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.

Women And Infants Hospital (NPI 1629218094)

Key Findings

Field	Value
Entity Type	Organization
Organization	Women And Infants Hospital
Address	101 Dudley St
City	Providence
State	RI
ZIP	02905
Taxonomy	General Acute Care Hospital
NPI Enumerated	February 25, 2009

Payer Source	Total Paid
Medicaid	$12.6M
Medicare	$0

This provider is effectively single-payer for the datasets shown: Total Medicaid revenue is $12.6M while there is no Medicare billing on file. The absence of Medicare activity suggests the provider’s market exposure and payer negotiations are concentrated on Medicaid populations.

Revenue concentration in Medicaid is high: the precomputed top three codes (99284, 99283, 87591) account for 40.5% of the provider’s total Medicaid revenue. Those three codes alone drive a disproportionate share of the $12.6M Medicaid revenue, indicating a narrow set of services account for much of the billing.

Emergency department activity is a primary revenue driver: 99284 accounts for $1.9M (19.1% of Medicaid revenue) with 1.2K claims and 99283 accounts for $1.4M (13.9%) with 1.3K claims. Both ED codes rank in mid-to-high state percentiles (99284 at #83/339, 76th percentile; 99283 at #49/291, 83rd percentile), which indicates substantial ED volume but not statewide dominance in emergency services.

The provider shows a pronounced women’s health and sexual health testing footprint: 87591 and 87491 each have 4.2K claims and contribute $742.5K (7.5%) and $740.8K (7.5%) respectively, and both rank #9 in their peer groups at the 94th percentile. High volume in cytology and HPV testing (88175 with 4.6K claims, $596.2K revenue, 93rd percentile; 87624 with 2.9K claims, $519.8K revenue, 93rd percentile) further supports a robust in-house lab and OB/GYN screening operation focused on women’s health.

Outpatient diagnostic and prenatal imaging services are also evident: 76816 has 1.1K claims and $200.5K revenue (2.0% of Medicaid), ranking #5/47 at the 91st percentile, and G0463 (hospital outpatient clinic visit) shows 1.2K claims and $163.7K (1.7%), rank #9/59 at the 86th percentile. These code patterns point to established prenatal follow-up and outpatient clinic activity alongside the ED and lab services.

Oncology infusion exists but is a secondary line: 96413 shows 288 claims and $266.4K revenue (2.7% of Medicaid) and ranks #7 of 12 providers (45th percentile), indicating some chemotherapy administration capacity but modest scale relative to other statewide providers.

Competitive standing is mixed across service lines: the hospital ranks in the 90th+ percentile for many lab and women’s health tests (multiple codes at or above the 90th percentile), marking it as a strong regional performer in women’s diagnostics, while its ED codes sit in the 76th–83rd percentiles, reflecting solid but not dominant emergency department volume. This split suggests the hospital is a regional leader in women’s and perinatal testing but a more typical competitor on emergency services.

The provider has an established operating history with its NPI enumerated on 2009-02-25 (~17 years ago), which, combined with concentrated Medicaid revenue and deep lab testing volumes, suggests long-standing ties to Medicaid patient flows and mature clinical lab and obstetrics pathways.

Medicaid: Complete Services Breakdown

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

123 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	1,220	$1,540	$1.9M
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.	1,340	$1,020	$1.4M
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	4,200	$180	$742.5K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	4,210	$180	$740.8K
99282	The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a straightforward level of medical decision making.	890	$790	$703.1K
88175	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	4,550	$130	$596.2K
87624	The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result.	2,890	$180	$519.8K
88305	The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	1,830	$200	$373.5K
87389	The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an…	2,500	$110	$274.9K
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…	290	$930	$266.4K

Showing 1–10 of 123

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

Women And Infants Hospital — 1 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

123 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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.	31	50	330	$50	$2.7M
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…	7	10	360	$430	$1.1M
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…	13	20	840	$210	$789.2K
99218	N/A	4	10	780	$720	$714.3K
96365	The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease.	13	20	310	$210	$394.7K
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.	83	340	370	$200	$272.8K
96415	In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the…	6	10	210	$270	$257.8K
76818	The provider performs a biophysical profile test to measure the health of the baby during pregnancy. The test consists of a nonstress test and an ultrasound.	4	20	90	$150	$257.5K
81220	The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR…	2	10	670	$350	$236.3K
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.	49	290	180	$170	$224.1K

Showing 1–10 of 123

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Women & Infants Hospital Of Rhode Island	RI	General Acute Care Hospital	$0	$132.1M
Chelsy Caren	RI	Obstetrics & Gynecology Physician	$0	$2.3M
Emily White	RI	Obstetrics & Gynecology Physician	$0	$1.6M
Karim Khanbhai	RI	Pediatrics Physician	$0	$1.4M
Michael Sisitsky	RI	Obstetrics & Gynecology Physician	$0	$721.9K
Nicole Anderson	FL	Radiation Oncology Physician	$719.5K	$0
Tanya Booker	RI	Maternal & Fetal Medicine Physician	$0	$709.6K
Martin Keszler	RI	Neonatal-Perinatal Medicine Physician	$0	$704.1K
Carroll Medeiros	RI	Obstetrics & Gynecology Physician	$560	$604.5K
Amr Abdel Kader	RI	Obstetrics & Gynecology Physician	$3.1K	$599.6K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Elmwood Home Care, Inc.	RI	Home Health Agency	$0	$38.6M
H&t Medicals, Inc	RI	Home Health Agency	$0	$14.8M
R.i.s.a.t., LLC	RI	Methadone Clinic	$321.1K	$14M
Meeting Street Center	RI	Early Intervention Provider Agency	$0	$13.8M
The Providence Community Health Centers, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$13.4M
Rhode Island Hospital	RI	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$13.2M
The Providence Community Health Centers, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$8.3M
Renaissance Adhc, LLC	RI	Adult Day Care Clinic/Center	$0	$7.4M
Catherine Allen	RI	Mental Health Counselor	$0	$7.4M
University Orthopedics, Inc.	RI	Orthopaedic Surgery Physician	$0	$5.3M

Women And Infants 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