Total health inspections
3
Maryland average 3.9
Last Health inspection on Jun 2025
Mostly short-term rehab stays
Most residents typically stay for a few weeks or months before returning home or moving on.
Autumn Lake Healthcare at Ballenger Creek
Nursing Home · Frederick, MD
CMS overall rating
The Overall CMS Rating is scored from 1 to 5 stars and combines results from health inspections, staffing levels, and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
The Overall CMS Rating is scored from 1 to 5 stars and combines results from health inspections, staffing levels, and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
Autumn Lake Healthcare at Ballenger Creek
Nursing Home · Frederick, MD
CMS overall rating
The Overall CMS Rating is scored from 1 to 5 stars and combines results from health inspections, staffing levels, and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
The Overall CMS Rating is scored from 1 to 5 stars and combines results from health inspections, staffing levels, and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
Autumn Lake Healthcare at Ballenger Creek accepts Medicare, Medicaid, and private pay.
Overview of Autumn Lake Healthcare at Ballenger Creek
Autumn Lake Healthcare at Ballenger Creek is the perfect nursing home to receive good care. It’s composed of a professional care staff who brings not only excellence to the recovery of every senior; residents can genuinely feel the high- end quality of care in a nurturing environment.
Expect nothing but quality when it comes to their service: an advanced level of recovery found by the support of a psychiatrist, a wound care specialist, and a physiatrist; 24/7 skilled nursing; speech, physical, and occupational therapy; restorative care, bereavement counseling, diabetes management, and track management care.
Autumn Lake Healthcare at Ballenger Creek is an independently owned and operated healthcare center that is licensed to use the Autumn Lake Healthcare name and receive non-healthcare related services. All healthcare-related services are provided solely by Autumn Lake Healthcare at Ballenger Creek.
Quality ratings
The Overall CMS Rating combines results from health inspections, staffing levels and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
Based on the results of the facility's three most recent standard inspections and any complaint investigations. CMS reviews the number, scope, and severity of deficiencies, with more recent findings weighted more heavily.
Measures average nursing staff hours per resident per day, including Registered Nurses (RNs) and total nursing staff. Ratings are adjusted based on the level of care residents require and are compared to state and national benchmarks.
Based on clinical and physical health indicators reported to CMS, such as hospital readmissions, falls, pressure ulcers, and improvements in mobility. These measures reflect how well residents' health needs are being managed.
Staffing hours breakdown
Daily nursing hours per resident by staff type, reported to CMS. Higher is generally better — compare this facility to state and national averages to see where staffing stands.
Total nursing care / resident
This home is ranked 82nd out of 111 homes in Maryland.
Total adjusted nursing hours per resident per day, combining RN, LPN, and aide time. CMS adjusts this for case-mix so facilities can be fairly compared.
This home is ranked 82nd out of 111 homes in Maryland.Total adjusted nursing hours per resident per day, combining RN, LPN, and aide time. CMS adjusts this for case-mix so facilities can be fairly compared.
3h 10m per day
Rank #82 / 111Nurse hours — state benchmarkedThis home is ranked 82nd out of 111 homes in Maryland.Shows adjusted nurse hours per resident per day benchmarked to the Maryland average, with a ranking across 111 Maryland SNFs. More hours mean more direct care. The national average is about 3.5 hrs; below 3.0 is a red flag.
vs Maryland avg
-16%
Standout metric
LPN / LVN is +20% above state avg
| Staff type | Hours / day | vs state avg |
|---|---|---|
|
Registered Nurse (RN)
RNs hold the highest nursing license and can assess residents, interpret test results, and direct care plans. More RN hours per day often signals stronger clinical oversight and faster response to health changes.
| 38m per day | ▼ 24% State avg: 50m per day · National avg: 41m per day |
|
LPN / LVN
Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) deliver routine hands-on care — medication administration, wound dressing, and monitoring vital signs. They work under RN supervision and make up a large share of daily bedside care.
