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.

Prospect Chartercare Rwmc, LLC (NPI 1285059287)

Prospect Chartercare Rwmc, LLC is a internal medicine physician provider located in Providence, Rhode Island. This profile covers 0 Medicare and 101 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Prospect Chartercare Rwmc, LLC
Address	825 Chalkstone Ave
City	Providence
State	RI
ZIP	02908
Taxonomy	Internal Medicine Physician
NPI Enumerated	February 27, 2014

Payer Source	Total Paid
Medicaid	$2.4M
Medicare	$0

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

101 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	1,970	$250	$495.2K
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…	4,530	$50	$235.8K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	670	$270	$176.2K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	1,920	$90	$168.6K
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…	6,680	$20	$133.6K
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…	1,480	$90	$129.8K
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…	2,530	$40	$109K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	860	$80	$65.5K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	860	$70	$63.6K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	380	$160	$61.2K

Showing 1–10 of 101

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

Prospect Chartercare Rwmc, LLC — 3 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

101 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	11	30	260	$60	$3.4M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	21	50	330	$50	$2.7M
96413	Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These…	8	10	360	$430	$1.1M
96375	Following the administration of a drug or other substance via intravenous, or IV, push, the provider sequentially infuses a different medication or medications, also via IV push. He administers the…	11	20	840	$210	$789.2K
J2405	Injection, ondansetron hydrochloride, per 1 mg	11	20	1,080	$180	$470.2K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	7	20	310	$210	$394.7K
96374	The provider administers a single medication or other substance rapidly into a vein to treat, prevent, or diagnose a condition.	15	20	280	$150	$330.2K
84484	The lab analyst performs the technical lab test typically using serum, plasma, or whole blood to quantitate troponin. Troponin is a protein labs commonly measure to verify a myocardial infarction and…	12	20	1,500	$110	$327.5K
J3010	Injection, fentanyl citrate, 0.1 mg	8	10	490	$260	$310.4K
J1644	Injection, heparin sodium, per 1000 units	6	10	770	$270	$307.9K

Showing 1–10 of 101

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prospect Chartercare Rwmc, LLC	RI	General Acute Care Hospital	$0	$57.1M
Roger Williams Medical Center	RI	Surgical Oncology Physician	$0	$5.4M
Thomas Defanti	CT	Addiction Medicine (Psychiatry & Neurology) Physician	$0	$3.6M
Sajid Siddiq	RI	Cardiovascular Disease Physician	$300.6K	$19.3K
Joseph Mazza	RI	Cardiovascular Disease Physician	$268.7K	$15.2K
Florian Koci	RI	Cardiovascular Disease Physician	$268.6K	$4.4K
Anila Peter-faherty	RI	Cardiovascular Disease Physician	$233K	$10.9K
Neal Kelley	RI	Cardiovascular Disease Physician	$173.2K	$32K
Rodrigo Nardi	RI	Psychiatry Physician	$173.5K	$31.1K
Ali Akhtar	RI	Internal Medicine Physician	$61.5K	$134.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
A Caring Experience Nursing Services, Inc.	RI	Home Health Agency	$0	$78.5M
Caregiver Homes Of Rhode Island Inc.	RI	Case Management Agency	$0	$43.4M
John Ricci	RI	Dentist	$0	$4.3M
Meals On Wheels Of Ri, Inc.	RI	Case Manager/Care Coordinator	$0	$4.1M
Professional Ambulance LLC	RI	Ambulance	$1.7M	$1.4M
University Pathologists, LLC	RI	Anatomic Pathology Physician	$0	$2.9M
Antonio Barajas	RI	Emergency Medical Services (Emergency Medicine) Physician	$0	$2.1M
Nakitta Noel	RI	Emergency Medicine Physician	$32.3K	$1.5M
Beth Toolan	RI	Pediatrics Physician	$0	$1.3M
Altug Koymen	RI	Obstetrics & Gynecology Physician	$0	$1.2M

Prospect Chartercare Rwmc, LLC — Billing Profile & Reimbursement Data

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Prospect Chartercare Rwmc, LLC — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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