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.

Gateway Healthcare Inc (NPI 1821078932)

Field	Value
Entity Type	Organization
Organization	Gateway Healthcare Inc
Address	101-103 Bacon St
City	Pawtucket
State	RI
ZIP	02860
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	January 17, 2006

Payer Source	Total Paid
Medicaid	$122.7M
Medicare	$0

Key Findings

GATEWAY HEALTHCARE INC reports $122.7M in lifetime Medicaid revenue and has no Medicare billing on file, making it effectively a single-payer (Medicaid) operation in the available dataset; the provider’s NPI was enumerated 2006-01-17 (~20 years ago), indicating long-standing participation in Medicaid programs.

Revenue is highly concentrated: the top three Medicaid codes (H0037, H0019, H0040) together account for 93.1% of the provider’s total Medicaid revenue, with H0037 at $49.4M (40.2%), H0019 at $33.2M (27.0%), and H0040 at $31.8M (25.9%); this concentration means changes to reimbursement or utilization for any of these codes would materially affect overall revenue.

The code mix points to a service model centered on residential and intensive community supports: H0019 is long-term residential per diem (245.7K claims, $135 avg paid/claim), H0040 is assertive community treatment per diem (26.1K claims, $1217 avg paid/claim), and H0037 is community psychiatric supportive treatment per diem (126.3K claims, $391 avg paid/claim). Together these per-diem, high-claim services suggest substantial capacity for residential stays and intensive day-based outreach or ACT teams.

On competitive standing within Rhode Island, GATEWAY is a dominant statewide participant for its top codes: H0019 ranks #1 of 25 providers (100th percentile; extreme outlier), H0037 ranks #2 of 69 (99th percentile; extreme outlier), and H0040 ranks #2 of 20 (95th percentile; typical, unremarkable volume). These ranks indicate the provider operates at substantially higher volumes for core residential and community-treatment lines than most in-state peers.

Operational footprint appears high-frequency and resource-intensive: in addition to per-diem volumes, H0036 (face-to-face, per 15 minutes) shows 233K claims and $4.2M revenue (3.4% of Medicaid revenue) and ranks #2 of 89 (99th percentile; extreme outlier), implying many brief, billed face-to-face contacts that drive staffing and scheduling demands.

GATEWAY also shows leadership in employment-support services and outpatient E/M relative to peers: H2023 (supported employment) has 23.5K claims and $1.8M revenue and ranks #1 of 13 (100th percentile; notably above typical), while 99214 has 16.7K claims and $666.3K revenue and ranks #16 of 1731 (99th percentile; extreme outlier). These figures suggest a supplemental mix of rehabilitation and medical-management activity alongside residential and ACT programs.

The dataset shows notable billing-record patterns where sizeable claim counts have $0 reported payment: H0046 (39K claims) and T1016 (48.2K claims) both report $0 avg paid/claim and $0 revenue while ranking in high percentiles (H0046 #7 of 70, 91st; T1016 #9 of 180, 96th). This indicates services are being reported at scale but not captured as paid revenue in the available Medicaid payment fields, which may reflect state reporting rules, bundled payments, or data capture limits rather than absence of service activity.

Strategic and risk implications: because Medicaid represents the entirety of reported payer revenue and three per-diem codes drive 93.1% of Medicaid revenue, the provider is highly exposed to state policy, per-diem rate changes, and utilization management for residential and ACT services; any contraction or rate adjustment in those specific programs would disproportionately affect its financials.

Medicaid: Complete Services Breakdown

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

32 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0037	Community psychiatric supportive treatment program, per diem	126,340	$390	$49.4M
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	245,650	$140	$33.2M
H0040	Assertive community treatment program, per diem	26,090	$1,220	$31.8M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	233,010	$20	$4.2M
H2023	Supported employment, per 15 minutes	23,480	$80	$1.8M
S9485	Crisis intervention mental health services, per diem	3,030	$220	$675.2K
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…	16,660	$40	$666.3K
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	12,080	$50	$567.9K
H2011	Crisis intervention service, per 15 minutes	3,770	$50	$169.6K
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…	3,470	$30	$114.6K

Showing 1–10 of 32

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

Gateway Healthcare Inc — 7 of 23 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

32 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	1	30	1,530	$360	$9.7M
H0040	Assertive community treatment program, per diem	2	20	350	$640	$6.3M
H0037	Community psychiatric supportive treatment program, per diem	2	70	190	$380	$3.2M
H0046	Mental health services, not otherwise specified	7	70	2,310	$70	$698K
S9485	Crisis intervention mental health services, per diem	5	30	160	$350	$494.7K
T1027	Family training and counseling for child development, per 15 minutes	72	90	350	$100	$363.8K
H2023	Supported employment, per 15 minutes	1	10	230	$80	$357.1K
T1016	Case management, each 15 minutes	9	180	400	$20	$230.7K
H2016	Comprehensive community support services, per diem	33	40	10,150	$10	$230.4K
H0004	Behavioral health counseling and therapy, per 15 minutes	62	80	340	$70	$223.7K

Showing 1–10 of 32

Related Providers

Other providers that share a Tax Identification Number (TIN) with Gateway Healthcare Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Heather Abrahams	RI	Psychiatry Physician	$0	$2.7M
Elizabeth James	RI	Counselor	$0	$2.3M
Gateway Healthcare, Inc	RI	Developmentally Disabled Services Day Training Agency	$0	$1.9M
Gateway Healthcare, Inc.	RI	Community/Behavioral Health Agency	$0	$1.3M
Gateway Healthcare, Inc	RI	Community/Behavioral Health Agency	$0	$1.1M
Gateway Healthcare, Inc	RI	Community/Behavioral Health Agency	$0	$731.2K
Brook Zambarano	RI	Mental Health Counselor	$0	$723.6K
Diane Reese	RI	Clinical Social Worker	$17.2K	$658.3K
Kyle Kaufer	RI	Clinical Social Worker	$0	$604.7K
Rosita Smith	RI	Counselor	$0	$499K

Nearby Providers

Other providers in the same ZIP code as Gateway Healthcare Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Nursing Placement, Inc.	RI	Home Health Agency	$0	$63.4M
United Cerebral Palsy Of Rhode Island, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$21.3M
Lifetime Financial Management Inc.	RI	Home Health Agency	$0	$20.9M
Addiction Recovery Institute	RI	Community/Behavioral Health Agency	$180.1K	$15.4M
Blackstone Valley Community Health Care	RI	Federally Qualified Health Center (FQHC)	$0	$14.2M
Blackstone Valley Community Health Care, Inc.	RI	Federally Qualified Health Center (FQHC)	$0	$12.4M
United Cerebral Palsy Of Rhode Island, Inc.	RI	Developmentally Disabled Services Day Training Agency	$0	$9.6M
Dr. Day Care, Inc.	RI	Counselor	$0	$8.7M
Sheila Brijade	RI	Pediatric Dentistry	$0	$7.7M
Staff Solutions, Inc.	RI	Home Health Agency	$0	$6.4M

Gateway Healthcare Inc — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References