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 Miriam Hospital (NPI 1487649430)

Field	Value
Entity Type	Organization
Organization	The Miriam Hospital
Address	164 Summit Ave
City	Providence
State	RI
ZIP	02906
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 15, 2005

Payer Source	Total Paid
Medicaid	$138.6M
Medicare	$0

Key Findings

THE MIRIAM HOSPITAL is effectively a Medicaid-centric provider: there is no Medicare billing on file and total Medicaid revenue is $138.6M, so the facility operates with a single-payer footprint in this dataset. Its NPI was enumerated on 2005-09-15 (~21 years ago), indicating long-standing enrollment and an established presence in the state market.

Revenue is concentrated in a small set of Medicaid codes: the precomputed top 3 Medicaid codes by revenue account for 25.4% of the provider's total Medicaid revenue. Those top three codes are 99285 ($7.1M, 10.4%), 87491 ($5.1M, 7.5%), and G0378 ($5.1M, 7.4%), showing meaningful dependence on high-acuity ED visits, high-volume NAAT lab testing, and observation-hour billing.

The code mix reflects an acute-care, high-throughput emergency and observation operation: 99285 (11.7K claims, $610 avg paid/claim) and 99284 (14.3K claims, $289 avg paid/claim) are among top revenue drivers, and G0378 (4.9K claims, $1030 avg paid/claim) is a top-3 revenue contributor. These patterns indicate substantial ED throughput plus an active observation service line that together generate a material portion of Medicaid revenue.

THE MIRIAM HOSPITAL is a major statewide center for diagnostic laboratory testing: multiple high-volume lab codes show extreme outlier status and very high claim counts, for example 87491 (61K claims, $5.1M; ranks #2 of 133, 99th percentile, extreme outlier), 87591 (56.5K claims, $4.7M; ranks #2 of 127, 99th percentile, extreme outlier), and 85025 (117.6K claims, $4.4M; ranks #2 of 289, 100th percentile, extreme outlier). The breadth of panels and NAAT testing (including 87651, 87661, 80048, 80053, 80061) implies a centralized lab operation handling large volumes of routine and molecular diagnostics.

Competitive standing in-state is strong on many Medicaid codes: the provider ranks at or near the top for numerous services (multiple #1 and #2 ranks and many 99th–100th percentile placements). Examples include 87651 (ranks #1 of 94, 100th percentile), 87661 (ranks #1 of 36, 100th percentile), and 93306 (4.8K claims, $3.1M; ranks #2 of 72, 99th percentile), which together portray the hospital as a dominant or major participant in both lab and selected imaging/service lines across Rhode Island.

Cardiology and monitoring services are a visible secondary revenue stream: 93306 (echocardiography, $3.1M) and 93005 (ECG without interpretation, $2.3M) along with troponin testing 84484 (11.4K claims, $1.5M; ranks #1 of 16, 100th percentile) indicate capacity for both diagnostic cardiac imaging and associated biomarker testing. These code relationships suggest integrated ED-to-cardiology workflows for acute cardiac evaluation.

Observation and infusion-related codes further characterize inpatient/short-stay capability: G0378 is a top-3 revenue code ($5.1M) and J7030 (normal saline infusion 1000 cc, $1.5M; ranks #2 of 12, 91th percentile) plus 96361 (IV fluids for additional hours, $1.4M; ranks #2 of 14, 92th percentile) show repeatable revenue from observation/infusion services. Together these items support a business model that monetizes post-ED observation and IV therapies.

The provider’s concentration in Medicaid and in a relatively small set of high-volume codes (Top 3 = 25.4% of Medicaid revenue) creates a clear exposure profile: policy or payment changes affecting ED evaluation/management, observation hours, or high-volume lab reimbursement could disproportionately affect overall revenue. Conversely, the hospital’s strong statewide ranks and extreme-outlier lab volumes suggest it also has scale advantages for negotiating contracts or centralizing testing services within the state market.

Medicaid: Complete Services Breakdown

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

423 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	11,670	$610	$7.1M
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	61,050	$80	$5.1M
G0378	Hospital observation service, per hour	4,940	$1,030	$5.1M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	56,490	$80	$4.7M
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	117,620	$40	$4.4M
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.	14,300	$290	$4.1M
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.	41,510	$80	$3.2M
93306	The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent…	4,850	$650	$3.1M
80048	The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood…	58,290	$40	$2.6M
80053	The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel.	68,890	$40	$2.5M

Showing 1–10 of 423

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

The Miriam Hospital — 18 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

423 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	3	30	260	$60	$3.4M
G0378	Hospital observation service, per hour	2	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.	5	50	330	$50	$2.7M
J1642	Injection, heparin sodium, (heparin lock flush), per 10 units	4	10	1,900	$240	$1.2M
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…	3	20	840	$210	$789.2K
J0131	Injection, acetaminophen, not otherwise specified,10 mg	2	10	1,670	$280	$740.4K
J7040	Infusion, normal saline solution, sterile (500 ml = 1 unit)	2	10	120	$290	$535.1K
70553	In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows…	15	20	190	$520	$504.7K
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	14	20	660	$180	$475.3K
J2405	Injection, ondansetron hydrochloride, per 1 mg	2	20	1,080	$180	$470.2K

Showing 1–10 of 423

Related Providers

Other providers that share a Tax Identification Number (TIN) with The Miriam Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lifespan Physician Group, Inc.	RI	Urgent Care Clinic/Center	$0	$6.5M
Lifespan Physician Group, Inc.	RI	General Practice Physician	$0	$5.6M
Lifespan Physician Group, Inc.	RI	Psychiatry Physician	$0	$4.4M
Leah Battista	RI	Maternal & Fetal Medicine Physician	$0	$1M
Joseph Garland	RI	Infectious Disease Physician	$17.4K	$743.1K
Tanya Booker	RI	Maternal & Fetal Medicine Physician	$0	$709.6K
Joseph Wyllie	RI	Cardiovascular Disease Physician	$110.6K	$537.2K
Meghan Geary	RI	Internal Medicine Physician	$5.8K	$619.6K
Jeffrey Burock	RI	Psychiatry Physician	$30K	$526.7K
Anthony Pham	OR	Hematology & Oncology Physician	$538.9K	$0

Nearby Providers

Other providers in the same ZIP code as The Miriam Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Family Service Of Rhode Island Inc.	RI	Taxi	$0	$12M
Butler Hospital	RI	Psychiatric Hospital	$0	$9.6M
Phoenix Houses Of New England, Inc.	RI	Substance Abuse Rehabilitation Facility	$0	$7.3M
Thomas Mulvey	RI	Pediatric Dentistry	$0	$6.3M
Silver Fern Practice, LLC	RI	Physical Therapist	$0	$5M
Providence Interventional Associates Ii LLC	RI	Ambulatory Surgical Clinic/Center	$1.9M	$8.3K
Gaurav Gupta	RI	Ophthalmology Physician	$1.8M	$5.8K
Robert Eden	RI	Pediatrics Physician	$0	$1.7M
Brian Ackerman	RI	Psychiatry Physician	$24.8K	$1.5M
Steven Hirsch	RI	Clinical Neuropsychologist	$0	$1.2M

The Miriam Hospital — Billing Profile & Reimbursement Data

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The Miriam Hospital — 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