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.

Rhode Island Hospital (NPI 1588659528)

Field	Value
Entity Type	Organization
Organization	Rhode Island Hospital
Address	593 Eddy St
City	Providence
State	RI
ZIP	02903
Taxonomy	General Acute Care Hospital
NPI Enumerated	September 15, 2005

Payer Source	Total Paid
Medicaid	$380.8M
Medicare	$0

Key Findings

RHODE ISLAND HOSPITAL is effectively a single-payer Medicaid institution in the dataset: there is no Medicare billing on file while total Medicaid revenue is $380.8M. This concentration means analyses of its clinical and financial footprint should be viewed through a Medicaid-centric lens rather than a mixed-payer perspective.

Revenue concentration is substantial: the top three Medicaid codes by revenue account for 31.7% of the hospital’s total Medicaid revenue, indicating that a relatively small set of services—led by observation and high-acuity emergency care—drives nearly a third of its Medicaid receipts. This level of concentration highlights dependence on a few high-volume service lines for the hospital’s Medicaid financial performance.

The hospital’s code mix points to a high-volume emergency and observation operation combined with significant infusion, chemotherapy, and imaging services. Leading codes include G0378 (hospital observation per hour), 99285/99284/99283 (ED visits across high, moderate and low complexity), and multiple infusion/oncology codes such as J1745 and 96413, suggesting a major acute-care ED with associated observation capacity and substantial outpatient infusion/oncology throughput.

Competitive standing within Rhode Island is dominant for many Medicaid codes: G0378 ranks #1 of 12 providers (100th percentile) and 99285/99284/99283 rank at the 99–100th percentiles among hundreds of state providers, which the dataset characterizes as “extreme outlier” or “notably above typical” volumes. These ranks indicate RHODE ISLAND HOSPITAL is a primary destination for emergency, observation, and related acute services in-state.

Several high-revenue procedure codes are labeled as extreme outliers in state volume—examples include 99285 (rank #3 of 277, 99th percentile), 99284 (rank #2 of 339, 100th percentile), and 96375 (rank #1 of 16, 100th percentile). In plain terms, the hospital delivers far higher Medicaid volumes for these ED and infusion services than typical Rhode Island providers, reinforcing its role as a major regional acute-care and infusion center.

The hospital also shows significant oncology and advanced-therapy revenue lines: J1745 (infliximab) generated $15.9M and J9271 (pembrolizumab) generated $6.5M, with these biologic/oncology injectables ranking at or near the top among in-state peers. Combined with radiation therapy billing such as 77386 ($5.0M, rank #1 of 1), this pattern signals a robust cancer-treatment program embedded in the hospital’s outpatient and infusion portfolio.

Service breadth is broad across inpatient observation, high-acuity emergency care, diagnostics, and supportive services: high claim counts for 85025 (CBC, 84K claims) and 80053 (CMP, 37.4K claims) alongside imaging CPT 70553 (MRI brain, $5.4M) and sleep study code 95810 ($4.3M) reflect both high throughput of routine hospital diagnostic work and specialized ancillary services. This mix supports the picture of a full-service acute-care hospital with heavy ED and outpatient testing volumes.

RHODE ISLAND HOSPITAL has long-tenure in the NPI registry, enumerated around 2005-09-15 (~21 years ago). That sustained presence, combined with dominant in-state rankings across many Medicaid codes, suggests entrenched referral flows and established operational capacity for high-volume emergency, observation, infusion, and oncology services within Rhode Island.

Medicaid: Complete Services Breakdown

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

667 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0378	Hospital observation service, per hour	10,050	$2,210	$22.2M
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.	24,700	$860	$21.2M
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.	34,990	$590	$20.7M
99283	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a low level of medical decision making.	53,270	$340	$17.8M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	3,820	$4,150	$15.9M
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	11,750	$880	$10.4M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	7,740	$1,020	$7.9M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	2,410	$3,030	$7.3M
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…	16,030	$430	$6.9M
J9271	Injection, pembrolizumab, 1 mg	1,120	$5,820	$6.5M

Showing 1–10 of 667

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

Rhode Island Hospital — 21 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

667 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1745	Injection, infliximab, excludes biosimilar, 10 mg	1	10	90	$4,170	$5.5M
Q5103	Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg	1	10	1,700	$3,190	$5.4M
77386	Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex	1	10	3,950	$1,280	$5M
J9271	Injection, pembrolizumab, 1 mg	1	10	620	$6,290	$3.9M
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…	4	30	260	$60	$3.4M
G0378	Hospital observation service, per hour	1	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.	8	50	330	$50	$2.7M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	2	10	220	$740	$2.6M
90999	Use 90999 to report dialysis services or procedures that do not have a specific code.	5	20	4,970	$270	$1.8M
J2501	Injection, paricalcitol, 1 mcg	2	10	6,170	$300	$1.5M

Showing 1–10 of 667

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rhode Island Hospital	RI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$13.2M
Rhode Island Hospital	RI	Pediatrics Physician	$0	$5.3M
Rhode Island Hospital	RI	Multi-Specialty Clinic/Center	$0	$4M
Rhode Island Hospital	RI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$2.6M
George Dupont	RI	Pediatric Dentistry	$0	$2.4M
Rhode Island Hospital	RI	Hematology & Oncology Physician	$0	$2.3M
Brian Savoie	RI	Retina Specialist (Ophthalmology) Physician	$1.4M	$55.1K
Chandan Lakhiani	RI	Pediatrics Physician	$0	$1.3M
Boris Skurkovich	RI	Pediatrics Physician	$0	$1.2M
Kristin Macdougall	NY	Rheumatology Physician	$1.1M	$33.8K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Maxim Healthcare Services, Inc.	RI	Home Health Agency	$0	$32.1M
Children's Friend And Service	RI	Voluntary or Charitable Agency	$0	$18.7M
City Of Providence Rhode Island	RI	Local Education Agency (LEA)	$0	$18.6M
Brown Emergency Medicine	RI	Emergency Medicine Physician	$0	$12.3M
The Providence Center	RI	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$11.9M
Brown Neurology	RI	Neurology Physician	$0	$9.9M
One Stone L.L.C.	RI	Home Health Agency	$0	$8.6M
Recovery Connection Centers Of America, Inc.	RI	Multi-Specialty Clinic/Center	$0	$7.5M
City Of Providence Rhode Island	RI	Land Ambulance	$917.7K	$6.4M
Lifespan Physician Group, Inc.	RI	General Practice Physician	$0	$5.6M

Rhode Island Hospital — Billing Profile & Reimbursement Data

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Rhode Island 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