| 1h 5m per day | ▲ 20% State avg: 54m per day · National avg: 52m per day |
|
Nurse Aide
Certified Nurse Aides (CNAs) provide the most direct day-to-day assistance: bathing, dressing, feeding, and mobility. Nurse aide hours are typically the largest staffing category and directly affect residents' quality of life.
| 2h 0m per day | ▼ 8% State avg: 2h 10m per day · National avg: 2h 21m per day |
|
Total Nursing (Weekend)
Combined nursing hours (RN + LPN + Nurse Aide) per resident per day on weekends. Staffing often drops on weekends — this figure reveals whether the facility maintains adequate coverage outside of weekday hours.
| 3h 23m per day | ▼ 3% State avg: 3h 29m per day · National avg: 3h 26m per day |
|
Physical Therapist
Hours per resident per day provided by licensed Physical Therapists (PTs) or PT Assistants. PT services help residents recover mobility after injury or illness and are especially important for post-acute (short-stay) rehabilitation.
| 4m per day | ▼ 20% State avg: 5m per day · National avg: 4m per day |
|
RN (Weekend)
Registered nurse hours specifically on weekends. Facilities sometimes reduce RN presence on Saturdays and Sundays — a low weekend RN figure compared to weekday hours can indicate reduced clinical oversight when most administrative staff are absent.
| 31m per day | ▼ 16% State avg: 37m per day · National avg: 29m per day |
Capacity and availability
This home usually has limited availability
Occupancy between 85% and 95% suggests balanced demand.
Occupancy rate
87.8%
Rank #47 / 113Occupancy rate — state benchmarkedThis home is ranked 47th out of 113 homes in Maryland.Shows this facility's occupancy rate versus the Maryland average, with its statewide rank out of 113. Higher occupancy signals strong local demand and financial stability.
Avg. Length of Stay
88 days
Occupancy rate
87.8%
Rank #47 / 113Occupancy rate — state benchmarkedThis home is ranked 47th out of 113 homes in Maryland.Shows this facility's occupancy rate versus the Maryland average, with its statewide rank out of 113. Higher occupancy signals strong local demand and financial stability.
Avg. Length of Stay
88 days
Who this home usually serves
Show admissions and discharges
TYPE OF STAY
Breakdown by payment type
Medicare
61% of new residents, usually for short-term rehab.
Typical stay
1 - 2 months
Private pay
32% of new residents, often for short stays.
Typical stay
1 - 2 months
Medicaid
7% of new residents, often for long-term daily care.
Typical stay
2 years
Finances and operations
Privately-owned community
Operated by a business corporation.
Home revenue
$21.0M
Profit
$1.3M
Privately-owned community
Operated by a business corporation.
Home revenue
$21.0M Rank #40 / 113Revenue — state benchmarkedThis home is ranked 40th out of 113 homes in Maryland.Shows this facility's annual revenue compared to the Maryland SNF average. Higher revenue generally means more resources for staffing and capital — read alongside Payroll %.
Profit
$1.3M
Payroll costs
The portion of the home's budget spent on staff, including nurses, caregivers, and other employees who support care and operations.
Rank #92 / 113Payroll — state benchmarkedThis home is ranked 92nd out of 113 homes in Maryland.Shows total annual staff payroll benchmarked to the Maryland average. Higher payroll investment relative to peers often signals better staffing and less reliance on cheaper contract labor.
$8.5M
The portion of the home's budget spent on staff, including nurses, caregivers, and other employees who support care and operations.
Rank #92 / 113Payroll — state benchmarkedThis home is ranked 92nd out of 113 homes in Maryland.Shows total annual staff payroll benchmarked to the Maryland average. Higher payroll investment relative to peers often signals better staffing and less reliance on cheaper contract labor.
Other operating costs
All remaining costs needed to run the home, such as food, utilities, building maintenance, supplies and administrative expenses.
$11.2M
All remaining costs needed to run the home, such as food, utilities, building maintenance, supplies and administrative expenses.
Total costs
$19.7M
Walk Score: 36 / 100 Rank #70 / 109Walk Score — state benchmarkedThis home is ranked 70th out of 109 homes in Maryland.Shows how walkable this facility's neighborhood is compared to the average Walk Score across Maryland SNFs. Higher scores benefit residents, families, and staff.
