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.

East Bay Pediatric & Adolescent Medicine Associates Inc (NPI 1760600266)

East Bay Pediatric & Adolescent Medicine Associates Inc is a pediatrics physician provider located in Barrington, Rhode Island. This profile covers 0 Medicare and 21 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	East Bay Pediatric & Adolescent Medicine Associates Inc
Address	234 Maple Avenue
City	Barrington
State	RI
ZIP	02806
Taxonomy	Pediatrics Physician
NPI Enumerated	April 23, 2007

Payer Source	Total Paid
Medicaid	$522.7K
Medicare	$0

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

21 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…	2,390	$110	$253.1K
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…	3,160	$70	$230.8K
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.	650	$20	$11.1K
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,…	360	$30	$10.2K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	70	$70	$4.9K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	60	$50	$2.7K
87880	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect Streptococcus, group A, in a patient sample, typically a throat swab.	190	$10	$1.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	20	$110	$1.7K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	490	$1	$1.5K
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…	10	$110	$1.3K

Showing 1–10 of 21

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

East Bay Pediatric & Adolescent Medicine Associates Inc — 0 of 20 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

21 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
85025	A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a…	162	290	100	$30	$88K
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…	142	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…	173	2,050	300	$50	$72.3K
85018	The lab analyst measures the hemoglobin in a whole blood sample. Hemoglobin is the red pigmented iron compound contained in the red blood cell that combines with oxygen needed by the body tissue.	19	30	230	$50	$48.4K
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…	184	190	160	$90	$39.1K
87502	The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly…	20	40	70	$90	$37K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	165	190	110	$90	$32K
87635	Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus…	49	80	90	$60	$26.6K
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.	97	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,…	34	150	120	$30	$16.4K

Showing 1–10 of 21

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Fogarty Center	RI	Developmentally Disabled Services Day Training Agency	$0	$224.3M
The Fogarty Center	RI	In Home Supportive Care Agency	$0	$109.9M
The Fogarty Center	RI	Developmentally Disabled Services Day Training Agency	$0	$52.3M
The Fogarty Center.	RI	Developmentally Disabled Services Day Training Agency	$0	$35.5M
The Fogarty Center	RI	Community/Behavioral Health Agency	$0	$9.6M
Barrington Public Schools	RI	Local Education Agency (LEA)	$0	$903.2K
Mark Shannon	RI	Internal Medicine Physician	$0	$486.8K
Rhode Island Cvs Pharmacy, L.L.C.	RI	Pharmacy	$164.6K	$0
Gregory Sadovnikoff	RI	Family Medicine Physician	$137.5K	$10.3K
Town Of Barrington	RI	Ambulance	$98K	$13.3K

East Bay Pediatric & Adolescent Medicine Associates Inc — Billing Profile & Reimbursement Data

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East Bay Pediatric & Adolescent Medicine Associates Inc — 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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