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.

Blackstone Valley Community Health Care (NPI 1104046226)

Field	Value
Entity Type	Organization
Organization	Blackstone Valley Community Health Care
Address	210 Main St
City	Pawtucket
State	RI
ZIP	02860
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	April 30, 2007

Payer Source	Total Paid
Medicaid	$14.2M
Medicare	$0

Key Findings

BLACKSTONE VALLEY COMMUNITY HEALTH CARE is operating as a Federally Qualified Health Center (FQHC) with Medicare billing absent from the dataset and all documented federal revenue coming from Medicaid; lifetime Medicaid revenue on file is $14.2M and there is no Medicare revenue reported. This profile indicates the organization is effectively single-payer in the public claims data available, with Medicaid driving its reimbursed activity.

Revenue concentration is extremely high around a single Medicaid billing code: T1015 accounts for $14.2M and is reported as 100.0% of this provider's total Medicaid revenue. This indicates the provider’s paid Medicaid revenue is dominated entirely by the all-inclusive clinic encounter code rather than fee-for-service dental or ancillary procedure payments.

The code mix and top-revenue driver reflect an FQHC primary care clinic operating model: T1015 (Clinic visit/encounter, all-inclusive) as the sole revenue source implies the site bills comprehensive encounter payments typical of FQHC scope (broad primary care and related services bundled into an encounter code), while the long list of dental procedure codes with high claim counts but $0 avg paid/claim suggests those services are recorded but not producing detectable paid Medicaid revenue in this dataset.

Competitive standing within Rhode Island for T1015 is strong by volume: the provider ranks #3 of 124 in-state and is described as an extreme outlier at the 98th percentile for that code. That ranking signals the organization is a major Medicaid clinic-volume player for the encounter-based FQHC payment model in the state, driving far more encounter billing than most peers.

Several dental and testing procedure codes show very high claim volumes but $0 reported paid amounts in this dataset (examples include D1110, D0120, D0220, D0274, D1206, D0603), with many of those codes marked as extreme outliers or notably above typical state volume (multiple codes at the 96–100th percentiles). These patterns suggest high utilization or documentation of dental and public-health testing activity that does not translate to paid Medicaid revenue in the available payment records, which may reflect separate funding streams, bundled payment treatments, reporting artifacts, or state-specific reimbursement practices.

The provider’s NPI was enumerated around 2007-04-30 (~19 years ago), indicating substantial tenure in the public program and likely an established local footprint. Combined with the high ranks on multiple codes, this longevity supports the picture of a long-standing FQHC that performs high volumes of encounters and ancillary services within the Rhode Island Medicaid population.

From a payer or contracting perspective, the T1015 concentration creates both predictability and risk: payers negotiating encounter rates will be dealing with a provider whose entire documented Medicaid revenue flows through the all-inclusive clinic encounter code, so changes to encounter valuation or encounter attribution could materially impact the provider’s revenue. Analysts should treat the reported $14.2M exclusively as encounter-driven Medicaid revenue when modeling financial exposure or rate-setting.

Across the listed Medicaid codes the provider’s statewide rankings are frequently in the high percentiles (many codes in the 96–100th percentile), which collectively portray the organization as a high-volume service provider across multiple procedure areas even when paid amounts are not recorded. That pattern — high claim counts paired with $0 paid/claim for many dental and testing codes — is a distinctive statewide footprint that merits verification if a payer needs to reconcile service volumes with payment flows.

Medicaid: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1015	Clinic visit/encounter, all-inclusive	95,940	$150	$14.2M
D0120	Periodic oral evaluation - established patient	20,320	$0	$0
D0140	Limited oral evaluation – problem focused	6,750	$0	$0
D0145	N/A	50	$0	$0
D0150	Comprehensive oral evaluation – new or established patient	7,630	$0	$0
D0210	Intraoral - complete series of radiographic images	7,020	$0	$0
D0220	Intraoral - periapical first radiographic image	10,920	$0	$0
D0230	Intraoral - periapical each additional radiographic image	1,330	$0	$0
D0272	N/A	110	$0	$0
D0274	N/A	16,380	$0	$0

Showing 1–10 of 28

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

Blackstone Valley Community Health Care — 1 of 1 code 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

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1015	Clinic visit/encounter, all-inclusive	3	120	400	$130	$896.9K
D7210	Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth, and including elevation; includes related cutting of gingiva and bone, removal of tooth structure, minor smoothing of…	26	30	350	$110	$158.2K
D1120	Prophylaxis–child	19	160	710	$30	$91.2K
D1206	Topical Fluoride Treatment – Except Varnish; Therapeutic application for moderate to high caries risk patients	8	150	800	$30	$81.3K
D7140	Extraction, erupted tooth or exposed root (elevation and/or forceps removal)	4	100	510	$50	$65.4K
D2392	Post 2 surface resin‑based composite	6	110	240	$60	$47.6K
D1110	Prophylaxis - adult; cleaning and polishing of the teeth	2	180	490	$20	$42.3K
D1351	Sealant - per tooth	21	90	670	$20	$41.4K
D0120	Periodic oral evaluation - established patient	4	210	930	$10	$38.1K
D0330	N/A	58	100	400	$40	$30.7K

Showing 1–10 of 28

Related Providers

Other providers that share a Tax Identification Number (TIN) with Blackstone Valley Community Health Care, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Blackstone Valley Community Health Care, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$12.4M
Beata Nelken	RI	Pediatrics Physician	$0	$4.2M
John Kiang	RI	Pediatric Dentistry	$0	$1.3M
Libertad Flores	RI	Obstetrics & Gynecology Physician	$0	$1.1M
Milton Liu	RI	Dentist	$0	$944.5K
Ursulina Bencosme	RI	Pediatrics Physician	$0	$912.6K
Anne Barylick	RI	Family Nurse Practitioner	$0	$878.6K
Steven Young	RI	Oral and Maxillofacial Surgery (Dentist)	$0	$733.9K
Cesar Mora Jaramillo	RI	Adult Medicine Physician	$0	$685.3K
Shirley Mengalle Dione	RI	Obstetrics & Gynecology Physician	$1.4K	$679.5K

Nearby Providers

Other providers in the same ZIP code as Blackstone Valley Community Health Care, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gateway Healthcare Inc	RI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$122.7M
Nursing Placement, Inc.	RI	Home Health Agency	$0	$63.4M
United Cerebral Palsy Of Rhode Island, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$21.3M
Lifetime Financial Management Inc.	RI	Home Health Agency	$0	$20.9M
Addiction Recovery Institute	RI	Community/Behavioral Health Agency	$180.1K	$15.4M
United Cerebral Palsy Of Rhode Island, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$9.6M
Dr. Day Care, Inc.	RI	Counselor	$0	$8.7M
Sheila Brijade	RI	Pediatric Dentistry	$0	$7.7M
Staff Solutions, Inc.	RI	Home Health Agency	$0	$6.4M
Resources For Human Development Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$6.2M

Blackstone Valley Community Health Care — Billing Profile & Reimbursement Data

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Blackstone Valley Community Health Care — 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