Somewhat walkable. A few nearby services may be reachable on foot, but most trips require transportation.
About this community
Rehabilitation Services
Respite Care
Short-Term Rehab
Health Inspection History
Inspections
Total health citations
59
Rank #81 / 113Health citations — state benchmarkedThis home is ranked 81st out of 113 homes in Maryland.Shows this facility's total health deficiency citations benchmarked to the Maryland state average, with a ranking across all 113 MD SNFs. Lower citation counts earn a better rank.
Maryland average 49.9
Citations per inspection
19.67
Rank #98 / 113Citations per inspection — state benchmarkedThis home is ranked 98th out of 113 homes in Maryland.Shows average deficiency citations per CMS inspection for this facility versus the Maryland mean across 113 SNFs with citation data. Lower is better.
Maryland average 12.81
Health citations are formal notices following inspections when they fail to comply with safety and care standards.
54 of 59 citations resulted from standard inspections; 1 of 59 resulted from complaint investigations; and 4 of 59 came from combined inspections (standard and complaint).
Breakdown of citation severity (last 8 years)
Critical Health citations
1
100% worse than Maryland averageMaryland average: 0.5
Serious Health citations
1
1
67% worse than Maryland averageMaryland average: 0.6
1 critical citation
1 serious citation
55 moderate citations
2 minor citations
Citations history (last 8 years)
Abuse/Neglect moderate citation
Issues related to protecting resident's from harm, including abuse, neglect, or mistreatment.
Jun 30, 2025
Issues related to protecting resident's from harm, including abuse, neglect, or mistreatment.
Jun 30, 2025
Corrected
Abuse/Neglect moderate citation
Issues related to protecting resident's from harm, including abuse, neglect, or mistreatment.
Jun 30, 2025
Issues related to protecting resident's from harm, including abuse, neglect, or mistreatment.
Jun 30, 2025
Corrected
Environmental moderate citation
Issues related to building safety, cleanliness, maintenance, and overall living conditions.
Jun 30, 2025
Issues related to building safety, cleanliness, maintenance, and overall living conditions.
Jun 30, 2025
Corrected
Infection Control moderate citation
Issues related to preventing and controlling infections, including hygiene practices and safety protocols.
Jun 30, 2025
Issues related to preventing and controlling infections, including hygiene practices and safety protocols.
Jun 30, 2025
Corrected
Data sourced from CMS Health Deficiencies reports. Citation severity codes range from A (least serious) to L (most serious). Immediate Jeopardy (J-L) citations indicate situations where the facility's noncompliance has placed residents at risk of death or serious harm.
Financial Assistance for
Nursing Home in Maryland
Autumn Lake Healthcare at Ballenger Creek is located in Frederick, Maryland.
Here are the financial assistance programs available to residents in Maryland.
Places of interest near Autumn Lake Healthcare at Ballenger Creek
1.6 miles from city center
Estimated distance in miles from Frederick's city center to Autumn Lake Healthcare at Ballenger Creek's address, calculated via Google Maps.
— 14.21 miles to nearest hospital (Frederick Health Mt Airy)
Calculate Travel Distance to Autumn Lake Healthcare at Ballenger Creek
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Staffing Data (Q2 2025)
This data corresponds to Q2 2025 and is based on CMS Payroll-Based Journal.
Total staff
195
Employees
122
Contractors
73
Staff to resident ratio
1.67:1
8% worse than Maryland averageMaryland average ratio: 1.81:1
Avg staff/day
65
Average shift
7.9 hours
0% compared with Maryland averageMaryland average: 8 hours
Total staff hours (quarter)
46,859
Nursing staff breakdown
Registered Nurse
Manages medical care and health needs.
Total count
21
Average shift length
Average shift length. Calculated as total hours divided by days worked and average staff per day.
8 hours
Average shift length. Calculated as total hours divided by days worked and average staff per day.
8 hoursThis role is partially covered by contractors.
Licensed Practical Nurse
Assists with medical care and medications.
