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NPI 1043382302 · Monroeville, PA · Specialty Pharmacy
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Procare Pharmacy Direct, LLC. is a specialty pharmacy provider located in Monroeville, Pennsylvania. This profile covers 2 Medicare and 60 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 | Procare Pharmacy Direct, LLC. |
| Address | 105 Mall Blvd |
| City | Monroeville |
| State | PA |
| ZIP | 15146 |
| Taxonomy | Specialty Pharmacy |
| NPI Enumerated | November 14, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $227.3M |
| Medicare | $8.3M |
This provider is overwhelmingly Medicaid-focused by scale: it reports $227.3M in lifetime Medicaid revenue versus $8.3M in lifetime Medicare revenue, indicating Medicaid is the primary payer relationship for the business. The contrast in absolute dollars shows the organization operates at materially different scale across the two programs rather than as a balanced dual-payer supplier.
Medicare billing is highly concentrated: the top 3 Medicare codes by revenue account for 100.0% of this provider's total Medicare revenue, with J7170 representing 57.5% and J7192 representing 42.5% of Medicare revenue. That concentration suggests Medicare receipts are driven by a very small set of specialty injectables rather than broad-based Part B service lines.
National competitive standing on Medicare is modest and uneven: J7170 ranks #6 of 6 providers nationally (0th percentile), described as typical/unremarkable volume, while J7192 ranks #3 of 7 (67th percentile), a more middle-tier national position. In aggregate this indicates the provider is not a dominant national supplier for the specialty drugs it bills to Medicare, with at least one code showing only routine volume versus peers.
Medicaid revenue is also concentrated but less so than Medicare: the top 3 Medicaid codes by revenue account for 50.0% of this provider's total Medicaid revenue, led by J0584 at $72.4M (32.7%), followed by J0638 at $19.8M (9.0%) and J1726 at $18.6M (8.4%). These three high-cost codes—particularly J0584—drive a substantial portion of Medicaid dollars, pointing to reliance on a few expensive specialty therapies.
State-level competitive positioning on Medicaid shows areas of clear dominance: the provider ranks as a top in-state supplier for multiple codes, including J7298 and J7307 (each 100th percentile and noted as extreme outliers) and J2357 (100th percentile, notably above typical state volume). At the same time, J0584 is ranked #2 of 4 in-state (67th percentile), indicating both leadership and competitive presence across different high-cost products in Pennsylvania.
The product mix and code descriptions indicate a specialty pharmacy operational model focused on high-cost biologics and specialty injectables as well as contraceptive device distribution. Codes driving Medicaid and Medicare revenue include rare-disease or specialty biologics such as J0584, J0638, J7170, and J7192 and high-volume contraceptive device codes like J7298 and J7307, consistent with specialty dispensing and device fulfillment services rather than routine retail pharmacy activity.
Concentration dynamics create exposure and strategic opportunity: Medicare income is effectively mono-product (top 3 codes = 100.0% of Medicare revenue), while Medicaid, though larger, derives half its revenue from its top three codes (top 3 Medicaid codes = 50.0%). That pattern means shifts in coverage, pricing, or access for a handful of specialty agents—particularly J0584 on Medicaid and J7170/J7192 on Medicare—would disproportionately affect revenue, but it also presents focused opportunities to deepen payer contracts for those high-value lines.
The provider has a long operational tenure, with NPI enumerated on 2006-11-14 (~20 years ago), which combined with large Medicaid volumes suggests an established, state-level specialty supplier. Long-standing enrollment plus leadership positions on multiple in-state codes implies institutional relationships and capabilities for handling complex/high-cost specialty therapies.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.
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.
60 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0584 | Injection, burosumab-twza 1 mg | 3,530 | $20,520 | $72.4M |
| J0638 | Injection, canakinumab, 1 mg | 910 | $21,800 | $19.8M |
| J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | 6,490 | $2,870 | $18.6M |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 760 | $21,740 | $16.6M |
| J3285 | Injection, treprostinil, 1 mg | 2,760 | $4,180 | $11.5M |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg | 11,980 | $900 | $10.8M |
| J2357 | Injection, omalizumab, 5 mg | 3,750 | $2,670 | $10M |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies | 9,190 | $900 | $8.3M |
| J2323 | Injection, natalizumab, 1 mg | 860 | $7,520 | $6.5M |
| J2182 | Injection, mepolizumab, 1 mg | 1,740 | $3,150 | $5.5M |
Showing 1–10 of 60
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
60 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0584 | Injection, burosumab-twza 1 mg | 2 | 10 | 2,490 | $15,640 | $38.8M |
| J3285 | Injection, treprostinil, 1 mg | 2 | 10 | 7,820 | $4,270 | $33.4M |
| J0638 | Injection, canakinumab, 1 mg | 1 | 10 | 910 | $21,800 | $19.8M |
| J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | 1 | 10 | 6,490 | $2,870 | $18.6M |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 2 | 10 | 790 | $17,150 | $13.6M |
| J2315 | Injection, naltrexone, depot form, 1 mg | 3 | 10 | 3,300 | $950 | $8M |
| J1559 | Injection, immune globulin (hizentra), 100 mg | 2 | 10 | 4,670 | $1,330 | $6.2M |
| J2182 | Injection, mepolizumab, 1 mg | 1 | 10 | 1,740 | $3,150 | $5.5M |
| J1561 | Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg | 4 | 10 | 1,490 | $2,430 | $3.8M |
| J0775 | Injection, collagenase, clostridium histolyticum, 0.01 mg | 1 | 10 | 270 | $9,860 | $2.7M |
Showing 1–10 of 60
Other providers in the same ZIP code as Procare Pharmacy Direct, LLC., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Bayada Home Health Care, Inc. | PA | Home Health Agency | $0 | $92M |
| Jade Wellness Center | PA | Substance Use Disorder Rehabilitation Clinic/Center | $0 | $10.6M |
| West Penn Allegheny Health System Inc. | PA | General Acute Care Hospital | $0 | $8.2M |
| Upmc East | PA | General Acute Care Hospital | $0 | $5.8M |
| Jared Knickelbein | PA | Retina Specialist (Ophthalmology) Physician | $1.8M | $99.4K |
| Med Health Services Management, LP | PA | Clinical Medical Laboratory | $111.4K | $1.7M |
| Paul Conrad | PA | Ophthalmology Physician | $1.5M | $62.5K |
| Shripaad Shukla | PA | Retina Specialist (Ophthalmology) Physician | $1.4M | $83.2K |
| Avni Vyas | PA | Retina Specialist (Ophthalmology) Physician | $1.3M | $34.5K |
| Deepam Rusia | PA | Retina Specialist (Ophthalmology) Physician | $1M | $76.5K |
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