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NPI 1689623563 · Worcester, MA · Magnetic Resonance Imaging (MRI) Clinic/Center
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Umass Memorial Mri & Imaging Center, LLC is a magnetic resonance imaging (mri) clinic/center provider located in Worcester, Massachusetts. This profile covers 36 Medicare and 20 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Umass Memorial Mri & Imaging Center, LLC |
| Address | 214 Shrewsbury St |
| City | Worcester |
| State | MA |
| ZIP | 01604 |
| Taxonomy | Magnetic Resonance Imaging (MRI) Clinic/Center |
| NPI Enumerated | May 9, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $8.1M |
| Medicare | $3.8M |
Service mix and capabilities: The provider’s billed code mix shows both advanced PET/PET–CT services and a broad portfolio of MRI studies, with high-volume procedure codes such as 78815 and MRI CPTs like 70553 and 72148 present at scale. The combination of multiple high-volume radiopharmaceutical codes (A9595, A9552, A9587) alongside large MRI volumes suggests the center operates as a combined molecular imaging (PET) and high-throughput MRI outpatient facility rather than a pure MRI-only clinic.
Medicare revenue concentration: For Medicare the top three codes account for 70.5% of Medicare revenue, driven by 78815 ($1.5M, 39.8% of Medicare revenue), A9595 ($631.6K, 17.1%), and A9552 ($500.6K, 13.6%). This indicates Medicare throughput and dollars are highly concentrated in PET/PET–CT procedures and associated radiopharmaceutical studies, making those service lines the primary Medicare revenue drivers.
Medicaid revenue concentration: For Medicaid the top three codes account for 50.9% of Medicaid revenue, with 70553 contributing $1.7M (21.3% of Medicaid revenue), 78815 $1.5M (18.8%), and 72148 $876.5K (10.8%). Medicaid revenue is therefore split between high-volume brain MRI work and substantial PET/CT activity, with lumbar MRI also a meaningful contributor to total Medicaid dollars.
Payer mix and scale: Reported totals show $3.8M in Medicare revenue versus $8.1M in Medicaid revenue, indicating Medicaid is the larger payer relationship by reported dollars. The larger Medicaid share suggests operational emphasis and revenue exposure are weighted toward state-program billing and the MRI/PET services that Medicaid reimburses at scale.
National competitive standing on Medicare: The center ranks at or near the top nationally on multiple Medicare codes associated with PET and MRI—78815 ranks #15 of 6566 providers nationally (100th percentile; extreme outlier), A9552 ranks #4 of 2411 (100th percentile; extreme outlier), and 70553 ranks #8 of 11271 (100th percentile; extreme outlier). Those rankings characterize the provider as a national-volume leader or outlier for several high-revenue imaging services.
State competitive standing on Medicaid: Within Massachusetts Medicaid data, the center is a leading statewide provider on key MRI/PET codes: 72148 ranks #2 of 105 in-state (99th percentile; notably above typical state volume), 73721 ranks #3 of 93 (98th percentile; notably above typical state volume), and 73221 ranks #2 of 60 (98th percentile; extreme outlier). Combined with top in-state positions for 70553 and 78815, the facility appears to hold a dominant regional position for MRI and PET services.
Tenure and specialized offerings: The NPI was enumerated on 2006-05-09 (~20 years ago), indicating long-standing operations in the market. The dataset also shows uniquely reported or rare radiotracer activity—A9591 appears as rank #1 of 1 providers nationally (no national peer volume comparison available) and multiple tracer/procedure codes are labeled as 'extreme outlier' or 'notably above typical'—which suggests capability to deliver specialized radiopharmaceutical diagnostics that are not widely available.