Total count
41
Average shift length
Average shift length. Calculated as total hours divided by days worked and average staff per day.
8.8 hours
Average shift length. Calculated as total hours divided by days worked and average staff per day.
8.8 hoursThis role is partially covered by contractors.
Certified Nursing Assistant
Helps with daily care and mobility.
Total count
91
Average shift length
Average shift length. Calculated as total hours divided by days worked and average staff per day.
7.7 hours
Average shift length. Calculated as total hours divided by days worked and average staff per day.
7.7 hoursThis role is partially covered by contractors.
Contractor staffing
Total hours from contractors
14.3%
6,716 contractor hours this quarter
Certified Nursing Assistant: 28
Licensed Practical Nurse: 13
Registered Nurse: 9
Physical Therapy Assistant: 5
Physical Therapy Aide: 5
Qualified Social Worker: 5
Respiratory Therapy Technician: 4
Speech Language Pathologist: 4
Staff by category
| Certified Nursing Assistant | 63 | 28 | 91 | 21,283 | 91 | 100% | 7.7 |
| Licensed Practical Nurse | 28 | 13 | 41 | 10,793 | 91 | 100% | 8.8 |
| Registered Nurse | 12 | 9 | 21 | 3,944 | 91 | 100% | 8 |
| Clinical Nurse Specialist | 7 | 0 | 7 | 2,918 | 84 | 92% | 7.5 |
| Speech Language Pathologist | 0 | 4 | 4 | 1,426 | 72 | 79% | 7.8 |
| Physical Therapy Assistant | 0 | 5 | 5 | 1,004 | 83 | 91% | 7.2 |
| Physical Therapy Aide | 0 | 5 | 5 | 926 | 71 | 78% | 7.5 |
| Other Dietary Services Staff | 6 | 0 | 6 | 864 | 72 | 79% | 7.8 |
| Respiratory Therapy Technician | 0 | 4 | 4 | 677 | 64 | 70% | 6.7 |
| Dental Services Staff | 1 | 0 | 1 | 524 | 63 | 69% | 8.3 |
| Administrator | 1 | 0 | 1 | 512 | 68 | 75% | 7.5 |
| Mental Health Service Worker | 1 | 0 | 1 | 505 | 62 | 68% | 8.1 |
| RN Director of Nursing | 1 | 0 | 1 | 501 | 64 | 70% | 7.8 |
| Nurse Practitioner | 1 | 0 | 1 | 500 | 64 | 70% | 7.8 |
| Qualified Social Worker | 0 | 5 | 5 | 267 | 37 | 41% | 6.9 |
| Dietitian | 1 | 0 | 1 | 217 | 26 | 29% | 8.3 |
91 Certified Nursing Assistant
% of Days
100%
41 Licensed Practical Nurse
% of Days
100%
21 Registered Nurse
% of Days
100%
7 Clinical Nurse Specialist
% of Days
92%
4 Speech Language Pathologist
% of Days
79%
5 Physical Therapy Assistant
% of Days
91%
5 Physical Therapy Aide
% of Days
78%
6 Other Dietary Services Staff
% of Days
79%
4 Respiratory Therapy Technician
% of Days
70%
1 Dental Services Staff
% of Days
69%
1 Administrator
% of Days
75%
1 Mental Health Service Worker
% of Days
68%
1 RN Director of Nursing
% of Days
70%
1 Nurse Practitioner
% of Days
70%
5 Qualified Social Worker
% of Days
41%
1 Dietitian
% of Days
29%
Facility Characteristics
Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)
Total residents
117
Medicare
31
26.5% of residents
Medicaid
62
53% of residents
Private pay or other
24
20.5% of residents
Programs & Services
Residents Group
Residents meet regularly to discuss policies, care quality, and activities
Nurse Aide Training
State-approved Nurse Aide Training and Competency Evaluation Program on-site
Active Resident Council
Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.
Data sourced from CMS Long-Term Care Facility Characteristics quarterly report. Payer mix reflects the current resident census by primary payment source.
Quality of care over time
These measures show how residents usually do over time at this home, based on health outcomes and preventive care.
