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NPI 1487916136 · Riverside, RI · Mental Health Clinic/Center (Including Community Mental Health Center)
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East Bay Community Action Program is a mental health clinic/center (including community mental health center) provider located in Riverside, Rhode Island. This profile covers 0 Medicare and 13 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 | Organization |
| Organization | East Bay Community Action Program |
| Address | 610 Wampanoag Trl |
| City | Riverside |
| State | RI |
| ZIP | 02915 |
| Taxonomy | Mental Health Clinic/Center (Including Community Mental Health Center) |
| NPI Enumerated | June 8, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $20.5M |
| Medicare | $0 |
This entity is effectively a Medicaid-focused provider: there is no Medicare billing on file and the provider reports $20.5M in Medicaid revenue, making Medicaid the sole material payer on record for this NPI. Analysts should treat this profile as single-payer Medicaid exposure rather than a mixed Medicare/Medicaid practice.
Revenue is highly concentrated in three per-diem/residential codes: H0037 generated $10.8M (52.6% of the provider's Medicaid revenue), H0040 generated $5M (24.5%), and H0019 generated $4.4M (21.4%); the precomputed top-3 share is 98.5% of total Medicaid revenue. This concentration indicates that nearly all of the reported Medicaid dollars flow through a very small set of program-oriented codes.
The code mix—H0037 (Community psychiatric supportive treatment program, per diem), H0040 (Assertive community treatment program, per diem), and H0019 (Behavioral health long-term residential, per diem)—points to a business model built around daily program delivery and long-term residential services rather than brief office-based encounters. This suggests operational capabilities in staffed, daily-treatment programs and residential care rather than routine outpatient E/M or psychotherapy as primary revenue drivers.
Competitive standing varies by program line: for H0037 the provider ranks #6 of 69 in-state (93th percentile; typical, unremarkable volume), indicating a relatively strong position in community psychiatric per-diem services; for H0040 it ranks #7 of 20 (68th percentile; typical, unremarkable volume), and for H0019 it ranks #16 of 25 (38th percentile; typical, unremarkable volume). In short, the provider is a notable participant in community psychiatric per-diem services but is more modest in assertive community treatment and long-term residential compared with in-state peers.
There are notable volume-versus-revenue patterns among non-top codes that suggest high-frequency, low-payment encounters: H0036 shows 52.3K claims but only $156.9K in revenue (0.8% of Medicaid revenue) and ranks #7 of 89 in-state (93th percentile; typical, unremarkable volume). Additionally, H0046 reports 66K claims with $0 reported revenue and ranks #2 of 70 (99th percentile; extreme outlier), which signals a reporting or reimbursement anomaly that merits follow-up if accurate unit-payments or program reporting are important to contracting or utilization management.
Traditional office E/M and psychotherapy codes contribute negligible Medicaid revenue: 99211 (2.9K claims, $20K revenue, 0.1%), 99213 (635 claims, $10.2K revenue, 0.0%), and 90834 (53 claims, $3.4K revenue, 0.0%). This reinforces that the provider’s financials are dominated by per-diem and residential program payments rather than face-to-face physician-level office visits or individual psychotherapy billing.
The NPI was enumerated on 2012-06-08 (~14 years ago), indicating the organization has an established presence in the market; tenure should be factored into analyses of contracting history, referral relationships, and program maturation.
From a risk/opportunity perspective, the provider’s dependence on per-diem program codes H0037, H0040, and H0019 (collectively 98.5% of Medicaid revenue) concentrates reimbursement exposure to changes in Medicaid per-diem policy, program authorizations, and utilization management for residential and community-treatment programs. Monitoring in-state rate adjustments or policy shifts for those specific codes will be essential for forecasting revenue stability and negotiating managed-care arrangements.
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.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H0037 | Community psychiatric supportive treatment program, per diem | 26,870 | $400 | $10.8M |
| H0040 | Assertive community treatment program, per diem | 4,220 | $1,200 | $5M |
| H0019 | Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | 1,150 | $3,830 | $4.4M |
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes | 52,300 | $1 | $156.9K |
| H0038 | Self‑help/peer services, per 15 minutes | 3,640 | $30 | $98.3K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 2,860 | $10 | $20K |
| H2023 | Supported employment, per 15 minutes | 230 | $50 | $12.5K |
| 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… | 640 | $20 | $10.2K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 50 | $60 | $3.4K |
| 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… | 20 | $0 | $0 |
Showing 1–10 of 13
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
13 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0019 | Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | 16 | 30 | 1,530 | $360 | $9.7M |
| H0040 | Assertive community treatment program, per diem | 7 | 20 | 350 | $640 | $6.3M |
| H0037 | Community psychiatric supportive treatment program, per diem | 6 | 70 | 190 | $380 | $3.2M |
| H0046 | Mental health services, not otherwise specified | 2 | 70 | 2,310 | $70 | $698K |
| H2023 | Supported employment, per 15 minutes | 7 | 10 | 230 | $80 | $357.1K |
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes | 7 | 90 | 510 | $10 | $187.5K |
| H0038 | Self‑help/peer services, per 15 minutes | 9 | 20 | 3,010 | $30 | $136.6K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 625 | 750 | 330 | $70 | $92.5K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 14 | 240 | 150 | $80 | $91.9K |
| 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… | 1,574 | 1,730 | 220 | $70 | $75.2K |
Showing 1–10 of 13
Other providers in the same ZIP code as East Bay Community Action Program, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Emma Pendleton Bradley Hospital | RI | Psychiatric Hospital | $0 | $37.6M |
| Emma Pendleton Bradley Hospital | RI | Psychiatric Hospital | $0 | $5M |
| Health Care Connections Nursing Services, Inc | RI | Home Health Agency | $0 | $3.6M |
| City Of East Providence | RI | Local Education Agency (LEA) | $0 | $2.2M |
| Amerita Inc | RI | Home Infusion Therapy Pharmacy | $0 | $1.1M |
| Care Resource, LLC | RI | Home Health Agency | $0 | $1.1M |
| Susie Hu | RI | Nephrology Physician | $30.9K | $911.1K |
| City Of East Providence | RI | Local Education Agency (LEA) | $0 | $768.1K |
| Victor Neel | RI | Dermatology Physician | $726.1K | $0 |
| Monissa Solberg | RI | Psychiatry Physician | $0 | $708.4K |
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