Rhode Island Medicare Revenue Analysis
CMS Medicare Physician & Other Practitioners data
Rhode Island has 5K Medicare providers who collectively received $235.5M in Medicare payments, averaging $48K per provider. With below-average per-provider Medicare revenue, Rhode Island practices may have substantial untapped potential in care management programs and E&M coding optimization.
The most common specialty is Nurse Practitioner with 611 providers, followed by Internal Medicine (568) and Physical Therapist in Private Practice (436). Nurse Practitioner providers in Rhode Island average $19K annually, with room to grow through CCM, RPM, and AWV program adoption.
The largest Medicare provider concentration is in Providence (1,851 providers), with Warwick and Pawtucket also serving as major healthcare hubs. Practices in these areas face competitive pressure, making revenue optimization through proper coding and program enrollment critical for financial performance.
Total Providers
5K
in Rhode Island
Total Medicare Payment
$235.5M
Avg Payment / Provider
$48K
Total Services
6.1M
Rhode Island Performance Signals
Revenue per Provider
$48,293
-39.4% vs benchmark · national avg $79,744
Provider Market Share
0.4% of US
-79.3% vs benchmark · 4,876 providers
CCM Adoption
0.2%
-98.0% vs benchmark · national 11.3%
RPM Adoption
0.0%
-99.7% vs benchmark · national 6.5%
AWV Completion
9.3%
-46.9% vs benchmark · national 17.5%
Key Stats
How This Compares
Top Opportunities
How Rhode Island Compares
vs Neighboring States
Top Revenue Opportunities in Rhode Island
Chronic Care Management (99490)
Only 0.2% of providers bill CCM vs 11.3% national average. 538 additional providers could adopt CCM to close this gap.
Remote Patient Monitoring (99454)
RPM adoption is 0.0% vs 6.5% nationally. 314 providers could implement RPM programs.
Annual Wellness Visits (G0438/G0439)
AWV completion at 9.3% trails the 17.5% national average. 400 additional providers could offer AWV services.
Market Opportunities by Specialty
Top Specialties in Rhode Island
| Specialty | Providers | Avg Payment |
|---|---|---|
| Nurse Practitioner | 611 | $19K |
| Internal Medicine | 568 | $33K |
| Physical Therapist in Private Practice | 436 | $36K |
| Physician Assistant | 402 | $22K |
| Emergency Medicine | 252 | $38K |
| Family Practice | 181 | $30K |
| Optometry | 167 | $23K |
| Psychiatry | 148 | $21K |
| Diagnostic Radiology | 133 | $123K |
| Certified Registered Nurse Anesthetist (CRNA) | 113 | $9K |
| Licensed Clinical Social Worker | 95 | $13K |
| Orthopedic Surgery | 94 | $78K |
| Anesthesiology | 92 | $16K |
| Obstetrics & Gynecology | 87 | $7K |
| Chiropractic | 86 | $13K |
| Cardiology | 86 | $96K |
| Mass Immunizer Roster Biller | 77 | $97K |
| Podiatry | 72 | $78K |
| Neurology | 70 | $38K |
| Ophthalmology | 67 | $286K |
Top Cities in Rhode Island
Providence
Warwick
Pawtucket
Cranston
East Providence
East Greenwich
Wakefield
Riverside
Woonsocket
Westerly
Johnston
Middletown
Newport
Lincoln
North Providence
Cumberland
Smithfield
North Kingstown
Bristol
West Warwick
Coventry
North Smithfield
Narragansett
Tiverton
Warren
Portsmouth
Barrington
Greenville
South Kingstown
E Providence
Top 50 Providers in Rhode Island
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