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.

The Providence Center Inc (NPI 1104847946)

Field	Value
Entity Type	Organization
Organization	The Providence Center Inc
Address	530 N Main St
City	Providence
State	RI
ZIP	02904
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	July 21, 2006

Payer Source	Total Paid
Medicaid	$170.9M
Medicare	$0

Key Findings

THE PROVIDENCE CENTER INC is effectively a Medicaid-focused provider with Total Medicaid revenue of $170.9M and no Medicare billing on file; the absence of Medicare activity indicates the organization operates almost entirely within the Medicaid market rather than across dual federal payers. Its NPI was enumerated 2006-07-21 (~20 years ago), signaling long tenure in the state market which is consistent with the large volumes reported.

Revenue is highly concentrated in three per-diem/community-service lines: H0037 accounts for $86.7M (50.8% of total Medicaid revenue), H0019 accounts for $29.4M (17.2%), and H0040 accounts for $27.2M (15.9%), and those top 3 codes together make up 83.9% of this provider's Medicaid revenue. This concentration implies the organization’s financial performance is tightly linked to inpatient/residential and intensive community treatment programs rather than a broad mix of low-dollar outpatient services.

The code mix and descriptions indicate a service model centered on residential and intensive community behavioral health: H0037 (Community psychiatric supportive treatment program, per diem), H0019 (long-term residential, without room and board, per diem), and H0040 (Assertive community treatment program, per diem) are the dominant revenue drivers. Those codes point to sustained stays and high-touch community outreach programs, suggesting sizable capacity for residential beds and multi-disciplinary ACT teams rather than a primarily office-based clinic.

THE PROVIDENCE CENTER ranks as a dominant state provider for several high-revenue Medicaid codes: H0037 ranks #1 of 69 providers in-state (100th percentile; extreme outlier) and H0019 ranks #2 of 25 providers in-state (96th percentile; extreme outlier). These standings characterize the organization as a major state-market player for residential and community psychiatric services, far above typical state volume for those services.

Operationally, the provider shows extremely high unit volumes in some low-paid, high-count services that carry administrative and delivery implications: H0036 records 431.4K claims at $3 avg paid/claim for $1.3M revenue and ranks #1 of 89 providers in-state (100th percentile; extreme outlier). This pattern of massive claim counts on low-dollar, per-15-minute codes suggests heavy use of minute-based billing structures that may require substantial scheduling, documentation, and workforce capacity to deliver numerous short-interval encounters.

Outpatient psychotherapy and evaluation services are also significant on a volume basis: 90834 has 88.2K claims for $5.8M revenue (3.4% of Medicaid revenue) and ranks #2 of 751 providers in-state (100th percentile; extreme outlier), while 99214 and 99213 together represent sizable office/E/M volumes (48.9K and 41K claims respectively). These figures show the organization operates both intensive residential/community programs and high-volume outpatient psychotherapy/E/M services, indicating a mixed model that spans crisis/residential care and routine therapeutic encounters.

Some specialty supports and social-determinant–focused services are notable: H0044 Supported housing ($704.8K; ranks #1 of 11 providers in-state, 100th percentile; notably above typical state volume) and H0038 Self-help/peer services ($694.8K; ranks #1 of 18 providers in-state, 100th percentile; extreme outlier) appear in the top code list, reflecting investment in housing supports and peer programming as part of the care continuum. These codes, together with supported employment H2023 and psychosocial rehabilitation H2018, reinforce that the provider’s portfolio includes non-clinical supports that extend beyond traditional outpatient therapy.

From a payer-mix and competitive perspective, this entity should be treated as a Medicaid market incumbent with specialized strengths in residential and assertive community treatment; the absence of Medicare revenue removes a potential diversification channel and concentrates market risk in state Medicaid policy and reimbursement. Analysts and contracting teams should consider the provider’s dominant state rankings and service concentration when assessing network adequacy, capacity for residential placements, and leverage in Medicaid-rate negotiations.

Medicaid: Complete Services Breakdown

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

43 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0037	Community psychiatric supportive treatment program, per diem	215,600	$400	$86.7M
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	224,270	$130	$29.4M
H0040	Assertive community treatment program, per diem	24,820	$1,100	$27.2M
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…	88,220	$70	$5.8M
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…	48,930	$80	$4.1M
H0010	Alcohol and/or drug services; sub‑acute detoxification (residential addiction program inpatient)	13,280	$250	$3.3M
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…	41,010	$50	$2.2M
S9485	Crisis intervention mental health services, per diem	4,510	$370	$1.7M
X0341	N/A	4,060	$330	$1.3M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	431,410	$1	$1.3M

Showing 1–10 of 43

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

The Providence Center Inc — 17 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

43 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	2	30	1,530	$360	$9.7M
H0040	Assertive community treatment program, per diem	3	20	350	$640	$6.3M
H0037	Community psychiatric supportive treatment program, per diem	1	70	190	$380	$3.2M
H0010	Alcohol and/or drug services; sub‑acute detoxification (residential addiction program inpatient)	1	10	6,920	$340	$2.3M
T1041	Medicaid certified community behavioral health clinic services, per month	11	10	1,080	$1,040	$1.5M
H2018	Psychosocial rehabilitation services, per diem	12	30	4,460	$60	$864.2K
H0043	Supported housing, per diem	3	10	130	$70	$635.4K
S9485	Crisis intervention mental health services, per diem	3	30	160	$350	$494.7K
X0341	N/A	1	10	270	$450	$439.4K
H2023	Supported employment, per 15 minutes	4	10	230	$80	$357.1K

Showing 1–10 of 43

Related Providers

Other providers that share a Tax Identification Number (TIN) with The Providence Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Providence Center	RI	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$11.9M
Linda Dewey	RI	Mental Health Counselor	$0	$1.2M
Sandrine Fujah	RI	Clinical Social Worker	$0	$602.2K
Reema Husain	RI	Psychiatry Physician	$11.7K	$449.6K
Omer Cermik	RI	Psychiatry Physician	$3.7K	$447.1K
Warren Ong	RI	Psychiatry Physician	$0	$434K
Anthony Parente	RI	Mental Health Counselor	$0	$380.7K
James Pinel	RI	Mental Health Counselor	$0	$373.4K
Grace Batista	RI	Clinical Social Worker	$10.1K	$190.8K
Anthony Hoyle	RI	Social Worker	$134.2K	$0

Nearby Providers

Other providers in the same ZIP code as The Providence Center Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Re-focus Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$102.5M
Hopehealth Hospice & Palliative Care	RI	Community Based Hospice Care Agency	$0	$33.3M
Mas Medical Staffing	RI	Home Health Agency	$0	$24.5M
Generations Adult Day Health Center	RI	Adult Day Care Clinic/Center	$0	$16.3M
Prospect Chartercare Sjhsri, LLC	RI	General Acute Care Hospital	$0	$10.9M
Global Homecare And Staffing Inc	RI	Home Health Agency	$0	$8.3M
Emergency Care Services Of New England PC	RI	Emergency Medicine Physician	$0	$6.9M
State Of Rhode Island	RI	Clinical Medical Laboratory	$570	$6.4M
The Providence Center	RI	Community/Behavioral Health Agency	$0	$5.9M
St. Joseph Health Services Of Ri	RI	General Acute Care Hospital	$0	$5.9M

The Providence Center Inc — Billing Profile & Reimbursement Data

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The Providence Center 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

Related Providers

Nearby Providers

Frequently Asked Questions

References