Physician	$3.2M	$0
The Richmond Center	IA	Mental Health Counselor	$0	$2.4M
Sonam Patel	IA	Hematology & Oncology Physician	$1.8M	$0
Joseph Merchant	IA	Hematology & Oncology Physician	$1.8M	$0
Tracy Kangas	IA	Ophthalmology Physician	$1.1M	$0

Mainstream Living, Inc. — Billing Profile & Reimbursement Data

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Mainstream Living, 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