Operational and contracting implications: Several high-cost, high-volume items drive material revenue (for example, Medicare 78815 avg paid/claim $1229 and Medicaid 78815 avg paid/claim $494; Medicare A9595 avg paid/claim $484), so changes in reimbursement, coverage rules, or access to radiotracers could materially affect revenue. Analysts evaluating network value or contract negotiations should prioritize PET radiopharmaceuticals and the facility’s high-volume MRI CPTs given their outsized contribution to payer-specific revenue.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
36 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 78815 | PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.… | 1,190 | $1,230 | $1.5M |
| A9595 | Piflufolastat f-18, diagnostic, 1 millicurie | 1,310 | $480 | $631.6K |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 1,220 | $410 | $500.6K |
| 78816 | The patient is injected with a radiopharmaceutical tracer called FDG (fluoro–deoxyglucose, a radioactive substance containing glucose) about one hour before the imaging is scheduled to begin. The… | 150 | $1,240 | $184.5K |
| 70553 | In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows… | 820 | $180 | $143.3K |
| 72148 | In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the lumbar spinal canal and contents without using contrast. | 900 | $100 | $91.8K |
| 74183 | The provider performs magnetic resonance imaging of the structures and organs of the abdomen, initially without control and then with additional sequences after injection of contrast. | 450 | $200 | $89K |
| 72197 | In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the pelvis first without using contrast and again after injecting contrast material. | 380 | $190 | $72.6K |
| A9587 | Gallium ga-68, dotatate, diagnostic, 0.1 millicurie | 1,460 | $40 | $64.2K |
| A9591 | Fluoroestradiol f 18, diagnostic, 1 millicurie | 100 | $590 | $60.1K |
Showing 1–10 of 36
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 36 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
20 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 70553 | In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows… | 6,420 | $270 | $1.7M |
| 78815 | PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.… | 3,070 | $490 | $1.5M |
| 72148 | In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the lumbar spinal canal and contents without using contrast. | 5,730 | $150 | $876.5K |
| 73721 | In this diagnostic procedure, the provider performs magnetic resonance imaging of a lower extremity joint without using contrast material. | 3,530 | $180 | $649.5K |
| 70551 | The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam. | 4,030 | $160 | $636.4K |
| 72141 | In this diagnostic procedure, the provider performs a magnetic resonance imaging (MRI) study of the cervical spinal canal and contents without using contrast material. | 3,540 | $140 | $488.8K |
| 73221 | In this diagnostic procedure, the provider performs a magnetic resonance imaging, or MRI imaging, of any of the joints of a patient’s upper extremity, which can be the shoulder, elbow, wrist, or… | 2,660 | $170 | $449.4K |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 3,260 | $130 | $416.8K |
| 74183 | The provider performs magnetic resonance imaging of the structures and organs of the abdomen, initially without control and then with additional sequences after injection of contrast. | 1,800 | $230 | $412.7K |
| 72197 | In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the pelvis first without using contrast and again after injecting contrast material. | 1,270 | $270 | $340.6K |
Showing 1–10 of 20
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
20 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 78815 | PET and CT scans are both standard imaging tools that allow doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen.… | 6 | 50 | 630 | $460 | $459.9K |
| 70553 | In this procedure, the provider performs a magnetic resonance imaging, or MRI, study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows… | 8 | 110 | 310 | $210 | $331K |
| 70551 | The provider uses magnetic resonance imaging, or MRI, to examine the brain and brain stem. The provider does not administer contrast for this exam. | 9 | 110 | 340 | $160 | $211.7K |
| 72148 | In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the lumbar spinal canal and contents without using contrast. | 2 | 110 | 660 | $140 | $176.7K |
| 74183 | The provider performs magnetic resonance imaging of the structures and organs of the abdomen, initially without control and then with additional sequences after injection of contrast. | 10 | 60 | 150 | $200 | $160.7K |
| 73721 | In this diagnostic procedure, the provider performs magnetic resonance imaging of a lower extremity joint without using contrast material. | 3 | 90 | 280 | $180 | $152.9K |
| 72197 | In this diagnostic procedure, the provider performs magnetic resonance imaging (MRI) of the pelvis first without using contrast and again after injecting contrast material. | 5 | 30 | 130 | $250 | $142.8K |
| 72141 | In this diagnostic procedure, the provider performs a magnetic resonance imaging (MRI) study of the cervical spinal canal and contents without using contrast material. | 2 | 80 | 260 | $150 | $94.1K |
| 73221 | In this diagnostic procedure, the provider performs a magnetic resonance imaging, or MRI imaging, of any of the joints of a patient’s upper extremity, which can be the shoulder, elbow, wrist, or… | 2 | 60 | 230 | $160 | $86.5K |
| 70544 | The provider performs magnetic resonance angiography of the vessels of the head and surrounding areas. The provider does not use contrast. | 5 | 20 | 90 | $150 | $71.8K |
Showing 1–10 of 20
Other providers in the same ZIP code as Umass Memorial Mri & Imaging Center, LLC, ranked by combined Medicare and Medicaid revenue.
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