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NPI 1114364528 · Milwaukee, WI · Anatomic Pathology & Clinical Pathology Physician
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David Mendoza is a anatomic pathology & clinical pathology physician provider located in Milwaukee, Wisconsin. This profile covers 5 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 | Individual |
| Organization | David Mendoza |
| Address | 9200 W Wisconsin Ave |
| City | Milwaukee |
| State | WI |
| ZIP | 53226 |
| Taxonomy | Anatomic Pathology & Clinical Pathology Physician |
| NPI Enumerated | May 24, 2013 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $927K |
| Medicaid | $5.2K |
This provider’s revenue profile is overwhelmingly Medicare‑driven: Total Medicare revenue is $927K versus Total Medicaid revenue of $5.2K, so Medicare accounts for virtually all billed dollars and the practice should be treated as effectively Medicare‑dominant rather than a mixed‑payer operation. The Medicaid program contributes only a small fraction of overall revenue, indicating limited engagement with Medicaid populations or contracts.
The mix of top service codes indicates a core surgical pathology and immunohistochemistry practice. The Medicare top codes include 88305 (level IV surgical pathology specimen examination) and 88342 (initial single antibody immunohistochemical stain with pathologist interpretation), and additional technical stain codes (88313, 88312, 88341) appear in the top Medicare list, which together point to a workflow centered on processing and interpreting surgical pathology specimens with frequent IHC testing.
Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes by revenue account for 88.5% of this provider's total Medicare revenue, with 88305 alone generating $590.4K (63.4% of Medicare revenue) and 88342 contributing $175.3K (18.8% of Medicare revenue). This concentration suggests that a small set of diagnostic services—primarily surgical pathology and IHC—drive the majority of Medicare receipts for the provider.
Competitive standing on Medicare is nationally prominent for the highest‑revenue codes. The provider ranks #234 of 14580 nationally for 88305 (98th percentile), and #98 of 11370 for 88342 (99th percentile) which is explicitly labeled an “extreme outlier” and indicates volume far above typical national peers for that IHC code; by contrast, 88313 and 88312 are in the 96th percentile range and characterized as typical, indicating strong but not unique volumes across secondary stain codes.
Medicaid billing is minimal and concentrated: the precomputed top 3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with 88305 at $4.6K (90.6% of Medicaid revenue) from 160 claims and 88342 at $480 (9.4% of Medicaid revenue) from 12 claims. In-state competitive standing on Medicaid is modest to weak: 88305 ranks #144 of 194 in-state (26th percentile) and 88342 ranks #66 of 69 (0th percentile), so this provider is not a leading Medicaid pathology vendor in the state.
There is a clear payer pricing and volume gap for identical services: for 88305 the Medicare average paid per claim is $54 versus the Medicaid average paid per claim of $29, and claim volume for 88305 is 10.9K on Medicare versus 160 on Medicaid. These differences indicate both higher Medicare reimbursement rates and much higher Medicare utilization for the same surgical pathology service.
Secondary technical stain and IHC-related codes support the primary surgical pathology workflow but do not individually approach the top two codes’ revenue share. On Medicare, 88313 produced $59.2K (6.4% of Medicare revenue, 870 claims) and 88312 produced $58.8K (6.3% of Medicare revenue, 646 claims), both ranked in the mid‑to‑high percentiles nationally and labeled typical, suggesting steady, routine use of special stains alongside the dominant 88305/88342 work.
Provider tenure is established: NPI enumerated 2013-05-24 (~13 years ago), which, together with the high national ranks on Medicare for 88305 and 88342, is consistent with a long‑standing pathology practice that has built substantial Medicare volume over time rather than a new entrant with transient spikes in billing.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 10,930 | $50 | $590.4K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 2,140 | $80 | $175.3K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 870 | $70 | $59.2K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 650 | $90 | $58.8K |
| 88341 | The lab analyst applies an additional single antibody stain on a slide or slides prepared from the same patient specimen as the initial antibody stain, such as tumor tissue. Then a qualified… | 680 | $70 | $47.9K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 160 | $30 | $4.6K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 10 | $40 | $480 |
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 144 | 190 | 940 | $20 | $115.2K |
| 88342 | The lab analyst applies an initial single antibody stain on a slide or slides prepared from a single patient specimen, such as tumor tissue. Then a qualified provider, typically a pathologist,… | 66 | 70 | 240 | $10 | $9.7K |
Other providers in the same ZIP code as David Mendoza, ranked by combined Medicare and Medicaid revenue.
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