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.

Beth Toolan (NPI 1750360236)

Beth Toolan is a pediatrics physician provider located in Providence, Rhode Island. This profile covers 0 Medicare and 29 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	Individual
Organization	Beth Toolan
Address	40 Candace St
City	Providence
State	RI
ZIP	02908
Taxonomy	Pediatrics Physician
NPI Enumerated	January 12, 2006

Payer Source	Total Paid
Medicaid	$1.3M
Medicare	$0

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

29 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	8,800	$70	$580.5K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,920	$80	$157.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,570	$70	$116.4K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	1,460	$80	$115.3K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	990	$90	$86K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	950	$60	$53K
90472	This code represents each injection of a vaccine after the first; list this code in addition to the code for the first injection.	2,000	$20	$32K
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	3,690	$10	$29.5K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	630	$40	$22.6K
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…	230	$90	$19.6K

Showing 1–10 of 29

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

Beth Toolan — 3 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

29 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average 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…	834	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…	39	2,050	300	$50	$72.3K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	9	190	160	$90	$39.1K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	15	160	160	$80	$39K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	11	190	110	$90	$32K
99394	The provider performs an established well–patient visit for an adolescent who is between the ages of 12 and 17.	9	140	90	$90	$29.2K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	82	500	90	$50	$24.9K
87428	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient specimen for antigens of severe acute respiratory syndrome (SARS) coronavirus, such as SARS–CoV–2…	19	170	160	$50	$23.8K
90460	In this procedure, the provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age.	48	240	440	$30	$22.5K
87426	The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,…	42	150	120	$30	$16.4K

Showing 1–10 of 29

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Providence Community Health Centers, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$13.4M
The Providence Community Health Centers, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$8.3M
Erica Knarr	RI	Dentist	$0	$3.5M
Raj Pande	RI	Dentist	$0	$2.1M
Steven Lowe	RI	Dentist	$0	$1.7M
Emily White	RI	Obstetrics & Gynecology Physician	$0	$1.6M
Jennifer Sunderland	RI	Advanced Practice Midwife	$0	$1.3M
Altug Koymen	RI	Obstetrics & Gynecology Physician	$0	$1.2M
Boris Skurkovich	RI	Pediatrics Physician	$0	$1.2M
Lonice Thomas	RI	Pediatrics Physician	$0	$1.1M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
A Caring Experience Nursing Services, Inc.	RI	Home Health Agency	$0	$78.5M
Prospect Chartercare Rwmc, LLC	RI	General Acute Care Hospital	$0	$57.1M
Caregiver Homes Of Rhode Island Inc.	RI	Case Management Agency	$0	$43.4M
Roger Williams Medical Center	RI	Surgical Oncology Physician	$0	$5.4M
John Ricci	RI	Dentist	$0	$4.3M
Meals On Wheels Of Ri, Inc.	RI	Case Manager/Care Coordinator	$0	$4.1M
Professional Ambulance LLC	RI	Ambulance	$1.7M	$1.4M
University Pathologists, LLC	RI	Anatomic Pathology Physician	$0	$2.9M
Prospect Chartercare Rwmc, LLC	RI	Internal Medicine Physician	$0	$2.4M
Antonio Barajas	RI	Emergency Medical Services (Emergency Medicine) Physician	$0	$2.1M

Beth Toolan — Billing Profile & Reimbursement Data

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Beth Toolan — 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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