NPI 1073251336 — Billing Profile & Reimbursement Data

The provider’s Medicare billing is heavily concentrated in molecular and genetic diagnostic assays, with top revenue drivers including 81307 (2.9K claims, $663 avg paid/claim, $2M revenue (13.0%)), 81321 (3K claims, $588 avg paid/claim, $1.8M revenue (11.7%)), and 81249 (2.8K claims, $588 avg paid/claim, $1.6M revenue (10.9%)). This code mix — full-gene and targeted sequencing for BRCA2/PALB2, PTEN, and G6PD among others — is consistent with a specialized clinical or commercial genomics laboratory focused on hereditary disease and oncology testing rather than routine clinical pathology services.

Revenue concentration is material: the precomputed top-3 codes account for 35.6% of this provider’s total Medicare revenue, against a lifetime Medicare revenue base of $15M. That level of concentration in a small set of genetic assays indicates the provider’s financial performance is meaningfully driven by demand and reimbursement dynamics for a narrow set of high-value tests.

This provider is effectively single-payer in the available data: Medicare revenue is $15M while there is no Medicaid billing on file. The absence of Medicaid activity suggests limited exposure to state Medicaid programs in the dataset and means analyses of payer mix, Medicaid market share, or state-level Medicaid contracting are not possible from the billing record provided.