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.

Prospect Chartercare Sjhsri, LLC (NPI 1588089759)

Field	Value
Entity Type	Organization
Organization	Prospect Chartercare Sjhsri, LLC
Address	200 High Service Ave
City	North Providence
State	RI
ZIP	02904
Taxonomy	Internal Medicine Physician
NPI Enumerated	February 25, 2014

Payer Source	Total Paid
Medicaid	$854.7K
Medicare	$0

Medicaid: Complete Services Breakdown

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

45 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	8,280	$30	$281.5K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	9,560	$10	$114.7K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	670	$100	$65.4K
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…	950	$70	$62.7K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	590	$80	$49.6K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	2,550	$20	$48.4K
99396	The provider performs an established well–patient visit for a patient who is between the ages of 40 and 64.	380	$90	$32.6K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	740	$40	$31.7K
90832	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…	620	$40	$25.9K
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…	330	$50	$16.3K

Showing 1–10 of 45

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

Prospect Chartercare Sjhsri, LLC — 4 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

45 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	32	40	10,150	$10	$230.4K
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…	219	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.	117	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…	708	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…	42	2,050	300	$50	$72.3K
90832	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…	54	190	270	$40	$51K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	21	100	70	$50	$42.2K
82962	Blood glucose monitoring at home with small electronic devices is an easy method to check blood sugar level on a daily basis. The patient himself can perform the procedure and the result is obtained…	36	50	110	$60	$42K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	14	170	80	$40	$40.3K
99239	The provider sees a patient for hospital inpatient or observation discharge day management, involving evaluation and management (E/M). The provider spends more than 30 minutes on the service on the…	22	70	50	$80	$39.8K

Showing 1–10 of 45

Related Providers

Other providers that share a Tax Identification Number (TIN) with Prospect Chartercare Sjhsri, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prospect Chartercare Sjhsri, LLC	RI	General Acute Care Hospital	$0	$10.9M
St. Joseph Health Services Of Ri	RI	General Acute Care Hospital	$0	$5.9M
Thomas Defanti	CT	Addiction Medicine (Psychiatry & Neurology) Physician	$0	$3.6M
Matthew Downey	RI	Pediatric Dentistry	$0	$2.8M
Chelsy Caren	RI	Obstetrics & Gynecology Physician	$0	$2.3M
John Kiang	RI	Pediatric Dentistry	$0	$1.3M
Daniel Kane	RI	Pediatric Dentistry	$0	$1.2M
Stephanie Avila	RI	Advanced Practice Midwife	$0	$1.1M
Yvonne Wolny	RI	Public Health Dentistry	$0	$1M
William Gordon	RI	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$1M

Nearby Providers

Other providers in the same ZIP code as Prospect Chartercare Sjhsri, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Providence Center Inc	RI	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$170.9M
Re-focus Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$102.5M
Hopehealth Hospice & Palliative Care	RI	Community Based Hospice Care Agency	$0	$33.3M
Mas Medical Staffing	RI	Home Health Agency	$0	$24.5M
Generations Adult Day Health Center	RI	Adult Day Care Clinic/Center	$0	$16.3M
Global Homecare And Staffing Inc	RI	Home Health Agency	$0	$8.3M
Emergency Care Services Of New England PC	RI	Emergency Medicine Physician	$0	$6.9M
State Of Rhode Island	RI	Clinical Medical Laboratory	$570	$6.4M
The Providence Center	RI	Community/Behavioral Health Agency	$0	$5.9M
Darlington Memory Lane	RI	Assisted Living Facility	$0	$4.9M

Prospect Chartercare Sjhsri, LLC — Billing Profile & Reimbursement Data

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Prospect Chartercare Sjhsri, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References