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.

Affinity Physicians LLC. (NPI 1184944662)

Key Findings

Field	Value
Entity Type	Organization
Organization	Affinity Physicians LLC.
Address	455 Toll Gate Rd
City	Warwick
State	RI
ZIP	02886
Taxonomy	Internal Medicine Physician
NPI Enumerated	June 7, 2010

Payer Source	Total Paid
Medicaid	$41.8M
Medicare	$0

This provider is effectively a single‑payer Medicaid operation: there is no Medicare billing on file and lifetime Medicaid revenue is $41.8M. The lack of Medicare activity combined with substantial Medicaid volume indicates the organization’s patient mix and revenue base are concentrated in state Medicaid reimbursement rather than federal Medicare programs.

Revenue is highly concentrated in a very small set of Medicaid codes: the precomputed top 3 Medicaid codes account for 54.6% of total Medicaid revenue. The single largest code is 99479 with $13.5M (33.8% of Medicaid revenue), followed by 99214 at $4.4M (11.1%) and 99213 at $3.9M (9.7%), indicating that a handful of services drive the majority of receipts.

The presence of 99479 ($13.5M) together with 99460 ($133.6K) and multiple obstetric ultrasound codes (76816 $526.7K, 76818 $508K, 76811 $354.6K, 76815 $156.6K) and 01967 ($648.4K) points to a significant perinatal and newborn care line of business. Those codes suggest the provider directs care for low birth weight infants and performs routine postnatal and obstetric imaging and anesthesia services, implying either a clinical focus on maternal‑fetal/newborn services or contractual arrangements with birthing centers and hospitals.

High volumes of outpatient E/M codes (99214 $4.4M, 99213 $3.9M, 99215 $365.8K, 99204 $192.3K) indicate a large ambulatory primary care or chronic‑care management footprint. The very large claim counts for 99214 (68.2K claims) and 99213 (76.4K claims) are consistent with heavy established‑patient clinic throughput and substantial time‑based or complexity‑based office visit work.

Substantial inpatient and emergency activity is visible: 99232 ($3M), 99233 ($1.1M), 99222 ($953.2K), 99239 ($1.3M), 99238 ($211.2K) and ED codes 99284 ($2.4M), 99285 ($2.2M), 99283 ($875.4K) are all material contributors. The mix of high‑level subsequent and initial hospital care codes and moderate to high ED E/M codes suggests the provider operates across hospital inpatient, observation, and emergency settings or has staffing arrangements that cover acute care.

Behavioral health services make a measurable contribution: 90792 ($2.2M), 90791 ($151K), 90847 ($212.6K) and add‑on psychotherapy 90833 ($179.6K) together reflect embedded psychiatric evaluation and psychotherapy activity. The prominence of 90792 (17.1K claims, ranks #1 of 158 in‑state and labeled an extreme outlier) indicates psychiatric evaluation services are an established and high‑volume component of the practice mix.

Competitive standing in‑state is strong and sometimes dominant for many high‑revenue codes: multiple codes rank #1 in the state at the 100th percentile (for example 99479 is #1 of 4, 99214 is #1 of 1731, 99232 is #1 of 167, and 99233 is #1 of 98), and many other codes are described as "extreme outlier, far above typical state volume" or near the top percentiles. This combination of #1 rankings and extreme outlier labels signals the provider is a major statewide performer for several inpatient, neonatal, and E/M services rather than a modest participant.

The provider has been NPI‑enumerated since 2010‑06‑07 (~16 years ago), indicating an established operational tenure. Combined with the concentrated Medicaid revenue base and the specialized service mix above, this longevity suggests an entrenched business model that is heavily oriented to Medicaid populations and to the specific clinical services identified above.

Medicaid: Complete Services Breakdown

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

132 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	31,250	$430	$13.5M
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…	68,160	$70	$4.4M
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…	76,350	$50	$3.9M
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	84,360	$40	$3M
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.	24,450	$100	$2.4M
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…	17,110	$130	$2.2M
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.	17,540	$120	$2.2M
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	15,680	$80	$1.3M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	19,560	$60	$1.1M
99222	The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	9,730	$100	$953.2K

Showing 1–10 of 132

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

Affinity Physicians LLC. — 21 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

132 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99479	The provider directs the care of a recovering low birth weight infant, whose current weight is between 1500 and 2500 grams.	1	10	830	$430	$3.6M
01967	The provider performs neuraxial anesthesia services for a patient undergoing a planned vaginal delivery.	3	10	1,040	$560	$1M
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.	4	280	290	$260	$296.3K
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.	4	340	370	$200	$272.8K
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	2	20	90	$150	$257.5K
T1016	Case management, each 15 minutes	176	180	400	$20	$230.7K
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.	4	290	180	$170	$224.1K
76811	The provider performs an ultrasound study using a transabdominal approach to examine the fetus and mother, along with additional examination of the fetal anatomy, such as the heart rate, amniotic…	2	10	160	$150	$160.5K
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	65	70	150	$250	$147K
01961	The provider performs anesthesia services for a cesarean delivery.	3	10	50	$400	$125.4K

Showing 1–10 of 132

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Zobeida Diaz	RI	Psychiatry Physician	$0	$4M
Richard Lim	RI	Internal Medicine Physician	$52.2K	$3.4M
Chelsy Caren	RI	Obstetrics & Gynecology Physician	$0	$2.3M
Ralph Santoro	RI	Internal Medicine Physician	$66.2K	$2.1M
Matthew Sarasin	RI	Emergency Medicine Physician	$21.9K	$1.9M
Emily White	RI	Obstetrics & Gynecology Physician	$0	$1.6M
Eilean Attwood	RI	Obstetrics & Gynecology Physician	$0	$1.3M
Altug Koymen	RI	Obstetrics & Gynecology Physician	$0	$1.2M
John Jardine	RI	Emergency Medicine Physician	$23.9K	$1.2M
Heather Smith	RI	Obstetrics Physician	$0	$1.2M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Bay Residential Services Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$145.8M
Kent County Memorial Hospital	RI	General Acute Care Hospital	$0	$90.8M
Avatar Residential, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$72.9M
Thrive Behavioral Health, Inc.	RI	Community/Behavioral Health Agency	$0	$71.9M
Bayada Home Health Care, Inc.	RI	Home Health Agency	$0	$69.5M
Community Living Of Rhode Island	RI	Developmentally Disabled Services Day Training Agency	$0	$65.7M
J.arthur Trudeau Memorial Center Conversion Waivers	RI	Developmentally Disabled Services Day Training Agency	$0	$57.1M
Gateways To Change, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$54.5M
J, Arthur Trudeau Memorial Center	RI	Developmentally Disabled Services Day Training Agency	$0	$33.9M
J.arthur Trudeau Memorial Home Based Therapy Services	RI	Community/Behavioral Health Agency	$0	$20.3M

Affinity Physicians LLC. — Billing Profile & Reimbursement Data

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Affinity Physicians 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