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

Why is the Medicaid comparison limited to Rhode Island 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. Rhode Island (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.

Prospect Chartercare Rwmc, LLC (NPI 1013332014)

Key Findings

Field	Value
Entity Type	Organization
Organization	Prospect Chartercare Rwmc, LLC
Address	825 Chalkstone Ave
City	Providence
State	RI
ZIP	02908
Taxonomy	General Acute Care Hospital
NPI Enumerated	February 27, 2014

Payer Source	Total Paid
Medicaid	$57.1M
Medicare	$0

This provider is effectively single-payer in the Medicare/Medicaid mix: there is no Medicare billing on file and all reported lifetime federal claims are through Medicaid, totaling $57.1M in Medicaid revenue. Analysts should treat Medicaid as the primary revenue stream when modeling this entity's financial profile and network leverage.

Revenue is concentrated in a small set of high-throughput codes: the precomputed top 3 Medicaid codes account for 27.2% of this provider's total Medicaid revenue. The three highest-revenue Medicaid codes are 99285 ($4.3M revenue, 10.9% of Medicaid revenue, 10.7K claims), 85025 ($3.4M revenue, 8.8% of Medicaid revenue, 30.8K claims), and 36415 ($3M revenue, 7.6% of Medicaid revenue, 25.3K claims).

The code mix indicates a high-volume emergency department footprint. High-acuity and lower-acuity ED E/M codes appear near the top of the list — 99285 (10.7K claims, ranks #6 of 277 in-state, 98th percentile, notably above typical state volume), 99283 (12.6K claims, $2.9M revenue, ranks #5 of 291, 99th percentile, notably above typical state volume), and 99284 (8.5K claims, $2.2M revenue, ranks #11 of 339, 97th percentile) — together these suggest the hospital operates a busy ED handling a spectrum of acuity.

Laboratory and diagnostic testing are major revenue drivers alongside ED throughput. Routine test codes such as 85025 (30.8K claims, $3.4M revenue, ranks #6 of 289, 98th percentile, notably above typical state volume), 36415 (25.3K claims, $3M revenue, ranks #4 of 237, 99th percentile, typical, unremarkable volume), 80048 ($2.4M revenue, 17K claims, ranks #5 of 98, 96th percentile) and panels like 80053 ($1.1M revenue, 15.6K claims, ranks #6 of 139, 96th percentile) indicate high specimen-processing and lab throughput tied to ED and inpatient activity.

Infusion, chemotherapy, and injection services are also material to Medicaid revenue and reflect on ambulatory/inpatient therapeutic capacity: 96413 (2.9K claims, $1.4M revenue, ranks #3 of 12, 82th percentile), 96375 (5.9K claims, $1.6M revenue, ranks #4 of 16, 80th percentile), 96374 (5.5K claims, $1M revenue, ranks #4 of 22, 86th percentile), and J1644 (3.1K claims, $1.1M revenue, ranks #1 of 8, 100th percentile, notably above typical state volume) point to sustained use of IV therapies and anticoagulation in the patient mix.

The provider holds strong competitive standing statewide on several specific codes, ranking in high percentiles: J1644 is #1 of 8 providers in-state (100th percentile, notably above typical state volume), 99283 and 99285 both sit in the 98–99th percentile statewide (notably above typical state volume), and 43239 is #3 of 37 (94th percentile, notably above typical state volume). These ranks signal market leadership on discrete service lines even if overall Medicaid revenue is split across many codes.

While the top three codes are concentrated, the remainder of the $57.1M Medicaid revenue is distributed across many diagnostic, ED, and infusion codes, indicating a diversified operational profile rather than dependence on a single service. Multiple mid-tier lab and procedure codes (e.g., 80307, G0480, 80076, 84484, 83690) each contribute materially and are often in above-average state percentiles or typical ranges, supporting a high-throughput acute care operation.

The provider has an established NPI tenure (enumerated 2014-02-27, ~12 years ago) and is listed under the General Acute Care Hospital taxonomy; combined with the high volumes of ED E/M codes, lab panels, and infusion/chemo services, the data support classifying this facility as a full-service acute care hospital with heavy emergency, diagnostic, and procedural throughput that should be modeled accordingly for contractual and utilization reviews.

Medicaid: Complete Services Breakdown

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

215 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	10,680	$400	$4.3M
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	30,810	$110	$3.4M
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	25,310	$120	$3M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	12,550	$230	$2.9M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	9,160	$280	$2.6M
80048	The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood…	16,990	$140	$2.4M
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	8,500	$250	$2.2M
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	5,860	$280	$1.6M
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	5,440	$270	$1.5M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	2,850	$510	$1.4M

Showing 1–10 of 215

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Rhode Island Distribution

Prospect Chartercare Rwmc, LLC — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Rhode Island

Full comparison — all codes billed, vs. Rhode Island median

215 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	5	30	260	$60	$3.4M
G0378	Hospital observation service, per hour	4	10	1,220	$1,410	$2.9M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	7	50	330	$50	$2.7M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	6	10	220	$740	$2.6M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	3	10	360	$430	$1.1M
A0428	Ambulance service, basic life support, non-emergency transport, (bls)	6	10	19,390	$60	$1M
T1030	Nursing care, in the home, by registered nurse, per diem	13	20	4,630	$120	$916.9K
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	4	20	840	$210	$789.2K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	13	20	190	$520	$504.7K
J2405	Injection, ondansetron hydrochloride, per 1 mg	5	20	1,080	$180	$470.2K

Showing 1–10 of 215

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Roger Williams Medical Center	RI	Surgical Oncology Physician	$0	$5.4M
Thomas Defanti	CT	Addiction Medicine (Psychiatry & Neurology) Physician	$0	$3.6M
Prospect Chartercare Rwmc, LLC	RI	Internal Medicine Physician	$0	$2.4M
Sajid Siddiq	RI	Cardiovascular Disease Physician	$300.6K	$19.3K
Joseph Mazza	RI	Cardiovascular Disease Physician	$268.7K	$15.2K
Florian Koci	RI	Cardiovascular Disease Physician	$268.6K	$4.4K
Anila Peter-faherty	RI	Cardiovascular Disease Physician	$233K	$10.9K
Neal Kelley	RI	Cardiovascular Disease Physician	$173.2K	$32K
Rodrigo Nardi	RI	Psychiatry Physician	$173.5K	$31.1K
Ali Akhtar	RI	Internal Medicine Physician	$61.5K	$134.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
A Caring Experience Nursing Services, Inc.	RI	Home Health Agency	$0	$78.5M
Caregiver Homes Of Rhode Island Inc.	RI	Case Management Agency	$0	$43.4M
John Ricci	RI	Dentist	$0	$4.3M
Meals On Wheels Of Ri, Inc.	RI	Case Manager/Care Coordinator	$0	$4.1M
Professional Ambulance LLC	RI	Ambulance	$1.7M	$1.4M
University Pathologists, LLC	RI	Anatomic Pathology Physician	$0	$2.9M
Antonio Barajas	RI	Emergency Medical Services (Emergency Medicine) Physician	$0	$2.1M
Nakitta Noel	RI	Emergency Medicine Physician	$32.3K	$1.5M
Beth Toolan	RI	Pediatrics Physician	$0	$1.3M
Altug Koymen	RI	Obstetrics & Gynecology Physician	$0	$1.2M

Prospect Chartercare Rwmc, 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