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NPI 1255694451 · Lincoln, RI · Internal Medicine Physician
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Mohammad Suhail is a internal medicine physician provider located in Lincoln, Rhode Island. This profile covers 14 Medicare and 12 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 | Individual |
| Organization | Mohammad Suhail |
| Address | 132 Old River Rd. |
| City | Lincoln |
| State | RI |
| ZIP | 02865 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | June 21, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $16M |
| Medicare | $126.3K |
This provider’s billing is overwhelmingly Medicaid-weighted: reported Medicaid revenue ($16M) dwarfs Medicare revenue ($126.3K), indicating the practice operates at scale on the Medicaid side and is effectively Medicaid-dominated rather than balanced across the two payers. Analysts should treat Medicare activity as a small complement to a Medicaid-centric business model when evaluating payer negotiation leverage or network value.
Medicaid revenue is extremely concentrated in hospice long-term care billing: the precomputed top 3 Medicaid codes account for 99.7% of this provider's total Medicaid revenue, and T2046 alone generated $15.9M (99.3% of Medicaid revenue) from 5.3K claims at an average paid/claim of $3012. This single-code concentration suggests the organization’s Medicaid revenue stream depends predominantly on per-diem hospice long-term care services.
The provider’s Medicare revenue is also concentrated but to a lesser degree: the precomputed top 3 Medicare codes account for 52.8% of total Medicare revenue, driven primarily by 99233 ($26.6K, 21.1%), 99306 ($24.8K, 19.7%), and 99305 ($15.3K, 12.1%). These codes indicate significant activity in facility-based evaluation & management services including subsequent inpatient visits and initial nursing facility visits rather than high-volume office-based outpatient care.
Service-line mix points to an institutional, facility-focused operation: the Medicaid-dominant T2046 hospice per-diem billing plus repeated nursing facility and inpatient E/M codes (99306, 99305, 99233, 99239, 99232) on both payers indicates the provider primarily delivers care in long-term care, hospice, and inpatient settings. Payer-specific averages and claim counts (for example, T2046 at $3012 avg/claim and 5.3K claims; Medicare 99233 at 286 claims, $93 avg/claim) reinforce that payments are driven by institutional encounters and per-diem arrangements rather than routine outpatient office visits.
On Medicare the provider shows above-average national volume for its top codes but remains a modest national participant: 99233 ranks #21055 of 128818 (84th percentile), 99306 ranks #1976 of 12836 (85th percentile), and 99305 ranks #1661 of 10126 (83rd percentile), each labeled in the source as "typical, unremarkable volume." Those percentiles indicate the provider bills these services more than many peers nationally, but the accompanying characterizations suggest the provider is not an extreme outlier or dominant national player in these codes.
State-level competitive standing on Medicaid is stronger and concentrated: for the dominant hospice code T2046 the provider ranks #4 of 25 in-state (88th percentile), which positions it as one of the larger in-state billers for hospice long-term care. Other Medicaid facility codes (for example, 99233 at rank #16 of 98, 85th percentile) also show above-typical in-state volumes, supporting the view that the provider is a meaningful regional player in facility-based services.
Operational throughput is high for the dominant Medicaid line and modest for Medicare facility visits: 5.3K T2046 claims drove the $15.9M Medicaid hospice line, while the leading Medicare code 99233 accounted for 286 Medicare claims and $26.6K in revenue. This split — very large per-diem claim volume on Medicaid versus limited claim counts and revenue on Medicare — signals an operational emphasis on sustaining long-duration, high-count hospice census rather than scaling fee-for-service Medicare outpatient visits.
The provider has an established billing history in the public data: NPI enumerated 2012-06-21 (~14 years ago) and is categorized as an Internal Medicine Physician, which supports a long-tenured presence and consistent specialty alignment with the facility-based E/M and hospice services reflected in the claims. Analysts should consider that the observed concentration and code mix are likely stable patterns rather than transient start-up behavior given this tenure.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 290 | $90 | $26.6K |
| 99306 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves high medical decision making, and/or the provider spends at least… | 170 | $150 | $24.8K |
| 99305 | The provider sees a patient for an initial nursing facility care visit involving evaluation and management (E/M). The visit involves moderate medical decision making or the provider spends at least… | 140 | $110 | $15.3K |
| 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… | 120 | $90 | $10.5K |
| 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… | 90 | $100 | $8.6K |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 60 | $130 | $8.1K |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 60 | $140 | $8.1K |
| 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… | 110 | $60 | $6.8K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 70 | $90 | $5.9K |
| 99308 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a low level of medical decision making and/or the provider… | 60 | $60 | $3.8K |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
14 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 99309 | 1,634 | 120 | 160 | $70 | $21.6K |
| 99214 | 16,034 | 1,950 | 100 | $80 | $11.7K |
| 99306 | 191 | 60 | 50 | $140 | $11.5K |
| 99308 | 1,843 | 110 | 70 | $50 | $10.7K |
| 99233 | 1,263 | 470 | 60 | $90 | $9.1K |
| G0439 | 2,787 | 450 | 60 | $100 | $7.7K |
| 99232 | 4,759 | 650 | 70 | $60 | $7.7K |
| 99213 | 20,885 | 1,950 | 70 | $60 | $7.4K |
| 99305 | 239 | 40 | 40 | $100 | $6.7K |
| 99223 | 2,683 | 540 | 30 | $130 | $6.4K |
Showing 1–10 of 14
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.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| T2046 | Hospice long term care, room and board only; per diem | 5,270 | $3,010 | $15.9M |
| 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… | 910 | $50 | $47.5K |
| 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… | 360 | $70 | $24.6K |
| 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. | 190 | $120 | $22.6K |
| 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… | 210 | $40 | $9.2K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 100 | $40 | $4.2K |
| 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… | 60 | $70 | $3.8K |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 170 | $10 | $2.4K |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 10 | $120 | $1.5K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 30 | $40 | $1.3K |
Showing 1–10 of 12
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
12 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T2046 | Hospice long term care, room and board only; per diem | 4 | 30 | 330 | $1,280 | $6.5M |
| 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… | 53 | 100 | 70 | $40 | $129K |
| 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. | 112 | 240 | 150 | $80 | $91.9K |
| 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… | 206 | 290 | 100 | $30 | $88K |
| 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… | 1,555 | 2,050 | 300 | $50 | $72.3K |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient | 27 | 60 | 90 | $50 | $59.2K |
| 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… | 16 | 100 | 70 | $50 | $42.2K |
| 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… | 55 | 170 | 80 | $40 | $40.3K |
| 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… | 13 | 70 | 50 | $80 | $39.8K |
| 99309 | The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or the provider… | 31 | 50 | 170 | $10 | $38.1K |
Showing 1–10 of 12
Other providers in the same ZIP code as Mohammad Suhail, ranked by combined Medicare and Medicaid revenue.
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