High-risk clinical events score
A composite score based on pressure ulcers, falls with injury, weight loss, walking ability decline, and activities of daily living decline.
18.6
A composite score based on pressure ulcers, falls with injury, weight loss, walking ability decline, and activities of daily living decline.
18.6
44% worse than Maryland averageMaryland average: 12.9
Functional decline score
A composite score based on activities of daily living decline, walking ability decline, and incontinence.
36.8
A composite score based on activities of daily living decline, walking ability decline, and incontinence.
36.8
43% worse than Maryland averageMaryland average: 25.7
Long-stay resident measures
CMS star rating based on long-stay quality measure performance. 5 stars = significantly above average, 1 star = significantly below average.
Need for Help with Daily Activities Increased
Percent of long-stay residents whose need for help with daily activities has increased
26.1%
Percent of long-stay residents whose need for help with daily activities has increased
26.1%
10% worse than Maryland averageMaryland average: 23.7%
Walking Ability Worsened
Percent of long-stay residents whose ability to move independently worsened
51.0%
Percent of long-stay residents whose ability to move independently worsened
51.0%
84% worse than Maryland averageMaryland average: 27.7%
Low Risk Residents with Bowel/Bladder Incontinence
Percent of low risk long-stay residents who lose control of their bowels or bladder
33.4%
Percent of low risk long-stay residents who lose control of their bowels or bladder
33.4%
29% worse than Maryland averageMaryland average: 25.9%
Falls with Major Injury
Percent of long-stay residents experiencing one or more falls with major injury
1.3%
Percent of long-stay residents experiencing one or more falls with major injury
1.3%
42% better than Maryland averageMaryland average: 2.3%
High Risk Residents with Pressure Ulcers
Percent of long-stay high risk residents with pressure ulcers
8.2%
Percent of long-stay high risk residents with pressure ulcers
8.2%
26% worse than Maryland averageMaryland average: 6.5%
Urinary Tract Infection
Percent of long-stay residents with a urinary tract infection
1.0%
Percent of long-stay residents with a urinary tract infection
1.0%
38% better than Maryland averageMaryland average: 1.6%
Lost Too Much Weight
Percent of long-stay residents who lose too much weight
6.5%
Percent of long-stay residents who lose too much weight
6.5%
12% worse than Maryland averageMaryland average: 5.8%
Depressive Symptoms
Percent of long-stay residents who have depressive symptoms
9.1%
Percent of long-stay residents who have depressive symptoms
9.1%
55% better than Maryland averageMaryland average: 20.2%
Antipsychotic Use
Percent of long-stay residents who received an antipsychotic medication
5.8%
Percent of long-stay residents who received an antipsychotic medication
5.8%
55% better than Maryland averageMaryland average: 12.9%
Pneumococcal Vaccine
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
100.0%
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
100.0%
9% better than Maryland averageMaryland average: 92.0%
Influenza Vaccine
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
100.0%
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
100.0%
In line with Maryland averageMaryland average: 96.6%
Hospitalizations per 1,000 days
Number of hospitalizations per 1,000 long-stay resident days.
1.21
Number of hospitalizations per 1,000 long-stay resident days.
1.21
8% better than Maryland averageMaryland average: 1.32
ED visits per 1,000 days
Number of outpatient emergency department visits per 1,000 long-stay resident days.
0.82
Number of outpatient emergency department visits per 1,000 long-stay resident days.
0.82
32% better than Maryland averageMaryland average: 1.21
Short-stay resident measures
CMS star rating based on short-stay quality measure performance. 5 stars = much above average, 1 star = much below average.
Pneumococcal Vaccine
Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine
92.8%
Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine
92.8%
18% better than Maryland averageMaryland average: 78.4%
Antipsychotic medication increase
Percent of short-stay residents who newly received an antipsychotic medication
0.5%
Percent of short-stay residents who newly received an antipsychotic medication
0.5%
66% better than Maryland averageMaryland average: 1.4%
Influenza Vaccine
Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine
94.4%
Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine
94.4%
17% better than Maryland averageMaryland average: 80.6%
Re-hospitalized after SNF stay
Percentage of short-stay residents who were re-hospitalized after their nursing home admission.
