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NPI 1093753303 · Nashville, TN · Anatomic Pathology & Clinical Pathology Physician
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Derek Welch is a anatomic pathology & clinical pathology physician provider located in Nashville, Tennessee. This profile covers 58 Medicare and 13 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 | Individual |
| Organization | Derek Welch |
| Address | 1010 Airpark Center Dr |
| City | Nashville |
| State | TN |
| ZIP | 37217 |
| Taxonomy | Anatomic Pathology & Clinical Pathology Physician |
| NPI Enumerated | June 2, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.1M |
| Medicaid | $99K |
Medicare revenue is the dominant payer for this provider, with $4.1M reported to Medicare versus $99K reported to Medicaid, indicating the practice is effectively Medicare-focused rather than evenly dual-payer. The scale disparity suggests strategic dependence on Medicare volumes and reimbursement patterns rather than Medicaid business.
Revenue concentration on Medicare is highly focused: the precomputed top 3 Medicare codes account for 72.1% of the provider's Medicare revenue, driven by very large contributions from 36415 ($2.2M, 55.6%), G0145 ($454.5K, 11.7%), and U0003 ($187.9K, 4.8%). This concentration implies the business model centers on a small set of high-volume services rather than a broad procedural mix.
The code mix and dollar volumes point to a lab/pathology operation built around high-volume specimen collection and automated cytology screening: 36415 (phlebotomy) is the single largest revenue driver at $2.2M (55.6% of Medicare) and G0145 (automated thin layer cytology screening) contributes $454.5K (11.7% of Medicare). Together these top procedural and screening codes imply the provider either operates or is tightly integrated with high-throughput specimen collection and centralized cytopathology workflows.
The provider is a national outlier on several Medicare services: 36415 ranks #25 of 86467 nationally and is labeled an "extreme outlier, far above typical national volume for this code," while G0145 ranks #3 of 349 and is also an "extreme outlier, far above typical national volume for this code." These rankings indicate a dominant presence at a national scale for routine blood draws and automated cytology screening relative to peers.
Molecular and infectious-agent testing is a meaningful secondary service line on Medicare, with U0003 ($187.9K, 4.8%), 87635 ($157.7K, 4.1% and flagged as an "extreme outlier, far above typical national volume for this code"), and multiple other NAAT and multiplex codes (e.g., 87637, 87624) appearing in the top 25. This pattern signals significant throughput in SARS-CoV-2 and respiratory/multiplex molecular diagnostics alongside cytology and phlebotomy.
On Medicaid the revenue picture is smaller and more distributed: the top 3 Medicaid codes (87491 $18.2K, 87591 $18.1K, U0003 $15.2K) account for 51.3% of Medicaid revenue, but each of those codes ranks in the mid-range statewide (for example 87491 ranks #22 of 74, 87591 ranks #22 of 72, U0003 ranks #48 of 95). In-state competitive standing on Medicaid is therefore modest and typical rather than dominant, suggesting the provider is a moderate local participant for sexually transmitted infection testing and COVID testing among Tennessee peers.
Despite the Medicare concentration, there are additional notable high-percentile signals: G0476 (HPV high-risk by NAAT) shows $38K in Medicare revenue and ranks #1 of 126 nationally with an "extreme outlier, far above typical national volume for this code" designation, highlighting specialized high-volume HPV screening beyond the primary revenue drivers. The presence of high national ranks across several distinct codes suggests operational scale in specific lab services rather than broad clinical scope.
The provider’s NPI tenure (enumerated 2006-06-02, ~20 years ago) indicates an established billing history. Combined with the concentrated, high-volume Medicare code mix and multiple extreme outlier rankings, the profile is consistent with a long-standing laboratory/pathology practice that has built scale in specimen collection, automated cytology screening, and high-throughput infectious disease testing.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
58 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. | 269,590 | $10 | $2.2M |
| G0145 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under… | 17,480 | $30 | $454.5K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 2,540 | $70 | $187.9K |
| 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… | 3,150 | $50 | $157.7K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 3,460 | $30 | $117.5K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 3,380 | $30 | $104.8K |
| 87637 | The lab analyst performs the technical steps to detect and differentiate severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2), influenza A, influenza B, and respiratory syncytial virus (RSV)… | 690 | $140 | $96.3K |
| 87624 | The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result. | 2,820 | $30 | $95.8K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 2,440 | $30 | $61K |
| 87511 | The lab analyst performs a test for Gardnerella vaginalis using amplified nucleic acid probe technique. Gardnerella vaginalis, typically causes bacterial vaginosis, an infection of the vagina that… | 1,570 | $30 | $53.5K |
Showing 1–10 of 58
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 58 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.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 1,510 | $10 | $18.2K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 1,510 | $10 | $18.1K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 400 | $40 | $15.2K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 1,110 | $10 | $11.1K |
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 1,110 | $10 | $11.1K |
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 10 | $510 | $6.1K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 1,430 | $1 | $5.7K |
| 87624 | The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result. | 390 | $10 | $5.5K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 1,690 | $1 | $3.4K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 1,510 | $1 | $3K |
Showing 1–10 of 13
How this provider's Medicaid billing volume and revenue compare to other Tennessee providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Tennessee median
13 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 48 | 100 | 400 | $60 | $524.7K |
| 81220 | The lab analyst performs the technical lab test to detect the presence of changes in the gene for cystic fibrosis transmembrane conductance regulator, also known as CFTR. The test evaluates the CFTR… | 10 | 10 | 210 | $200 | $285.2K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 11 | 30 | 480 | $20 | $283.4K |
| 88175 | The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer… | 14 | 30 | 700 | $10 | $227.5K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 22 | 70 | 250 | $20 | $215.6K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 22 | 70 | 270 | $20 | $215.5K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 5 | 20 | 190 | $10 | $192.8K |
| 87624 | The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result. | 15 | 30 | 390 | $20 | $169.8K |
| 87798 | The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified… | 11 | 50 | 180 | $20 | $153.7K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 36 | 50 | 540 | $20 | $152.7K |
Showing 1–10 of 13
Other providers in the same ZIP code as Derek Welch, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.