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NPI 1083709141 · Mayaguez, PR · Clinical Medical Laboratory
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Laboratorio Clinico Irizarry Guasch Inc is a clinical medical laboratory provider located in Mayaguez, Puerto Rico. This profile covers 87 Medicare and 49 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 | Laboratorio Clinico Irizarry Guasch Inc |
| Address | Calle De Diego #51 |
| City | Mayaguez |
| State | PR |
| ZIP | 00680 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | October 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.2M |
| Medicare | $164.2K |
Provider-level payer mix is heavily skewed to Medicaid: this lab reported $1.2M in Medicaid revenue versus $164.2K in Medicare, making Medicaid the dominant source of billed revenue for this entity. The scale difference implies operations and contracting are likely oriented toward the state Medicaid market rather than Medicare as the primary revenue driver.
Revenue concentration is meaningful on both payers: the top three Medicare codes account for 31.0% of the provider's Medicare revenue, while the top three Medicaid codes account for 38.4% of Medicaid revenue. For Medicare those top three are 36415, 84443, and 80061; for Medicaid they are 87426, 84443, and 85025, so a small set of routine collection and diagnostic tests disproportionately drive receipts.
The code mix indicates a full-service clinical laboratory with heavy volume in routine diagnostic testing and specimen collection. On Medicare the largest single code is 36415 ($16.3K, 2K claims) with strong representation from 84443 ($14.3K, 891 claims) and 80061 ($13K, 997 claims); on Medicaid the lab’s three biggest lines are 87426 ($214.4K, 5K claims), 84443 ($126K, 7.4K claims), and 85025 ($122.2K, 15.3K claims), reflecting a combination of high-volume CBC/chemistry testing, ongoing TSH monitoring, and large COVID antigen testing throughput.
Competitive standing differs by payer and test. For Medicare the provider posts high national percentiles on core codes (36415 at the 99th percentile, 84443 at the 97th, 80061 at the 97th) but these usages are characterized in the source as "typical, unremarkable volume," suggesting the lab is a high-volume but not anomalous national participant for routine draws and analyses. For Medicaid the provider shows upper-percentile in-state placement on its top tests (87426 at the 87th percentile, 84443 at the 85th, 85025 at the 91th percentile) and those are likewise described as "typical, unremarkable volume," indicating a strong regional throughput for these services within Puerto Rico.
The practice shows specific statistical outliers and above-typical signals on select codes that suggest operational emphasis beyond routine panels. On Medicare, 81000 is described as "notably above typical national volume" (rank #106 of 3903, 97th percentile) and 87804 is also flagged "notably above typical national volume," which aligns with a pattern of elevated point-of-care or rapid infectious-disease testing in addition to standard lab panels.
Specimen-collection and outreach activity appears to be a meaningful operational component. Medicaid shows large revenue for specimen-collection and COVID-related entries—G2023 ($107.9K, 4.5K claims) and 87426 ($214.4K, 5K claims)—and Medicare records P9604 ($8.4K, 763 claims) for prorated trip charges. Together these entries indicate the lab performs home- or nursing-home draws and high-volume public-health testing in addition to in-lab analyses.
Tenure and establishment are long-standing: the NPI was enumerated on 2006-10-04 (~20 years ago), which supports the interpretation that the lab is an established local operator with multiple years of billing history across both Medicare and Medicaid. This longevity increases the credibility of observed volume patterns in routine testing and specimen collection.
From a revenue-risk and contracting perspective, the provider’s dependence on a small set of codes and on Medicaid revenue creates sensitivity to changes in testing demand or reimbursement for those specific services. The precomputed concentration (Medicare top three = 31.0%; Medicaid top three = 38.4%) combined with Medicaid being the larger payer ($1.2M vs $164.2K) means policy, public-health testing cycles, or contract changes in the state market could materially impact overall revenue performance.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
87 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 2,040 | $10 | $16.3K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 890 | $20 | $14.3K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 1,000 | $10 | $13K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 1,520 | $10 | $12.2K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 400 | $30 | $11.6K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 910 | $10 | $9.1K |
| P9604 | Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge | 760 | $10 | $8.4K |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 210 | $40 | $7.4K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 650 | $10 | $6.5K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 130 | $40 | $5.3K |
Showing 1–10 of 87
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 87 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
49 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 4,990 | $40 | $214.4K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 7,410 | $20 | $126K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 15,270 | $10 | $122.2K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 4,500 | $20 | $107.9K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 7,090 | $10 | $99.3K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 7,250 | $10 | $79.7K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 2,170 | $30 | $65.1K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 2,270 | $30 | $56.7K |
| 87804 | The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings. | 4,400 | $10 | $52.8K |
| 86328 | The lab analyst performs a single–step immunoassay to qualitatively or semiquantitatively evaluate the patient’s specimen for antibodies to the severe acute respiratory syndrome coronavirus 2… | 1,740 | $20 | $33.1K |
Showing 1–10 of 49
How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Puerto Rico median
49 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 85 | 650 | 1,260 | $40 | $93.7K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 115 | 770 | 2,520 | $20 | $65.5K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 101 | 590 | 1,440 | $20 | $65.4K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 136 | 370 | 370 | $50 | $63.3K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 126 | 810 | 2,350 | $10 | $52.7K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 123 | 290 | 170 | $30 | $43.8K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 142 | 310 | 190 | $30 | $43.1K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 118 | 790 | 2,360 | $10 | $41.9K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 73 | 850 | 3,250 | $10 | $40.5K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 109 | 650 | 630 | $30 | $35.8K |
Showing 1–10 of 49
Other providers in the same ZIP code as Laboratorio Clinico Irizarry Guasch Inc, ranked by combined Medicare and Medicaid revenue.
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