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.

Women & Infants Hospital Of Rhode Island (NPI 1447233788)

Field	Value
Entity Type	Organization
Organization	Women & Infants Hospital Of Rhode Island
Address	101 Dudley St
City	Providence
State	RI
ZIP	02905
Taxonomy	General Acute Care Hospital
NPI Enumerated	November 21, 2005

Payer Source	Total Paid
Medicaid	$132.1M
Medicare	$0

Key Findings

WOMEN & INFANTS HOSPITAL OF RHODE ISLAND is effectively a single-payer Medicaid provider in the available data: there is no Medicare billing on file while total Medicaid revenue is $132.1M, indicating the facility’s outpatient, obstetric, gynecologic and lab-heavy business is being captured primarily through Medicaid payors. The absence of Medicare revenue suggests either limited Medicare-eligible services or billing relationships focused on Medicaid-covered populations.

Revenue concentration in Medicaid is moderately concentrated among a small set of high-volume codes: the precomputed top 3 Medicaid codes account for 26.4% of total Medicaid revenue, signaling that over one quarter of the provider’s Medicaid receipts derive from a few high-yield service lines. This concentration implies operational dependence on those lines and potential sensitivity to rate or policy changes affecting them.

The top-revenue CPT/HCPCS mix shows a clinical focus on women’s health, obstetrics, gynecology, and high-volume laboratory screening. High-ranking codes include 76818 (biophysical profile), 76816 (follow-up obstetric ultrasound), 76815 (limited fetal ultrasound), 77067 (mammography), 76830 (transvaginal ultrasound) and numerous lab codes (87491, 87591, 87624, 88175, 87389, 86803), which together point to integrated prenatal, obstetric imaging and large-scale sexual health and cytology laboratory operations. The presence of chemotherapy administration code 96413 and infusion-related code 96375 also indicates an active oncology/infusion service line in the outpatient setting.

WOMEN & INFANTS is a statewide leader on many Medicaid codes, frequently appearing in the 98th–100th percentiles for volume. For example, the provider ranks #1 in-state for 76818, 76815, 76816, 76830, 76856, 87624 and 88175 (100th percentile) and ranks #2 or #3 on additional lab and imaging codes. Multiple codes are labeled as "extreme outlier" or "notably above typical state volume," supporting characterization of the hospital as a dominant in-state provider for obstetric imaging and women’s health lab testing.

Several laboratory and screening codes are exceptionally high volume relative to peers and collectively represent substantial revenue: 87491 ($6.2M, ranks #3, 98th percentile, extreme outlier), 87591 ($4.4M, ranks #3, 98th percentile, extreme outlier), 88175 ($2.9M, ranks #1, 100th percentile, extreme outlier) and 87624 ($3.1M, ranks #1, 100th percentile, extreme outlier). This pattern indicates centralized lab capacity and a high throughput of STI, HPV, cytology and related infectious disease testing on Medicaid patients.

The provider also draws notable ED and observation revenue under Medicaid, with emergency codes 99284 ($7.9M, 97th percentile) and 99285 ($2.4M, 94th percentile) among top Medicaid earners, plus G0378 observation ($2.3M). These entries show that the hospital operates an active emergency/observation function that complements its obstetric and outpatient services and contributes meaningfully to total Medicaid revenue.

Clinical-service implications: the mix of high-volume obstetric ultrasounds (76818, 76815, 76816), fetal monitoring (59025) and gynecologic imaging (76856, 76830) together with large-scale screening labs and cytology suggests Women & Infants operates as a referral center for prenatal care, maternal–fetal surveillance and women's health screening for Medicaid populations. The presence of pathology code 88305 ($4.2M, ranks #2, 99th percentile, extreme outlier) also supports a significant surgical pathology and specimen-processing capability.

Tenure and market presence: the NPI was enumerated on 2005-11-21 (~21 years ago), indicating longstanding operation and established payer relationships in Rhode Island. Combined with consistent top-percentile ranks across many codes, the data imply entrenched referral patterns and scale advantages in obstetrics, gynecology, imaging and laboratory services within the state.

Medicaid: Complete Services Breakdown

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

338 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99284	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making.	9,480	$830	$7.9M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	46,280	$140	$6.2M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	45,550	$100	$4.4M
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…	24,080	$170	$4.2M
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…	7,880	$440	$3.4M
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	13,000	$250	$3.3M
87624	The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result.	31,890	$100	$3.1M
88175	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	45,660	$60	$2.9M
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.	16,820	$150	$2.6M
99285	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making.	2,530	$970	$2.4M

Showing 1–10 of 338

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

Women & Infants Hospital Of Rhode Island — 20 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

338 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9271	Injection, pembrolizumab, 1 mg	2	10	620	$6,290	$3.9M
G0378	Hospital observation service, per hour	6	10	1,220	$1,410	$2.9M
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.	3	50	330	$50	$2.7M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	5	10	220	$740	$2.6M
J1642	Injection, heparin sodium, (heparin lock flush), per 10 units	2	10	1,900	$240	$1.2M
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…	2	10	360	$430	$1.1M
96417	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 administration of a different chemotherapy…	2	10	2,830	$370	$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…	2	20	840	$210	$789.2K
J2469	Injection, palonosetron hcl, 25 mcg	2	10	2,490	$310	$777.6K
Q5117	Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg	1	10	180	$4,390	$777K

Showing 1–10 of 338

Related Providers

Other providers that share a Tax Identification Number (TIN) with Women & Infants Hospital Of Rhode Island, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Women And Infants Hospital	RI	General Acute Care Hospital	$0	$12.6M
Chelsy Caren	RI	Obstetrics & Gynecology Physician	$0	$2.3M
Emily White	RI	Obstetrics & Gynecology Physician	$0	$1.6M
Karim Khanbhai	RI	Pediatrics Physician	$0	$1.4M
Michael Sisitsky	RI	Obstetrics & Gynecology Physician	$0	$721.9K
Nicole Anderson	FL	Radiation Oncology Physician	$719.5K	$0
Tanya Booker	RI	Maternal & Fetal Medicine Physician	$0	$709.6K
Martin Keszler	RI	Neonatal-Perinatal Medicine Physician	$0	$704.1K
Carroll Medeiros	RI	Obstetrics & Gynecology Physician	$560	$604.5K
Amr Abdel Kader	RI	Obstetrics & Gynecology Physician	$3.1K	$599.6K

Nearby Providers

Other providers in the same ZIP code as Women & Infants Hospital Of Rhode Island, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
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
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
Catherine Allen	RI	Mental Health Counselor	$0	$7.4M
University Orthopedics, Inc.	RI	Orthopaedic Surgery Physician	$0	$5.3M

Women & Infants Hospital Of Rhode Island — Billing Profile & Reimbursement Data

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Women & Infants Hospital Of Rhode Island — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References