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NPI 1760488449 · Warwick, RI · Rheumatology Physician
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Edward Reardon is a rheumatology physician provider located in Warwick, Rhode Island. This profile covers 18 Medicare and 2 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 | Individual |
| Organization | Edward Reardon |
| Address | 1050 Warwick Ave |
| City | Warwick |
| State | RI |
| ZIP | 02888 |
| Taxonomy | Rheumatology Physician |
| NPI Enumerated | June 27, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $389.2K |
| Medicaid | $19.3K |
This provider’s payer mix is heavily Medicare‑weighted: total Medicare revenue is $389.2K compared with total Medicaid revenue of $19.3K, so Medicare dominates the revenue picture while Medicaid represents a much smaller share of billed dollars. Analysts should treat this as effectively a Medicare-driven practice for revenue forecasting and utilization review.
Medicare revenue is highly concentrated in three biologic/infusion drugs: J1745, J1602, and J0897 together account for 77.3% of this provider’s total Medicare revenue. These codes correspond to high-cost injectable biologics (infliximab, golimumab, denosumab) and signal that the practice’s Medicare economics are driven by drug administration rather than office E/M alone.
The provider’s operational profile is consistent with an infusion‑capable rheumatology practice: frequent use of infusion and chemotherapy administration codes such as 96413, 96365, and 96374 alongside biologic J‑codes indicates on‑site infusion sessions and staffed infusion workflows. Procedure codes like 20610 (joint injections) further support a mix of procedural and infusion services typical of a specialty rheumatology clinic.
By contrast, Medicaid billing is almost exclusively office visits: the top Medicaid code 99214 accounts for 82.4% of Medicaid revenue and the top three Medicaid codes account for 100.0% of the provider’s Medicaid revenue. This indicates that for Medicaid patients the practice’s revenue comes from evaluation and management visits rather than biologic drug administration.
The provider’s competitive standing for the top Medicare biologic codes is modest rather than dominant: J1745 ranks #375 of 1352 providers nationally (72th percentile; typical, unremarkable volume for this code), J1602 ranks #610 of 1041 (41th percentile; typical, unremarkable volume), and J0897 ranks #4543 of 10057 (54th percentile; typical, unremarkable volume). Taken together, these ranks suggest the practice is an active but not leading national player in administering these specific biologic products.
Visit‑level patterns show relatively elevated established‑patient activity on Medicare but limited new‑patient intake: 99213 ranks #31127 of 457151 providers nationally (93th percentile; typical, unremarkable volume), while 99204 new‑patient visits rank near the bottom at the 8th percentile. This pattern is consistent with an established specialty panel that sees many returning patients and fewer new consultations.
The provider has long tenure in the NPI registry (NPI enumerated 2005-06-27 (~21 years ago)), which supports the idea of an established referral base and stable practice operations in rheumatology and infusion services. That longevity is relevant for network contracting and utilization trend analysis.
From a revenue‑risk and contracting perspective, the heavy Medicare concentration in a small set of biologics (77.3% of Medicare revenue) combined with Medicaid dependence on office visits (99214 = 82.4% of Medicaid revenue) means payers should monitor changes in drug pricing, formulary placement, or infusion reimbursement; shifts in those areas could materially affect this provider’s Medicare revenue while Medicaid impact would be realized primarily through E/M rates and visit volume.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
18 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 4,970 | $30 | $129.2K |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 11,480 | $10 | $114.8K |
| J0897 | Injection, denosumab, 1 mg | 3,000 | $20 | $54K |
| 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… | 460 | $60 | $29.5K |
| 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… | 180 | $110 | $19.3K |
| 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. | 180 | $50 | $9.5K |
| 99443 | N/A | 90 | $100 | $8.7K |
| 20610 | In this procedure, the provider inserts a needle through the skin of a patient and into a major joint or bursa and then uses the syringe attachment to the needle to remove fluid or he may inject a… | 140 | $60 | $8.6K |
| 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… | 140 | $20 | $3.2K |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 200 | $10 | $2.2K |
Showing 1–10 of 18
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 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.
2 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… | 300 | $50 | $15.9K |
| 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… | 60 | $50 | $3.4K |
How this provider's Medicaid billing volume and revenue compare to other Rhode Island providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Rhode Island median
2 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… | 738 | 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… | 1,531 | 2,050 | 300 | $50 | $72.3K |
Other providers in the same ZIP code as Edward Reardon, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Your Choice Of Home Care LLC | RI | Home Health Agency | $0 | $54.7M |
| Inner You LLC | RI | Clinical Social Worker | $0 | $8.5M |
| Nash Corp | RI | Homemaker | $0 | $2.3M |
| Rhode Island Parent Information Network, Inc | RI | Case Management Agency | $0 | $1.6M |
| James Leroy | RI | Oral and Maxillofacial Surgery (Dentist) | $0 | $1.2M |
| Oes Home Of Ri,inc/ethan Place | RI | Assisted Living Facility | $0 | $1.1M |
| Matthew Brennan | RI | Orthodontics and Dentofacial Orthopedics Dentistry | $0 | $920.6K |
| Alternative Integrative Medicine, Inc | RI | Pain Medicine Physician | $0 | $840.6K |
| Alexander Turchetta | RI | Clinical Psychologist | $0 | $576.8K |
| Child And Family Psychiatry, Inc. | RI | Psychiatry Physician | $0 | $471.3K |
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