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 Physicians, LLC (NPI 1629493135)

Prospect Chartercare Physicians, LLC is a internal medicine physician provider located in Cranston, Rhode Island. This profile covers 0 Medicare and 94 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Prospect Chartercare Physicians, LLC
Address	1681 Cranston St
City	Cranston
State	RI
ZIP	02920
Taxonomy	Internal Medicine Physician
NPI Enumerated	February 20, 2014

Payer Source	Total Paid
Medicaid	$2.3M
Medicare	$0

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

94 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	18,370	$40	$716.5K
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…	21,720	$30	$630K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	1,440	$180	$255.4K
62323	The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)…	1,110	$130	$146.3K
99404	At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient’s age, family history, and areas of concern. The subjects…	1,010	$110	$105.9K
97803	The provider reassesses the dietary needs of a patient and uses specific diet therapy to treat medical conditions and related symptoms by interacting individually with the patient. This code…	1,560	$50	$73.3K
99204	The provider sees a new 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 provider…	1,150	$40	$43.6K
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	130	$220	$29.1K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	200	$150	$28.8K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	510	$60	$28.4K

Showing 1–10 of 94

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 Physicians, LLC — 9 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

94 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
45380	The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include…	7	20	110	$460	$140.3K
43239	The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis.	4	40	70	$300	$116.1K
83013	The lab analyst tests multiple breath samples for the presence of an isotope that indicates the presence of the H. pylori bacteria. This organism can cause irritation and ulcers of the stomach lining.	9	10	30	$110	$111.8K
62323	The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)…	1	10	180	$260	$82.2K
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…	13	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…	14	2,050	300	$50	$72.3K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	133	160	50	$150	$59.2K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	24	160	90	$110	$54.6K
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…	14	50	110	$60	$42K
99310	The provider sees a patient for a subsequent nursing facility care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the provider spends…	7	10	140	$10	$41.2K

Showing 1–10 of 94

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ralph Santoro	RI	Internal Medicine Physician	$66.2K	$2.1M
Thomas Rocco	RI	Surgery Physician	$92.7K	$558.4K
Douglas Heiner	UT	Procedural Dermatology Physician	$530K	$0
Alison Fischer	OK	Dermatology Physician	$490.5K	$25.2K
Tatiana Antoci	RI	Family Medicine Physician	$95.7K	$349.7K
Holli Brousseau	RI	Acute Care Nurse Practitioner	$2.9K	$368.8K
Hua Zhou	RI	Dermatology Physician	$171K	$78.6K
Sumit Das	RI	Specialist	$163.1K	$67.2K
Courtney Csikesz	MA	Dermatology Physician	$229.1K	$0
Shahzad Khurshid	FL	Hospice and Palliative Medicine (Internal Medicine) Physician	$194.3K	$7.7K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Justice Resource Institute, Inc	RI	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$29M
Opportunities Unlimited For People With Differeing Abilities, Inc	RI	Developmentally Disabled Services Day Training Agency	$0	$22.6M
Comprehensive Community Action, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$17.7M
Option Care Enterprises, Inc,	RI	Home Infusion Therapy Pharmacy	$0	$11.1M
Naresh Dasari	RI	Internal Medicine Physician	$199.5K	$7M
Garden City Treatment Center, Inc.	RI	Emergency Medical Services (Emergency Medicine) Physician	$0	$6.4M
Phenix Home Care	RI	Home Health Agency	$0	$5.8M
Jun Parks	RI	Internal Medicine Physician	$74.6K	$5M
Juyoung An	RI	Pediatric Dentistry	$0	$3.9M
Heather Abrahams	RI	Psychiatry Physician	$0	$2.7M

Prospect Chartercare Physicians, 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

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