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NPI 1104923036 · Brooklyn, NY · Community/Retail Pharmacy
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Pharmakon Pharmacy Inc is a community/retail pharmacy provider located in Brooklyn, New York. This profile covers 1 Medicare and 2 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 | Pharmakon Pharmacy Inc |
| Address | 1914 Avenue M |
| City | Brooklyn |
| State | NY |
| ZIP | 11230 |
| Taxonomy | Community/Retail Pharmacy |
| NPI Enumerated | September 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $14.1M |
| Medicaid | $2.3K |
This provider is effectively single-payer in scale: Total Medicare revenue is $14.1M compared with Total Medicaid revenue of $2.3K, indicating Medicare accounts for the vast majority of billed dollars and Medicaid activity is negligible in aggregate. Analysts should treat Medicare patterns as the primary driver of business performance.
Medicare revenue is highly concentrated: the precomputed top-3 Medicare codes by revenue account for 100.0% of this provider's total Medicare revenue, and the single code K1034 is reported with 1.2M claims, $12 avg paid/claim, and $14.3M revenue (100.0% of this provider's total Medicare revenue). This concentration indicates the provider’s Medicare activity is narrowly focused on one service line.
K1034 indicates the provider’s operational focus is distribution/provision of nonprescription self-administered COVID-19 tests; such a code mix is consistent with a community/retail pharmacy model that processes very high volumes of over-the-counter diagnostic tests rather than a broad clinical service portfolio. The high claim count and the description suggest a transaction-driven retail dispensing operation rather than a diversified clinical practice.
On Medicare competitive standing for the top code, the provider is a national outlier: K1034 ranks #34 of 30143 providers nationally (100th percentile; extreme outlier), which signals unusually large national-scale volume for that specific code compared with peers. This ranking implies market prominence for K1034-related dispensing at a national level, even if other services are not represented.
Medicaid billing is minimal and concentrated: the precomputed top-3 Medicaid codes by revenue account for 100.0% of Medicaid revenue, with K1034 at $1.3K (72.1% of Medicaid revenue, 1.3K claims, $1 avg paid/claim) and T4535 at $516 (27.9% of Medicaid revenue, 12 claims, $43 avg paid/claim). These figures show Medicaid receipts are small in absolute dollars and focused narrowly on the same COVID-19 test code plus a minor incontinence supply line.
The provider’s Medicaid competitive standing is mixed and modest: K1034 ranks #7 of 19 in-state (67th percentile; typical, unremarkable volume for this code) while T4535 ranks #192 of 198 in-state (0th percentile; typical, unremarkable volume). In-state presence on Medicaid does not mirror the provider’s national prominence on Medicare for K1034.
Concentration in a single high-volume code creates operational sensitivity: because Medicare activity is dominated by K1034 (100.0% of Medicare revenue per precomputed data), changes in reimbursement policy, coding rules, or demand for over-the-counter COVID-19 tests could disproportionately affect this provider’s revenue. Payor strategy and program changes tied to diagnostic test billing will be the most impactful levers.
The provider has an established enrollment history, with NPI enumerated 2006-09-20 (~20 years ago), indicating long-term registration as a community/retail pharmacy. Despite this tenure, its billing footprint is narrow and highly concentrated on diagnostic test dispensing rather than a diversified set of pharmacy services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 1,195,170 | $10 | $14.3M |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
1 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| K1034 | 2 | 1,800 | 730 | $10 | $60.3K |
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 New York providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New York median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | 192 | 200 | 2,660 | $30 | $442.1K |
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 7 | 20 | 180 | $1 | $2.2K |
Other providers in the same ZIP code as Pharmakon Pharmacy Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Home Health Care Services Of Ny | NY | Home Health Agency | $0 | $589M |
| Quality Healthcare, Inc. | NY | Home Health Agency | $0 | $217.5M |
| Quality Family Care, LLC. | NY | Home Health Agency | $0 | $180.2M |
| Marks Homecare Cdpap, LLC | NY | In Home Supportive Care Agency | $0 | $164.9M |
| Summit Home Health Care | NY | Home Health Agency | $0 | $148.9M |
| Global Home Care Inc. | NY | Home Health Agency | $0 | $132M |
| Supportive Home Care LLC | NY | Home Health Agency | $0 | $116.7M |
| Future Care Health Services | NY | Home Health Agency | $0 | $105.7M |
| Homecare Services For Ind. Living | NY | Home Health Agency | $0 | $103.4M |
| Welcome Care Inc | NY | Home Health Agency | $0 | $98.8M |
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