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NPI 1124061619 · Manitowoc, WI · Anatomic Pathology & Clinical Pathology Physician
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Douglas Hansen is a anatomic pathology & clinical pathology physician provider located in Manitowoc, Wisconsin. This profile covers 8 Medicare and 1 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 | Douglas Hansen |
| Address | 801 York St |
| City | Manitowoc |
| State | WI |
| ZIP | 54220 |
| Taxonomy | Anatomic Pathology & Clinical Pathology Physician |
| NPI Enumerated | June 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.4M |
| Medicaid | $2.9K |
Medicare dominates this provider’s payer mix: reported Medicare revenue is $1.4M compared with Medicaid revenue of $2.9K, so the practice is effectively Medicare-focused with only a de minimis Medicaid footprint on file. This concentration in a single payer suggests referrals and billing operations are primarily aligned with Medicare workflows and reimbursement patterns.
Revenue is highly concentrated in a few pathology codes: the top three Medicare codes (88305, 88342, 88341) account for 92.7% of the provider’s Medicare revenue, with 88305 alone representing $1.1M or 77.6% of Medicare revenue. On the Medicaid side the top three codes account for 100.0% of Medicaid revenue, and Medicaid activity is entirely represented by 88305 (75 claims, $2.9K revenue).
The procedural mix indicates a surgical pathology and immunohistochemistry-centric operation: 88305 (level IV surgical pathology read) is the dominant revenue driver, and high-volume immunostain interpretation is shown by 88342 and 88341. Those code profiles together point to a practice model focused on surgical specimen examination and ancillary IHC testing and interpretation rather than a broad multimodal clinical service mix.
At the national level this provider is an outlier on key Medicare codes: 88305 ranks #66 of 14580 providers nationally and is labeled an "extreme outlier" (100th percentile), and 88342 ranks #107 of 11370 (99th percentile; "extreme outlier"). These rankings indicate unusually high national volumes for both surgical pathology reads and initial antibody stains, implying either a high local caseload or a centralized reading role.
Not all high-volume codes are uniformly extreme: 88341 (additional single antibody stain) generated $65.7K and ranks #408 of 10274 nationally (96th percentile), which the data characterizes as typical or unremarkable relative to peers. This suggests while the provider is exceptional on primary surgical pathology and initial IHC testing, follow-up/ancillary stain volumes are elevated but closer to high-end peer norms.
Medicaid competitive standing is modest despite Medicare dominance: the Medicaid 88305 line shows 75 claims and $2.9K revenue and ranks #156 of 194 in-state (20th percentile). In plain terms, the provider’s Medicare presence is nationally prominent for key pathology services but its Medicaid market share and in-state ranking are limited, indicating different referral patterns or payer acceptance on Medicaid.
Operational scale for leading Medicare codes shows very high claim counts and material revenue: 88305 has 21.1K claims with $52 avg paid/claim and $1.1M revenue, 88342 has 2K claims with $74 avg paid/claim and $148.5K revenue, and 88341 has 1K claims with $64 avg paid/claim and $65.7K revenue. These volumes reinforce that the provider’s business is transactionally centered on read/interpretation services and immunohistochemistry workload.
The provider has long tenure in the NPI system, enumerated 2006-06-13 (~20 years ago), which combined with the concentrated code mix and national outlier ranks suggests a stable, specialized pathology practice that has developed sustained high-volume workflows for a narrow set of pathology services. This also implies revenue concentration risk if referral patterns or reimbursement for those few high-impact codes change.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
8 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… | 21,140 | $50 | $1.1M |
| 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,… | 2,010 | $70 | $148.5K |
| 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… | 1,030 | $60 | $65.7K |
| 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… | 640 | $80 | $53K |
| 88304 | The physician, typically a pathologist, performs a level III examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 690 | $30 | $21.2K |
| 88350 | The analyst performs an immunofluorescent study using a single antibody stain procedure to detect autoimmune disease or an infectious organism in a tissue or cellular sample. Code +88350 describes… | 230 | $90 | $20.2K |
| 88346 | The analyst performs an immunofluorescent study using a single antibody stain procedure to detect autoimmune disease or an infectious organism in a tissue or cellular sample. | 60 | $120 | $6.4K |
| 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,… | 40 | $60 | $2.5K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 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.
1 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… | 80 | $40 | $2.9K |
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
1 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… | 156 | 190 | 940 | $20 | $115.2K |
Other providers in the same ZIP code as Douglas Hansen, ranked by combined Medicare and Medicaid revenue.
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