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NPI 1376614966 · Providence, RI · Gastroenterology Physician
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Philip Mcandrew is a gastroenterology physician provider located in Providence, Rhode Island. This profile covers 17 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 | Philip Mcandrew |
| Address | 148 W River St |
| City | Providence |
| State | RI |
| ZIP | 02904 |
| Taxonomy | Gastroenterology Physician |
| NPI Enumerated | November 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $326.9K |
| Medicaid | $231.8K |
This provider bills materially to both Medicare and Medicaid, with $326.9K in lifetime Medicare revenue and $231.8K in lifetime Medicaid revenue; Medicare is the larger single payer but Medicaid also represents a substantial share of the practice’s reimbursement base. The split indicates the practice is not single‑payer dependent and maintains a mixed commercial footprint across government payers.
Medicare billing is highly concentrated in a small set of infusion drugs: the top three Medicare codes (J3380, J1745, J1439) account for 80.7% of Medicare revenue. J3380 alone is $193.8K (59.7% of Medicare revenue) and ranks #194 of 620 providers nationally (68th percentile; typical, unremarkable volume for this code), while J1745 is $46.5K (14.3%) and J1439 is $21.8K (6.7%), signaling a business model that depends heavily on in‑office biologic and injectable therapies.
Medicaid revenue shows a different top‑code mix with endoscopic procedures and a biosimilar driving the bulk of reimbursement: the top three Medicaid codes (45380, 43239, Q5121) account for 86.5% of Medicaid revenue. 45380 is $76.8K (33.1%) and 43239 is $63.9K (27.6%), while Q5121 (biosimilar infliximab, avsola) is $59.9K (25.8%) and is reported as #1 of 1 providers in‑state (no state peer comparison available), indicating a Medicaid revenue base dominated by procedural endoscopy plus high‑value infusion drugs.
The code mix across payers (J3380, J1745, Q5121, 45380, 43239) points to a gastroenterology practice that combines endoscopy/diagnostic and therapeutic procedures with onsite infusion services. Presence of infusion/chemotherapy administration codes such as 96413 (Medicare $4.8K, 1.5% of Medicare revenue; Medicaid $9.9K, 4.3% of Medicaid revenue) and 96365 (Medicare $3.8K, 1.2%) supports the conclusion that the site operates infusion capability for biologics and occasional chemotherapy/infusion therapies.
Competitive standing is mixed by market: for its largest Medicare code J3380 the provider is a typical, unremarkable national participant (rank #194 of 620, 68th percentile), while some procedural codes show relatively strong national placement — for example Medicare 45380 is $14.1K (4.4% of Medicare revenue) and ranks #2579 of 16427 nationally (84th percentile; typical, unremarkable volume for this code). At the state level the provider’s Medicaid endoscopy volumes are competitive: Medicaid 43239 ranks #8 of 37 in‑state (81st percentile) and 45380 ranks #6 of 15 in‑state (64th percentile), indicating above‑average in‑state upper endoscopy and colonoscopy biopsy activity.
There are service concentration implications for operations and contracting: Medicare revenue is heavily weighted to a single biologic (J3380 is 59.7% of Medicare revenue) and Medicaid revenue is concentrated across two procedure codes plus one high‑value biosimilar (the top three Medicaid codes equal 86.5% of Medicaid revenue). This concentration suggests the provider’s financial performance is sensitive to utilization or reimbursement changes affecting a small number of drug and procedure codes, and that payers or contract negotiators should pay attention to the negotiated rates and utilization patterns for those specific items.
The provider has long tenure in the billing system, with an NPI enumerated on 2006-11-13 (~20 years ago), which supports interpretation of these patterns as established practice behavior rather than a short‑term anomaly. Historical presence combined with the recurring mix of infusion and endoscopy services suggests stable practice lines rather than a new or transient clinical focus.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J3380 | Injection, vedolizumab, intravenous, 1 mg | 11,400 | $20 | $193.8K |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 1,790 | $30 | $46.5K |
| J1439 | Injection, ferric carboxymaltose, 1 mg | 21,750 | $1 | $21.8K |
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 120 | $110 | $14.1K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 60 | $210 | $12.4K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 100 | $50 | $5.3K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 30 | $180 | $4.9K |
| 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… | 50 | $110 | $4.8K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 40 | $110 | $4.6K |
| 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 | $4.1K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J3380 | 1 | 10 | 8,700 | $20 | $152.8K |
| J1745 | 3 | 10 | 1,850 | $30 | $65K |
| 45385 | 30 | 60 | 60 | $310 | $27.9K |
| 45380 | 10 | 60 | 60 | $210 | $17.9K |
| J1439 | 1 | 10 | 18,000 | $1 | $15.1K |
| 43239 | 18 | 60 | 60 | $130 | $12.3K |
| 99214 | 1,542 | 1,950 | 100 | $80 | $11.7K |
| G0105 | 19 | 40 | 20 | $300 | $10.8K |
| 96413 | 7 | 10 | 50 | $110 | $8.6K |
| G0121 | 7 | 20 | 20 | $310 | $8.4K |
Showing 1–10 of 17
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 |
|---|---|---|---|---|
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 300 | $260 | $76.8K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 440 | $150 | $63.9K |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | 40 | $1,390 | $59.9K |
| 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… | 120 | $90 | $9.9K |
| 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… | 110 | $60 | $6.4K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 60 | $90 | $5.1K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 20 | $310 | $4.6K |
| 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 | $50 | $2.7K |
| 99204 | The provider sees a new 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 provider… | 20 | $100 | $1.7K |
| 96415 | In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the… | 40 | $20 | $800 |
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 |
|---|---|---|---|---|---|---|
| 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… | 9 | 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… | 16 | 20 | 840 | $210 | $789.2K |
| 96415 | In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the… | 5 | 10 | 210 | $270 | $257.8K |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 22 | 20 | 120 | $220 | $244.1K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 59 | 70 | 360 | $90 | $154.9K |
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 6 | 20 | 110 | $460 | $140.3K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 8 | 40 | 70 | $300 | $116.1K |
| 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… | 1,089 | 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… | 1,564 | 2,050 | 300 | $50 | $72.3K |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | 1 | 10 | 40 | $1,390 | $59.9K |
Showing 1–10 of 12
Other providers in the same ZIP code as Philip Mcandrew, ranked by combined Medicare and Medicaid revenue.
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