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.

Prima Inc (NPI 1285664524)

Prima Inc is a pediatrics physician provider located in Cumberland, Rhode Island. This profile covers 0 Medicare and 27 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	Prima Inc
Address	2178 Mendon Rd
City	Cumberland
State	RI
ZIP	02864
Taxonomy	Pediatrics Physician
NPI Enumerated	July 3, 2006

Payer Source	Total Paid
Medicaid	$1M
Medicare	$0

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

27 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	7,140	$60	$450K
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…	2,930	$90	$263.4K
92587	Code 92587 is in the Medicine/Special Otorhinolaryngologic Services Section. It involves special procedures of the ears/nose/throat. This code is for screening purposes with interpretation and…	1,080	$60	$60.7K
0241U	N/A	370	$120	$45.1K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	2,910	$20	$43.6K
97802	The provider treats medical conditions and related symptoms using specific diet therapy by interacting individually with the patient. This code represents each 15 minutes of the first visit with the…	1,840	$20	$34.9K
96110	The provider screens the patient for a developmental disorder using a standardized instrument (such as a recognized form) focused on areas such as developmental milestones and age–appropriate…	2,040	$10	$26.5K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	240	$90	$20.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	160	$100	$15.3K
90461	In this procedure, the provider administers an additional live attenuated vaccine either via a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age after the…	440	$30	$11.7K

Showing 1–10 of 27

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

Prima Inc — 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

27 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
0241U	N/A	7	20	80	$150	$83.7K
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…	113	1,730	220	$70	$75.2K
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…	50	2,050	300	$50	$72.3K
87651	The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat.	37	90	90	$60	$67.5K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	96	160	90	$110	$54.6K
87811	The lab analyst performs the technical lab test to analyze for the presence of severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) (Coronavirus disease [COVID–19]) in a specimen by…	21	30	90	$30	$53.7K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	77	190	160	$90	$39.1K
92587	Code 92587 is in the Medicine/Special Otorhinolaryngologic Services Section. It involves special procedures of the ears/nose/throat. This code is for screening purposes with interpretation and…	6	40	160	$60	$33.2K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	84	190	110	$90	$32K
97802	The provider treats medical conditions and related symptoms using specific diet therapy by interacting individually with the patient. This code represents each 15 minutes of the first visit with the…	2	30	110	$70	$31.7K

Showing 1–10 of 27

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ocean State Nursing Services, Inc	RI	Home Health Agency	$0	$21.7M
Michael Klufas	RI	Geriatric Medicine (Internal Medicine) Physician	$68.4K	$6.1M
Autumn Villa Inc.	RI	Assisted Living Facility	$0	$5.5M
Open Mri Of New England, Inc.	RI	Diagnostic Radiology Physician	$0	$2.1M
Pulmonary And Sleep Office Of New England, PC	RI	Pulmonary Disease Physician	$0	$1.9M
William Chan	RI	Pediatric Dentistry	$0	$1.4M
Cumberland Public Schools	RI	Local Education Agency (LEA)	$0	$1.4M
Lincare Inc.	RI	Durable Medical Equipment & Medical Supplies	$0	$1.4M
Denise Goodman	RI	Pediatric Dentistry	$0	$1.3M
Maria Younes	RI	Neurology with Special Qualifications in Child Neurology Physician	$4.7K	$843.6K

Prima Inc — Billing Profile & Reimbursement Data

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Prima Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Maria Starakiewicz	RI	Pediatrics Physician	$0	$749.3K
Pranati Jha	RI	Pediatrics Physician	$0	$563K