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NPI 1023678240 · Seattle, WA · Community/Retail Pharmacy
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Washington Institute For Coagulation is a community/retail pharmacy provider located in Seattle, Washington. This profile covers 1 Medicare and 3 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 | Washington Institute For Coagulation |
| Address | 701 Pike St Ste 1900 |
| City | Seattle |
| State | WA |
| ZIP | 98101 |
| Taxonomy | Community/Retail Pharmacy |
| NPI Enumerated | June 19, 2019 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $117M |
| Medicare | $656.3K |
Business profile and service lines are consistent with a specialty community/retail pharmacy that focuses on hemophilia and other high-cost injectable therapies: the Medicaid top codes are J7170 (emicizumab), J7192 (factor viii recombinant) and S9430 (pharmacy compounding and dispensing services), indicating the provider dispenses specialty biologics and performs compounding/dispensing services on a large scale. The taxonomy is Community/Retail Pharmacy, which aligns with a dispensing-focused operation rather than an infusion clinic or hospital-based service line.
Medicaid revenue is highly concentrated in a single drug: the top 3 Medicaid codes account for 100% of the provider's Medicaid revenue, with J7170 alone representing 75.3% of Medicaid revenue at $88.1M. This concentration indicates clinical and commercial dependence on emicizumab for the provider's Medicaid business and suggests limited diversification across other Medicaid product lines.
Medicare revenue is entirely driven by a single code: the top 3 Medicare codes account for 100.0% of Medicare revenue, and J7192 is reported as 100.0% of this provider's total Medicare revenue with $790.7K listed for that code. The listing shows J7192 as the sole Medicare revenue source, signaling that Medicare billing activity is focused exclusively on factor VIII products as reported.
The provider's payer mix is effectively Medicaid-dominant: lifetime Medicaid revenue is $117M versus lifetime Medicare revenue of $656.3K, so operations are overwhelmingly supported by Medicaid reimbursements. Analysts should treat this entity as functionally single-payer from a revenue-risk perspective, with Medicaid pricing and utilization driving financial performance.
Competitive standing for core products differs by payer and code. For the Medicaid-dominant product J7170 the provider ranks #1 of 2 in-state (100th percentile; typical, unremarkable volume for this code), indicating it is the leading in-state dispenser of emicizumab among the small peer set; for S9430 the provider ranks #5 of 21 in-state (80th percentile), showing relatively high compounding/dispensing volume; for J7192 in-state it ranks #2 of 2 (0th percentile; typical, unremarkable volume), suggesting it is the smaller of two in-state dispensers of factor VIII on Medicaid.
Nationally for Medicare J7192 the provider ranks #5 of 7 (33th percentile; typical, unremarkable volume for this code), characterizing it as a modest participant in Medicare factor VIII billing on a national scale rather than a dominant national supplier. This contrasts with its leading position for J7170 within the state Medicaid market.
Tenure is relatively recent: the NPI was enumerated 2019-06-19 (~7 years ago), indicating the provider has been active for a moderate period and has scaled substantial Medicaid specialty volumes within that timeframe. Analysts should consider that growth and consolidation in specialty pharmacy contracting could materially affect future volumes given this relatively short operating history.
There are notable per-claim payment patterns across payers that merit follow-up: Medicaid average paid/claim is high for key products (J7170 at $28777 avg paid/claim and S9430 at $3907 avg paid/claim), while Medicare lists J7192 with $1 avg paid/claim despite $790.7K in revenue and 790.7K claims reported for that code. These differences are consistent with unitization and pricing differences between payers (or reporting conventions) and should prompt verification of claim-level pricing or billing unit definitions when performing utilization or cost comparisons.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified | 790,700 | $1 | $790.7K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
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| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J7192 | 1 | 10 | 790,700 | $1 | $655.9K |
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.
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 1 | 10 | 1,970 | $27,570 | $54.3M |
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified | 2 | 10 | 1,250 | $13,430 | $16.8M |
| S9430 | Pharmacy compounding and dispensing services | 5 | 20 | 1,170 | $280 | $2.2M |
Other providers in the same ZIP code as Washington Institute For Coagulation, ranked by combined Medicare and Medicaid revenue.
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