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NPI 1114079167 · Toledo, OH · Clinical Medical Laboratory
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Toledo Clinic Incorporated is a clinical medical laboratory provider located in Toledo, Ohio. This profile covers 136 Medicare and 108 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 | Toledo Clinic Incorporated |
| Address | 4235 Secor Rd |
| City | Toledo |
| State | OH |
| ZIP | 43623 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 18, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.1M |
| Medicaid | $2M |
TOLEDO CLINIC INCORPORATED operates as a high-volume clinical medical laboratory with broad outpatient testing throughput across both Medicare and Medicaid; its top Medicare codes include common phlebotomy and routine chemistry/hematology panels (36415, 80053, 85025) and specialty analytes like 82306 (vitamin D) and 84443 (TSH), indicating a lab-focused, specimen-processing operation that handles both high-volume collection and a mix of routine and specialized assays.
Revenue concentration on Medicare is meaningful: the precomputed top-3 Medicare codes account for 36.8% of total Medicare revenue, with 36415 alone representing $271.5K (16.8% of Medicare revenue). This concentration implies that procedural volume from blood draws plus a small set of high-use panels drive a large share of Medicare dollars for the facility.
On Medicaid the top-3 codes account for 29.1% of total Medicaid revenue, showing a somewhat more diversified payer-specific mix compared with Medicare; 82306 (vitamin D) is the single largest Medicaid revenue code at $184.5K (12.4% of Medicaid revenue), illustrating strong demand for that specific assay among the provider’s Medicaid population.
TOLEDO CLINIC’s payer mix is nearly balanced in scale between Medicare and Medicaid with reported lifetime revenues of $2.1M (Medicare) and $2M (Medicaid), suggesting the laboratory serves both elderly/disabled and low-income populations at comparable volumes rather than being effectively single-payer.
Competitive standing on Medicare: the provider ranks in the highest national percentiles for many routine codes (e.g., 36415 ranks #93 of 86467, listed as "notably above typical" national volume; 80053 and 85025 are 99–100th percentile rankings), indicating it is a major national-volume performer on common lab services and high relative throughput for phlebotomy and basic panels. On Medicaid, several codes show strong in-state positioning (e.g., 82306 ranks #27 of 264 in-state at the 90th percentile and 80061 at the 89th percentile), signaling the lab is a leading state-level performer for certain assays.
Statistical outliers and unusually high volumes: 36415 on Medicare is flagged as "notably above typical national volume," meaning the provider performs substantially more blood-draw procedures than most peers. Multiple Medicare codes also sit at or near the 99–100th national percentiles (80053, 85025, 82728, 83036), reinforcing the characterization of unusually high throughput for routine lab and panel testing.
Tenure: the NPI was enumerated on 2007-01-18 (~19 years ago), indicating long-standing operation in the market and likely established referral relationships with clinicians and health systems that support consistent test volume over time.
Service-line implications from the code mix include a heavy reliance on high-frequency, low-reimbursement tests (many CPTs with low average paid/claim) combined with a subset of higher-paid specialized assays (e.g., 82306, 83970, 86235), suggesting an operational model that leverages scale on routine testing while supplementing revenue with selected specialty assays and immunology panels.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
136 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. | 33,940 | $10 | $271.5K |
| 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. | 17,890 | $10 | $178.9K |
| 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… | 18,180 | $10 | $145.4K |
| 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… | 4,570 | $30 | $132.4K |
| 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… | 7,270 | $20 | $116.3K |
| 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. | 7,320 | $10 | $95.1K |
| 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. | 1,870 | $40 | $74.8K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 3,580 | $20 | $53.7K |
| 82784 | The lab analyst performs the technical lab test to analyze the concentration of a particular gamma globulin in the specimen. The analyst may test for immunoglobulin A, immunoglobulin D,… | 5,250 | $10 | $47.3K |
| 82728 | The lab analyst measures the level of ferritin, an important protein composed of about 20 percent iron. Ferritin also acts as an iron reserve in the body, and is present in serum in only minute… | 3,250 | $10 | $42.3K |
Showing 1–10 of 136
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 136 CPT/HCPCS codes.
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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.
108 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 10,850 | $20 | $184.5K |
| 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. | 28,080 | $10 | $140.4K |
| 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. | 15,290 | $10 | $107K |
| 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… | 15,050 | $10 | $105.4K |
| 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… | 29,760 | $1 | $89.3K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 2,390 | $30 | $81.3K |
| 86235 | The lab analyst performs an assay to evaluate the patient’s serum for each antibody to an extractable nuclear antigen, also called ENA. Types of ENA antibodies include anti ribonuclear protein,… | 1,150 | $60 | $71.5K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 32,110 | $1 | $64.2K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 7,150 | $10 | $57.2K |
| 84439 | The lab analyst performs a test to measure free thyroxine, or free T4, typically in patient serum. | 10,760 | $10 | $53.8K |
Showing 1–10 of 108
How this provider's Medicaid billing volume and revenue compare to other Ohio providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Ohio median
108 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 13 | 50 | 220 | $30 | $675.9K |
| 0241U | N/A | 66 | 90 | 1,960 | $120 | $464.3K |
| U0004 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by… | 16 | 40 | 230 | $130 | $455.9K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 166 | 340 | 2,260 | $30 | $398.2K |
| 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… | 55 | 140 | 410 | $30 | $384.3K |
| 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. | 81 | 270 | 8,700 | $10 | $353.7K |
| 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… | 38 | 240 | 2,610 | $10 | $239.7K |
| 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… | 27 | 260 | 760 | $20 | $187.3K |
| 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. | 32 | 280 | 1,450 | $10 | $178.3K |
| 80074 | The lab analyst performs an acute hepatitis panel; the panel must include tests for hepatitis A IgM antibody, hepatitis B core IgM antibody, hepatitis B surface antigen, and hepatitis C antibody. | 42 | 90 | 250 | $30 | $152.4K |
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Other providers in the same ZIP code as Toledo Clinic Incorporated, ranked by combined Medicare and Medicaid revenue.
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