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 Fogarty Center (NPI 1609164144)

Field	Value
Entity Type	Organization
Organization	The Fogarty Center
Address	310 Maple Avenue
City	Barrington
State	RI
ZIP	02806
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	July 19, 2011

Payer Source	Total Paid
Medicaid	$52.3M
Medicare	$0

Key Findings

THE FOGARTY CENTER is effectively a Medicaid-focused provider: it reports $52.3M in lifetime Medicaid revenue and has no Medicare billing on file. This makes the organization functionally single-payer (Medicaid) in scale, concentrating its reimbursement exposure and strategic dependence on state waiver programs rather than Medicare fee-for-service markets.

Revenue is highly concentrated in a handful of waiver service lines: the top 3 Medicaid codes by revenue account for 87.5% of this provider's total Medicaid revenue. That concentration means a majority of cashflow is tied to a small set of program-specific rates and utilization patterns rather than a broad mix of procedures or outpatient services.

The single largest revenue driver is T2033 (Residential care, not otherwise specified (nos), waiver; per diem): 4.9K claims, $5798 avg paid/claim, $28.3M revenue (54.2% of this provider's total Medicaid revenue). Despite producing the majority of the provider’s Medicaid dollars, the provider ranks #15 of 22 in-state (33th percentile; typical, unremarkable volume), indicating it is a major operator of residential-per-diem services internally but not a statewide leader on that specific code.

Day habilitation is the second major axis of operations: T2021 (Day habilitation, waiver; per 15 minutes) shows 19.9K claims, $519 avg paid/claim, $10.3M revenue (19.7% of total). The provider ranks #11 of 33 in-state (69th percentile; typical, unremarkable volume), which signals above-median market share among peers for day habilitation and substantial operational capacity in time-based community services.

Residential habilitation (T2017 – Habilitation, residential, waiver; 15 minutes) is also material: 4K claims, $1801 avg paid/claim, $7.1M revenue (13.6% of total) with a #18 of 36 in-state rank (51th percentile; typical, unremarkable volume). This position places the provider near the state median for this code, reinforcing a service mix centered on residential and habilitation supports rather than diversified clinical lines.

Secondary Medicaid lines support the core residential/day habilitation business but are much smaller individually: T2003 (Non-emergency transportation) produced $3.5M (7.7K claims) and T2019 (Habilitation, supported employment) produced $1.3M (2.4K claims). These ancillary services (and smaller streams like T2022 case management at $989.4K and T2015 prevocational at $298.5K) suggest an integrated service model—transportation, employment supports, and care coordination—that complements the large residential and day habilitation footprint.

Competitive standing across codes is generally mid-pack to above-median rather than dominant statewide: ranks and percentiles are mostly in the middle ranges (examples include 33th, 69th, and 51th percentiles for the top three codes), so THE FOGARTY CENTER is a significant regional operator in waiver-funded residential and habilitation services but not a statewide outlier or monopoly for these codes. The provider’s market position looks more like specialization and concentration in waiver services than broad competitive leadership across many Medicaid service lines.

The NPI tenure (enumerated 2011-07-19, ~15 years ago) indicates an established presence in the state’s developmental disability service market. Combined with high per-claim averages for per-diem residential (T2033 $5798 avg) and per-15-minute residential habilitation (T2017 $1801 avg), the profile is consistent with an organization operating fixed residential sites and high-volume day habilitation programs that rely on stable Medicaid waiver reimbursement streams.

Medicaid: Complete Services Breakdown

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
T2033	Residential care, not otherwise specified (nos), waiver; per diem	4,890	$5,800	$28.3M
T2021	Day habilitation, waiver; per 15 minutes	19,870	$520	$10.3M
T2017	Habilitation, residential, waiver; 15 minutes	3,960	$1,800	$7.1M
T2003	Non-emergency transportation; encounter/trip	7,720	$460	$3.5M
T2019	Habilitation, supported employment, waiver; per 15 minutes	2,360	$560	$1.3M
T2022	Case management, per month	6,600	$150	$989.4K
T2015	Habilitation, prevocational, waiver; per hour	2,310	$130	$298.5K
T2020	Day habilitation, waiver; per diem	450	$320	$146.1K
T1002	Rn services, up to 15 minutes	130	$970	$128.2K
T2025	Waiver services; not otherwise specified (nos)	290	$240	$69.7K

Showing 1–10 of 13

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 Fogarty Center — 0 of 13 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

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	15	20	6,780	$1,890	$39.8M
T2017	Habilitation, residential, waiver; 15 minutes	18	40	3,820	$510	$10.6M
T2021	Day habilitation, waiver; per 15 minutes	11	30	12,340	$410	$10M
T2025	Waiver services; not otherwise specified (nos)	17	30	620	$70	$1.2M
T2022	Case management, per month	17	40	5,460	$150	$1.2M
T2003	Non-emergency transportation; encounter/trip	27	60	7,480	$80	$1.1M
T2020	Day habilitation, waiver; per diem	8	20	450	$950	$864.4K
T1003	Lpn/lvn services, up to 15 minutes	5	10	710	$120	$727K
T2019	Habilitation, supported employment, waiver; per 15 minutes	7	10	1,870	$230	$688.6K
T2015	Habilitation, prevocational, waiver; per hour	3	20	330	$460	$396.2K

Showing 1–10 of 13

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Fogarty Center	RI	Developmentally Disabled Services Day Training Agency	$0	$224.3M
The Fogarty Center	RI	In Home Supportive Care Agency	$0	$109.9M
The Fogarty Center.	RI	Developmentally Disabled Services Day Training Agency	$0	$35.5M
The Fogarty Center	RI	Community/Behavioral Health Agency	$0	$9.6M
Barrington Public Schools	RI	Local Education Agency (LEA)	$0	$903.2K
East Bay Pediatric & Adolescent Medicine Associates Inc	RI	Pediatrics Physician	$0	$522.7K
Mark Shannon	RI	Internal Medicine Physician	$0	$486.8K
Rhode Island Cvs Pharmacy, L.L.C.	RI	Pharmacy	$164.6K	$0
Gregory Sadovnikoff	RI	Family Medicine Physician	$137.5K	$10.3K
Town Of Barrington	RI	Ambulance	$98K	$13.3K

The Fogarty Center — Billing Profile & Reimbursement Data

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The Fogarty Center — 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

Nearby Providers

Frequently Asked Questions

References