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NPI 1124603451 · Wharton, TX · Community/Retail Pharmacy
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Health Wise Affordable Pharmacy is a community/retail pharmacy provider located in Wharton, Texas. This profile covers 1 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 | Organization |
| Organization | Health Wise Affordable Pharmacy |
| Address | 214 W Ahldag St |
| City | Wharton |
| State | TX |
| ZIP | 77488 |
| Taxonomy | Community/Retail Pharmacy |
| NPI Enumerated | March 17, 2021 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.2M |
| Medicaid | $940 |
HEALTH WISE AFFORDABLE PHARMACY is a Community/Retail Pharmacy located in WHARTON, TX with an NPI enumerated on 2021-03-17 (~5 years ago). The provider's billing profile is narrowly focused by taxonomy and tenure, consistent with a retail pharmacy that has been active for a multi-year period but is not an incumbent with decades of claims history.
Medicare revenue is concentrated entirely in a single service line: K1034 accounts for 100.0% of this provider's total Medicare revenue, representing $5.2M in lifetime Medicare payments from 431.1K claims at an average paid amount of $12 per claim. The provider ranks #93 of 30143 nationally for K1034 (100th percentile) and is described as an extreme outlier, indicating it operates at a far higher national volume for this code than typical peers.
Medicaid billing is also concentrated in the same single code: K1034 represents 100.0% of the provider's total Medicaid revenue, equal to $941 from 941 claims at an average paid amount of $1 per claim. Within Texas the provider ranks #24 of 77 for K1034 (70th percentile) and shows a typical, unremarkable volume relative to in-state peers.
Payer mix is heavily skewed toward Medicare: lifetime Medicare revenue of $5.2M dwarfs lifetime Medicaid revenue of $941, making this effectively a Medicare-dominated operation by scale. Analysts should treat the entity as functionally single-payer dominant for revenue impact and forecasting, with Medicaid contributing a negligible share of dollar revenue.
The code mix (solely K1034: provision of nonprescription, self-administered COVID-19 tests) suggests the business model centers on dispensing or distributing FDA-approved/authorized OTC COVID-19 tests and claiming reimbursement for those transactions. This service-line alignment is consistent with a retail pharmacy that bills payers for point-of-sale COVID-19 test provisioning rather than for broader pharmacy dispensing or clinical services.
There is a stark divergence in claim volume and unit payment between payers: Medicare shows 431.1K claims at $12 average paid/claim versus Medicaid's 941 claims at $1 average paid/claim. This pattern implies materially different reimbursement and utilization dynamics across payers for the same code, which has direct implications for revenue sensitivity to payer policy changes.
Given that precomputed top-3 shares are 100.0% for both Medicare and Medicaid, the provider's revenue profile is highly concentrated in a single CPT/HCPCS code and therefore operationally vulnerable to changes in demand, reimbursement, or medical policy for K1034. The provider's national standing as an extreme outlier on Medicare for this code further signals a unique market position that payers and competitors should monitor for capacity, sourcing, or contracting implications.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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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 | 431,090 | $10 | $5.2M |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
1 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| K1034 | 18 | 2,490 | 450 | $10 | $117.8K |
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 |
|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 940 | $1 | $940 |
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 24 | 80 | 340 | $1 | $1.5K |
Other providers in the same ZIP code as Health Wise Affordable Pharmacy, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| All The Little Things Count, Lc | TX | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | $0 | $26.5M |
| Nadim Jafri | TX | Gastroenterology Physician | $192.6K | $0 |
| Namita Tuli | TX | Specialist | $126.8K | $0 |
| Peggy Avendano | TX | Family Nurse Practitioner | $75.3K | $0 |
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