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 Ent Center Of Rhode Island LLC (NPI 1295906956)

Field	Value
Entity Type	Organization
Organization	The Ent Center Of Rhode Island LLC
Address	55 Lambert Lind Hwy
City	Warwick
State	RI
ZIP	02886
Taxonomy	Ambulatory Surgical Clinic/Center
NPI Enumerated	March 20, 2008

Payer Source	Total Paid
Medicare	$384.6K
Medicaid	$0

Key Findings

THE ENT CENTER OF RHODE ISLAND LLC is an ambulatory surgical clinic/center enumerated on 2008-03-20 (~18 years ago) with lifetime Medicare revenue of $384.6K and no Medicaid billing on file. The NPI tenure and specialty taxonomy align with a small, established outpatient surgical practice focused on procedural care for older patients.

The provider’s Medicare claims mix is dominated by ophthalmic surgery: 66984 (cataract extraction with IOL insertion) is by far the single largest line, and the next two top codes, 67042 and 67108, are complex vitreoretinal procedures. This code mix indicates the clinic operates primarily as an ophthalmic surgical center performing both routine cataract surgery and higher-complexity retina work.

Revenue concentration is high: the top 3 Medicare codes by revenue account for 77.5% of the provider’s total Medicare revenue. In isolation those three codes are 66984: $229.3K revenue (59.6% of Medicare revenue), 67042: $35.9K revenue (9.3%), and 67108: $32.9K revenue (8.6%), which shows a heavy dependence on a small set of surgical services for overall topline.

This provider is effectively single-payer in the claims record — Medicare $384.6K versus no Medicaid billing on file — signaling a patient population and revenue base concentrated in Medicare beneficiaries and limited exposure to Medicaid. Analysts should treat reimbursement shifts or utilization changes in Medicare as the primary financial risk, since there is no recorded Medicaid revenue to offset Medicare fluctuations.

Competitive standing on key procedures is modest and within typical national volumes rather than indicating a high-volume specialty center. For 66984 the provider ranks #4424 of 15965 providers nationally (72th percentile; typical, unremarkable volume for this code), for 67042 it ranks #434 of 1087 (57th percentile; typical, unremarkable volume), and for 67108 it ranks #207 of 706 (68th percentile; typical, unremarkable volume); these placements suggest routine, not dominant, market presence for these CPTs.

Payment-per-claim profiles reflect case complexity: 66984 reports $872 avg paid/claim across 263 claims, while retina procedures 67042 and 67108 report higher avg paid/claim of $1561 and $1566 respectively (23 and 21 claims). The higher per-claim payments for retina codes correspond with more complex, resource-intensive procedures and explain their outsized contribution to revenue despite lower claim volumes.

The practice shows additional, lower-revenue procedure breadth that complements its ophthalmology focus: 66982 ($29K, 34 claims, 7.5% of Medicare revenue), 67036 ($25.1K, 16 claims, 6.5%), 67961 ($12K, 18 claims, 3.1%), 67311 ($11.3K, 22 claims, 2.9%), and 69436 ($9.2K, 24 claims, 2.4%) all rank within typical national percentiles and are described as typical, unremarkable volume for those codes. This mix points to a core cataract/retina surgical practice with supplementary oculoplastic/strabismus and occasional ENT procedure work, but no evidence of outlier concentration in any secondary line.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
66984	The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…	260	$870	$229.3K
67042	In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…	20	$1,560	$35.9K
67108	The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or…	20	$1,570	$32.9K
66982	The provider inserts an intraocular lens prosthesis after extracapsular cataract extraction using complex techniques and devices. He may perform this by means of an iris expansion device, providing…	30	$850	$29K
67036	The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana.	20	$1,570	$25.1K
67961	The provider excises damaged or diseased tissue of the eyelid that may include the edges of the lid, the lid’s inner plate, the membrane lining of the lid, or the corner where the lids come together.…	20	$670	$12K
67311	The provider realigns an imbalance in the eye muscles by either recession, which weakens the eye muscle or resection, which strengthens the muscles so as to restore normal vision. This procedure is…	20	$510	$11.3K
69436	This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia.	20	$380	$9.2K

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Rhode Island Distribution

The Ent Center Of Rhode Island LLC — 0 of 8 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. state median

8 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
66984	22	40	370	$80	$71.1K
67042	1	10	20	$1,560	$35.9K
67108	1	10	20	$1,570	$32.9K
66982	5	10	30	$410	$25.2K
67036	1	10	20	$1,570	$25.1K
67961	1	10	20	$670	$12K
69436	1	10	20	$380	$9.2K
67311	1	10	20	$500	$8.9K

Nearby Providers

Other providers in the same ZIP code as The Ent Center Of Rhode Island LLC, ranked by combined Medicare and Medicaid revenue.

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
Affinity Physicians LLC.	RI	Internal Medicine Physician	$0	$41.8M
J, Arthur Trudeau Memorial Center	RI	Developmentally Disabled Services Day Training Agency	$0	$33.9M

The Ent Center Of Rhode Island LLC — Billing Profile & Reimbursement Data

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The Ent Center Of Rhode Island LLC — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References