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NPI 1124060843 · Juncos, PR · Clinical Medical Laboratory
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Jose Carlos Flores Santiago is a clinical medical laboratory provider located in Juncos, Puerto Rico. This profile covers 26 Medicare and 127 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 | Jose Carlos Flores Santiago |
| Address | Carr 189 Km 12.7 |
| City | Juncos |
| State | PR |
| ZIP | 00777 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 11, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $9.5M |
| Medicare | $16.4K |
Medicaid-dominant revenue profile: this provider reports $9.5M in lifetime Medicaid revenue versus only $16.4K from Medicare, indicating the practice operates overwhelmingly in the Medicaid market. The scale difference suggests the entity functions as a high-volume in-state laboratory or specimen-collection network rather than as a Medicare-facing outpatient lab.
Concentrated revenue drivers for Medicaid and Medicare: the provider’s top three Medicare codes account for 35.0% of its Medicare revenue, while the top three Medicaid codes account for 32.8% of Medicaid revenue. In both payers the highest-revenue codes are laboratory panels and common diagnostic tests (for example 84443, 80061, 80053), indicating revenue is concentrated in a relatively small set of test families.
Medicaid service mix signals large-scale diagnostic and COVID testing operations: the top Medicaid codes include 84443, 87426, 80061, 87635, 80053, and G2023 which together generate major revenue shares and very large claim volumes (e.g., 56.8K claims for 84443 and 22.5K claims for 87426). The presence of amplified SARS-CoV-2 testing codes (87635) and specimen-collection code G2023 indicates active involvement in mass or community testing and centralized processing.
State-level competitive dominance on Medicaid: multiple Medicaid codes rank at or near the top in-state with labels such as "extreme outlier" — for example 84443 ranks #2 of 771, 87426 ranks #3 of 649, 80061 ranks #3 of 810 and 80053 ranks #2 of 792. These high ranks and the repeated "extreme outlier" designation show the provider is a major in-state performer for many routine panels and COVID-related tests.
Modest national standing on Medicare: the provider’s Medicare code ranks are generally mid-percentile and described as "typical, unremarkable volume" (for example 84443 at the 67th percentile, 80061 at the 65th percentile, and 80053 at the 62th percentile). This pattern indicates the provider bills these tests to Medicare at ordinary national volumes and is not a dominant national Medicare lab for its top CPT/HCPCS codes.
Specimen collection and peripheral services are part of the operating model: Medicare activity includes 36415 (244 claims) and P9604 (66 claims, travel allowance), while Medicaid shows large counts for G2023 (27.9K claims) and 81000 (69.7K claims). The mix of blood-draw, specimen-collection, dipstick urinalysis, and travel allowance codes suggests the provider conducts both in-office and outreach/home specimen collection in addition to central lab testing.
Business risk from code concentration: with top-three concentration of 35.0% on Medicare and 32.8% on Medicaid, a relatively small set of tests (notably panels and TSH testing like 84443) drive a large share of revenue. Payors and network managers should note that changes in utilization, reimbursement, or contracting on these specific codes could disproportionately affect the provider’s revenue.
Long-tenured billing presence: the provider’s NPI was enumerated on 2006-06-11 (~20 years ago), indicating established tenure in the market. Combined with the large Medicaid volumes and dominant in-state ranks, the data are consistent with a stable, long-running laboratory operation that has scaled participation in Medicaid testing programs over time.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
26 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 130 | $20 | $2.1K |
| 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. | 150 | $10 | $2K |
| 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. | 170 | $10 | $1.7K |
| 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… | 210 | $10 | $1.5K |
| 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… | 50 | $30 | $1.3K |
| 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,… | 30 | $40 | $1.1K |
| 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).… | 110 | $10 | $1K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 240 | $1 | $980 |
| 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 | 70 | $10 | $660 |
| 84153 | The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and… | 30 | $20 | $580 |
Showing 1–10 of 26
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 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.
127 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 56,820 | $20 | $1M |
| 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,… | 22,520 | $40 | $968.4K |
| 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. | 59,140 | $10 | $828K |
| 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… | 15,910 | $50 | $811.2K |
| 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. | 64,050 | $10 | $704.6K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 27,920 | $20 | $670.1K |
| 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… | 92,610 | $10 | $648.2K |
| 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… | 16,640 | $30 | $449.1K |
| 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).… | 37,910 | $10 | $379.1K |
| 81000 | The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dip stick, and shakes off the excess urine. Alternatively, the analyst may place drops of the urine specimen… | 69,700 | $1 | $209.1K |
Showing 1–10 of 127
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
127 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,… | 3 | 650 | 1,260 | $40 | $93.7K |
| 87490 | The lab analyst performs a test for Chlamydia trachomatis using direct nucleic acid probe technique. Chlamydia trachomatis causes a common sexually transmitted disease and certain eye infections. | 28 | 70 | 150 | $20 | $71.9K |
| 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… | 2 | 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 | 4 | 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… | 6 | 370 | 370 | $50 | $63.3K |
| 87590 | The lab analyst performs a test for Neisseria gonorrhoeae, a bacteria, using direct nucleic acid probe technique. | 38 | 80 | 150 | $20 | $59.4K |
| 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. | 3 | 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. | 16 | 290 | 170 | $30 | $43.8K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 15 | 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. | 2 | 790 | 2,360 | $10 | $41.9K |
Showing 1–10 of 127
Other providers in the same ZIP code as Jose Carlos Flores Santiago, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Frenchys Ambulance Inc | PR | Land Ambulance | $66.6K | $2.8M |
| Instituto De Fisiatria Y Medicina Deportiva Del Este, Inc | PR | Rehabilitation Clinic/Center | $0 | $1.8M |
| Edda Bautista Perez | PR | General Practice Dentistry | $0 | $751.8K |
| Carmen Cermira Rivera Marcano | PR | Clinical Medical Laboratory | $0 | $734.8K |
| Victorias Advanced Life Support Corp | PR | Land Ambulance | $4.9K | $667K |
| Ricardo Calderon Ortiz | PR | Nephrology Physician | $32.9K | $553.4K |
| Walgreen Co | PR | Pharmacy | $95.9K | $0 |
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.