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NPI 1891775128 · Providence, RI · Federally Qualified Health Center (FQHC)
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The Providence Community Health Centers, Inc. is a federally qualified health center (fqhc) provider located in Providence, Rhode Island. This profile covers 0 Medicare and 109 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 | The Providence Community Health Centers, Inc. |
| Address | 375 Allens Ave |
| City | Providence |
| State | RI |
| ZIP | 02905 |
| Taxonomy | Federally Qualified Health Center (FQHC) |
| NPI Enumerated | January 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $13.4M |
| Medicare | $0 |
This provider has no Medicare billing on file and reports $13.4M in lifetime Medicaid revenue, making it effectively a Medicaid-focused organization in the claims universe. The absence of Medicare activity implies the provider's payer exposure and competitive dynamics should be evaluated primarily within the Medicaid market rather than across dual payers.
Revenue is highly concentrated in a small set of visit codes: the precomputed top three Medicaid codes account for 67.3% of the provider's Medicaid revenue. The three revenue leaders are 99213 ($4.2M, 34.2% of Medicaid revenue), 99214 ($3.1M, 25.0%), and T1015 ($1M, 8.2%), showing that routine evaluation-and-management and bundled clinic encounters are the principal revenue drivers.
The code mix points to a high-volume primary care and FQHC delivery model: 99213 and 99214 are the single largest revenue sources and represent routine established-patient office visits at low and moderate complexity, respectively. G0467 (FQHC visit) also appears on the list, which—combined with the E/M dominance—supports interpretation of an organization operating as a community health center focused on frequent longitudinal outpatient care.
Preventive and pediatric services are a meaningful secondary service line. Preventive medicine codes 99391 (6.5K claims, $359.1K, 2.9% of Medicaid revenue) and 99392 (5.4K claims, $319.4K, 2.6%) both rank #1 in-state and are described as extreme outliers, indicating an unusually large well-visit volume for children and adults relative to peers in Rhode Island.
Behavioral health appears embedded in the service mix: psychotherapy code 90832 accounts for $898.5K (7.2% of Medicaid revenue) with 17.6K claims and ranks #3 in-state (99th percentile; extreme outlier). Additional psychiatric evaluation and longer psychotherapy codes (90792, 90834) are also present, signaling integrated mental/behavioral health capacity within the clinic footprint.
High volumes of immunizations and point-of-care respiratory testing indicate robust preventive and episodic care operations. Vaccine administration codes 90471 (25.9K claims, $206.9K) and 90472 (10.4K claims, $166.3K) rank at the top of peers, and respiratory/flu/COVID testing codes such as 87428, 87804, and 87880 are all extreme outliers in-state, consistent with on-site testing and vaccination programs.
Vision and optical services are part of the care bundle rather than an isolated ancillary line: V2020 (frames) and 92014 (comprehensive eye exam) each generate several thousand claims and together contribute nontrivial Medicaid revenue ($234.2K and $193.3K respectively). The presence of 92340 (eyeglass fitting) further indicates point-of-care optical dispensing or a co-located vision clinic component.
Competitive standing is dominant within Rhode Island Medicaid for multiple service categories: 99213 and 99214 rank #2 of 2046 and #2 of 1731 providers in-state (both 100th percentile; extreme outliers), G0467 ranks #1 of 55 (100th percentile; extreme outlier), and several preventive and testing codes rank at or near #1–#2. The NPI was enumerated on 2006-01-20 (~20 years ago), indicating long-standing enrollment and presence in the state's Medicaid provider network despite having no Medicare billing history.
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.
109 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… | 94,220 | $50 | $4.2M |
| 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… | 51,740 | $60 | $3.1M |
| T1015 | Clinic visit/encounter, all-inclusive | 26,660 | $40 | $1M |
| 90832 | 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… | 17,620 | $50 | $898.5K |
| 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… | 6,530 | $60 | $359.1K |
| 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… | 5,410 | $60 | $319.4K |
| 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… | 4,400 | $50 | $237.6K |
| V2020 | Frames, purchases | 5,450 | $40 | $234.2K |
| G0467 | Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which… | 6,170 | $40 | $215.8K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 25,860 | $10 | $206.9K |
Showing 1–10 of 109
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
109 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T1015 | Clinic visit/encounter, all-inclusive | 8 | 120 | 400 | $130 | $896.9K |
| T1017 | Targeted case management, each 15 minutes | 20 | 20 | 170 | $80 | $259.8K |
| H0033 | Oral medication administration, direct observation | 6 | 10 | 110 | $80 | $238.8K |
| T1016 | Case management, each 15 minutes | 166 | 180 | 400 | $20 | $230.7K |
| 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… | 225 | 750 | 330 | $70 | $92.5K |
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 152 | 240 | 150 | $80 | $91.9K |
| 76856 | A pelvic ultrasound is a noninvasive procedure used to assess body parts such as the bladder, ovaries, uterus, cervix, and fallopian tubes in females and the bladder, prostate gland, and seminal… | 33 | 40 | 160 | $110 | $89.6K |
| 76815 | The provider performs a limited examination of the fetus using ultrasound. The provider performs the examination of certain parameters for one or more fetuses. | 27 | 40 | 180 | $80 | $77.5K |
| 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 | 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… | 2 | 2,050 | 300 | $50 | $72.3K |
Showing 1–10 of 109
Other providers in the same ZIP code as The Providence Community Health Centers, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Women & Infants Hospital Of Rhode Island | RI | General Acute Care Hospital | $0 | $132.1M |
| Elmwood Home Care, Inc. | RI | Home Health Agency | $0 | $38.6M |
| H&t Medicals, Inc | RI | Home Health Agency | $0 | $14.8M |
| R.i.s.a.t., LLC | RI | Methadone Clinic | $321.1K | $14M |
| Meeting Street Center | RI | Early Intervention Provider Agency | $0 | $13.8M |
| Rhode Island Hospital | RI | End-Stage Renal Disease (ESRD) Treatment Clinic/Center | $0 | $13.2M |
| Women And Infants Hospital | RI | General Acute Care Hospital | $0 | $12.6M |
| Renaissance Adhc, LLC | RI | Adult Day Care Clinic/Center | $0 | $7.4M |
| Catherine Allen | RI | Mental Health Counselor | $0 | $7.4M |
| University Orthopedics, Inc. | RI | Orthopaedic Surgery Physician | $0 | $5.3M |
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