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NPI 1063574135 · Pawtucket, RI · Federally Qualified Health Center (FQHC)
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Blackstone Valley Community Health Care, Inc. is a federally qualified health center (fqhc) provider located in Pawtucket, Rhode Island. This profile covers 0 Medicare and 76 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Blackstone Valley Community Health Care, Inc. |
| Address | 39 East Ave |
| City | Pawtucket |
| State | RI |
| ZIP | 02860 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | December 15, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $12.4M |
| Medicare | $0 |
This provider is effectively single‑payer: there is no Medicare billing on file and all recorded federal payer revenue is Medicaid, totaling $12.4M. The absence of Medicare activity alongside significant Medicaid volume indicates the organization operates primarily within the Medicaid safety‑net population as an FQHC.
Revenue is highly concentrated in a small set of Medicaid codes: the precomputed top three codes (99213, 99214, 87636) account for 66.1% of the provider's total Medicaid revenue. Specifically, 99213 generates $4.3M (35.8%), 99214 generates $2.7M (22.4%), and 87636 generates $952.6K (7.9%), signaling material dependence on office E/M visits and multiplex respiratory pathogen testing.
The code mix points to a core primary‑care and comprehensive ambulatory operation: high volumes and revenue from 99213 and 99214 reflect routine established patient office visits, while strong counts in preventive codes (99392, 99391, 99393) and clinic encounter code T1015 indicate a broad primary‑care and preventive services footprint typical of an FQHC. Vaccination codes 90471 and 90472 and vision codes 92014/92015 further support a multi‑service outpatient clinic model that includes immunizations and basic optometry.
Competitive standing in Rhode Island is dominant for several key services: 99213 ranks #3 of 2046 providers in‑state (100th percentile, extreme outlier) and 99214 ranks #5 of 1731 (100th percentile, extreme outlier), while 87636 ranks #1 of 21 providers in‑state (100th percentile, extreme outlier). Multiple other codes also sit at or near top percentiles (for example, 90471 and 90472 are both ranked #1 where reported), which characterizes the provider as a major state‑level volume leader for routine outpatient visits, immunizations, and COVID/respiratory testing.
There is a substantial pediatric and preventive services component: 99392 ($316.2K) and 99391 ($285.3K) both rank #2 in‑state and are labeled extreme outliers (99th percentile), and 99393 contributes $250.8K (rank #2). Large vaccination claim counts (90471: 29.1K claims, $233K revenue; 90472: 10.9K claims, $164K revenue) further indicate heavy pediatric and preventive throughput consistent with family‑oriented primary care.
Behavioral health is a meaningful ancillary service line: psychotherapy codes 90834 (10.8K claims, $678.8K, 5.6% of Medicaid revenue) and 90832 (7.9K claims, $340.9K, 2.8%) together represent a sizeable portion of outpatient revenue, with 90834 ranked #12 of 751 providers (99th percentile, notably above typical) and 90832 ranked #7 of 185 (97th percentile). This mix suggests integrated mental‑health services are part of the FQHC’s care model rather than marginal or peripheral offerings.
Diagnostic and screening services are high‑volume contributors beyond E/M: 87636 (multiplex SARS–CoV‑2/flu testing) is prominent at $952.6K and ranks as an extreme state outlier, and related lab codes such as 87880 and 87426 also appear with above‑typical state volume. The presence of 96110 (developmental screening, $86.4K, ranked #1) signals systematic pediatric developmental screening workflows within clinical encounters.
The provider has a long operational tenure with its NPI enumerated on 2006-12-15 (~20 years ago), consistent with an established FQHC and deep Medicaid relationships. Given that the top three codes account for 66.1% of Medicaid revenue, changes in reimbursement or utilization of office E/M services or respiratory testing could materially affect overall revenue, so analysts should monitor policy or coding shifts that touch 99213/99214/87636.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
76 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 93,890 | $50 | $4.3M |
| 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… | 42,970 | $60 | $2.7M |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 7,680 | $120 | $952.6K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 10,770 | $60 | $678.8K |
| T1015 | Clinic visit/encounter, all-inclusive | 12,320 | $40 | $541.9K |
| 90832 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 7,930 | $40 | $340.9K |
| 99392 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 4,940 | $60 | $316.2K |
| 99391 | Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby… | 4,530 | $60 | $285.3K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 8,250 | $30 | $264K |
| 99393 | The provider performs an established well–patient visit for a child who is between the ages of 5 and 11. | 3,800 | $70 | $250.8K |
Showing 1–10 of 76
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
76 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 17 | 120 | 400 | $130 | $896.9K |
| 59400 | In this global service, the provider and nonphysician healthcare providers in the practice provide all of the antepartum care, admission to the hospital for delivery, labor management, including… | 2 | 10 | 40 | $1,690 | $105K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 12 | 750 | 330 | $70 | $92.5K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 63 | 240 | 150 | $80 | $91.9K |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 94 | 360 | 280 | $90 | $86.4K |
| 87636 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, and influenza B using a multiplex amplified nucleic… | 1 | 20 | 60 | $140 | $82.1K |
| 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… | 5 | 1,730 | 220 | $70 | $75.2K |
| 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… | 3 | 2,050 | 300 | $50 | $72.3K |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 9 | 100 | 90 | $100 | $70.7K |
| 90792 | In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical… | 94 | 160 | 50 | $150 | $59.2K |
Showing 1–10 of 76
Other providers in the same ZIP code as Blackstone Valley Community Health Care, Inc., ranked by combined Medicare and Medicaid revenue.
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