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.

University Gastroenterology, LLC (NPI 1386952612)

University Gastroenterology, LLC is a gastroenterology physician provider located in Providence, Rhode Island. This profile covers 0 Medicare and 20 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	University Gastroenterology, LLC
Address	33 Staniford St
City	Providence
State	RI
ZIP	02905
Taxonomy	Gastroenterology Physician
NPI Enumerated	September 21, 2010

Payer Source	Total Paid
Medicaid	$2.8M
Medicare	$0

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	7,220	$150	$1.1M
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.	3,960	$120	$462.9K
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…	7,260	$50	$384.7K
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…	1,040	$190	$193.8K
88342	The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,…	3,310	$50	$178.7K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	550	$280	$151.5K
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…	730	$100	$75.5K
99152	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, in a patient five years of age or…	1,070	$50	$50.5K
88312	The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets…	940	$50	$47.1K
00731	The anesthesia provider performs anesthesia services for an unspecified type of upper gastrointestinal endoscopic procedure during which another provider introduces the endoscope to but not beyond…	100	$340	$33K

Showing 1–10 of 20

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

University Gastroenterology, LLC — 9 of 19 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

20 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…	12	10	360	$430	$1.1M
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…	3	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…	2	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.	1	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…	43	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…	1,117	2,050	300	$50	$72.3K
88342	The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,…	2	20	40	$60	$46.4K
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…	1	10	150	$370	$44.4K
45378	The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush…	1	10	70	$340	$40.7K
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…	33	300	50	$130	$40.6K

Showing 1–10 of 20

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Robert Najarian	MA	Anatomic Pathology Physician	$520.7K	$878.6K
Philip Mcandrew	RI	Gastroenterology Physician	$326.9K	$231.8K
Jason Ferreira	RI	Gastroenterology Physician	$261.5K	$246.5K
Aamir Ahmad	MA	Diagnostic Radiology Physician	$342.4K	$33.1K
David Rowe	RI	Diagnostic Radiology Physician	$150.4K	$211.6K
Jeffrey Nadelson	RI	Gastroenterology Physician	$243.9K	$4.6K
Jeffrey Silverstein	RI	Diagnostic Radiology Physician	$239.7K	$0
Luciano De Lima Villarinho	MO	Vascular & Interventional Radiology Physician	$150.5K	$57.1K
Roshan Arjal	RI	Diagnostic Radiology Physician	$178K	$290
Mary Fortuna-silva	RI	Family Nurse Practitioner	$59.6K	$90.9K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Women & Infants Hospital Of Rhode Island	RI	General Acute Care Hospital	$0	$132.1M
Elmwood Home Care, Inc.	RI	Home Health Agency	$0	$38.6M
H&t Medicals, Inc	RI	Home Health Agency	$0	$14.8M
R.i.s.a.t., LLC	RI	Methadone Clinic	$321.1K	$14M
Meeting Street Center	RI	Early Intervention Provider Agency	$0	$13.8M
The Providence Community Health Centers, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$13.4M
Rhode Island Hospital	RI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$13.2M
Women And Infants Hospital	RI	General Acute Care Hospital	$0	$12.6M
The Providence Community Health Centers, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$8.3M
Renaissance Adhc, LLC	RI	Adult Day Care Clinic/Center	$0	$7.4M

University Gastroenterology, 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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