17.6%
Percentage of short-stay residents who were re-hospitalized after their nursing home admission.
17.6%
17% better than Maryland averageMaryland average: 21.2%
Emergency department visits
Percentage of short-stay residents who had an outpatient emergency department visit.
7.4%
Percentage of short-stay residents who had an outpatient emergency department visit.
7.4%
25% better than Maryland averageMaryland average: 9.9%
Falls with major injury
Percentage of SNF residents who experience falls with major injury during their stay.
0.4%
Percentage of SNF residents who experience falls with major injury during their stay.
0.4%
49% better than Maryland averageMaryland average: 0.8%
Ability to care for self at discharge
Percentage of residents at or above expected ability to care for themselves at discharge.
51.9%
Percentage of residents at or above expected ability to care for themselves at discharge.
51.9%
In line with Maryland averageMaryland average: 53.7%
Successful return to home or community
Rate of successful return to home or community from a skilled nursing facility.
57.1%
Rate of successful return to home or community from a skilled nursing facility.
57.1%
13% better than Maryland averageMaryland average: 50.6%
Quality measures are calculated from Minimum Data Set (MDS) assessments. For most measures, lower percentages indicate better care quality.
Penalties and fines
Federal penalties imposed by CMS for regulatory violations, including civil money penalties (fines) and denials of payment for new Medicare/Medicaid admissions.
Source: CMS Penalties Database
No penalties in the past 3 years
No civil money penalties or payment denials were reported in the last 3 years.
Compare Nursing Home around Frederick
The information below is reported by the Maryland Department of Health, Office of Health Care Quality.
Filter by care type
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| Autumn Lake Healthcare at Ballenger Creek |
NH Nursing Home Licensed facility providing 24/7 skilled nursing care for residents with complex, ongoing medical needs. Staffed by RNs, LPNs, and CNAs. Inspected and star-rated annually by CMS. Accepts Medicare (short-term rehab) and Medicaid (long-term care). | Frederick (Ballenger Creek Center) | 130 | 87.8% | +7% | 3.16 | -18% | -16% | 0 | 59 | 19.7 | 2 | 118 | 36 | 347 Ballenger Holdco LLC | $21.0M | $1.3M | 6.1% | 215001 | ||||
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AL Assisted Living A licensed, long-term care setting for seniors or individuals with disabilities who need help with daily activities — like bathing, dressing, and medication management — but not 24-hour skilled nursing. Offers housing, meals, and around-the-clock support while aiming to maximize resident independence.
IL Independent Living Lifestyle-focused communities for older adults offering dining, activities, and transportation with minimal personal care. Best for active, independent seniors who want community without medical support.
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Financial Trends
Historical financial and operational data for Autumn Lake Healthcare at Ballenger Creek based on CMS SNF Cost Reports.
Occupancy Rate
87.8%
↑ 1.4pp vs 2022
Net Income
$1.3M
↓ ~$234.9K vs 2022
Total Payroll
$8.5M
↓ ~$136.3K vs 2022
Profit Margin
6.2%
↓ 1.3pp vs 2022
Guides for Better Senior Living
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Frequently Asked Questions about Autumn Lake Healthcare at Ballenger Creek
What neighborhood is Autumn Lake Healthcare at Ballenger Creek in?
Autumn Lake Healthcare at Ballenger Creek is in the Ballenger Creek Center neighborhood.
Is Autumn Lake Healthcare at Ballenger Creek in a walkable area?
Autumn Lake Healthcare at Ballenger Creek has a walk score of 36. Somewhat walkable. A few nearby services may be reachable on foot, but most trips require transportation.
What is the phone number of Autumn Lake Healthcare at Ballenger Creek?
(301) 663-5181 will put you in contact with the team at Autumn Lake Healthcare at Ballenger Creek.
Is Autumn Lake Healthcare at Ballenger Creek Medicare or Medicaid certified?
Yes — Autumn Lake Healthcare at Ballenger Creek is a CMS-certified provider of Medicare and Medicaid.
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