Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Puerto Rico for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Puerto Rico only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Puerto Rico (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Southern Pathology Services, Inc. (NPI 1134119233)

Key Findings

Field	Value
Entity Type	Organization
Organization	Southern Pathology Services, Inc.
Address	234 Daigue Industrial Sabanetis
City	Ponce
State	PR
ZIP	00715
Taxonomy	Anatomic Pathology Physician
NPI Enumerated	October 28, 2005

Payer Source	Total Paid
Medicaid	$18.9M
Medicare	$0

SOUTHERN PATHOLOGY SERVICES, INC. reports no Medicare billing on file and $18.9M in lifetime Medicaid revenue, making its activity effectively single-payer Medicaid in the available data. The absence of Medicare revenue suggests this entity’s commercial and Medicare-facing footprint is minimal or not captured in the dataset, while its Medicaid role is material and measurable.

Revenue for this provider is highly concentrated: the precomputed top 3 Medicaid codes account for 55.3% of total Medicaid revenue, driven by 88305 ($5.7M, 30.5%), 88307 ($2.6M, 14.0%), and 88341 ($2M, 10.8%). That degree of concentration indicates surgical pathology and related interpretive services are the primary revenue drivers for the practice.

The provider’s code mix points to a full-service anatomic pathology operation that combines high-volume surgical pathology interpretation (multiple 8830x levels) with immunohistochemistry and cytopathology. Notable examples include 88305 (71K claims, $81 avg paid/claim, $5.7M) and 88307 (11.7K claims, $226 avg paid/claim, $2.6M), plus immunostain codes such as 88341 (8.7K claims, $235 avg paid/claim, $2M) and 88342 (25.3K claims, $79 avg paid/claim, $2M).

State-level competitive standing is strong on several high-value codes: the provider ranks #1 of 18 for 88307 (100th percentile) and #1 of 15 for 88342 (100th percentile), while ranking #2 of 32 for 88305 (97th percentile). These ranks indicate the practice is a dominant in-state supplier for key surgical pathology and ancillary testing services.

High cytology throughput is evident and contributes materially to Medicaid revenue: 88142 appears with 82.9K claims and $1.8M revenue (9.7% of total Medicaid revenue), ranking #2 of 52 providers in-state (98th percentile). This volume profile is consistent with a lab that performs large-scale Pap/HPV screening and cytology processing under physician supervision.

The provider is also an outlier in molecular/NAAT infectious disease testing: 87491 (23.7K claims, $30 avg paid/claim, $710.8K, 3.8%) and 87591 (23.5K claims, $29 avg paid/claim, $682K, 3.6%) both rank #5 of many state peers and are labeled as “extreme outlier, far above typical state volume for this code.” Such elevated NAAT volumes suggest substantial contracted throughput for STI testing in Medicaid populations.

The breadth of interpretive complexity is supported by presence of higher-level surgical pathology codes and specialty stains: 88309 (593 claims, $362 avg paid/claim, $214.7K, 1.1%) ranks #1 of 6 providers (100th percentile) and 88361 (331 claims, $312 avg paid/claim, $103.3K, 0.5%) is reported as #1 of 1 providers with no state peer volume comparison available. This mix indicates capacity to handle complex specimens and specialized immunohistochemistry workflows.

The provider’s NPI was enumerated on 2005-10-28 (~21 years ago), reflecting long tenure in the market. That longevity, together with concentrated Medicaid revenue and top-state ranks on core pathology and laboratory codes, supports the characterization of an established, Medicaid-focused anatomic pathology service with significant in-state market share for several high-volume codes.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

49 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…	70,970	$80	$5.7M
88307	The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	11,710	$230	$2.6M
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…	8,700	$240	$2M
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,…	25,320	$80	$2M
88142	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	82,940	$20	$1.8M
87624	The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result.	23,540	$30	$729.7K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	23,690	$30	$710.8K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	23,520	$30	$682K
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…	13,730	$30	$453.2K
87798	The lab analyst performs a test for an infectious agent not specified in another code using an amplified nucleic acid probe technique. Use this code if you know the laboratory technique is amplified…	10,800	$30	$324K

Showing 1–10 of 49

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.

Claims Volume vs. Puerto Rico Distribution

Southern Pathology Services, Inc. — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

49 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…	2	30	4,250	$80	$1.3M
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…	2	10	1,420	$300	$1.2M
87661	The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique.	4	10	4,190	$30	$655.7K
87624	The lab analyst performs a test to determine the presence of human papillomavirus, or HPV. The provider uses nucleic acid detection for high–risk types and produces a pooled result.	5	30	910	$40	$638.8K
88307	The physician, typically a pathologist, performs a level V examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally…	1	20	1,210	$190	$535.5K
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…	25	30	1,210	$150	$530.3K
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,…	1	20	2,030	$80	$485.9K
88142	The lab analyst performs the technical lab test to analyze a cervical or vaginal cytopathology specimen that a clinician collected in preservative fluid. The test uses automated thin layer…	2	50	370	$20	$247.3K
88173	The lab analyst performs the technical lab test to analyze a cytopathology specimen from a fine needle aspirate and then interprets and reports the results.	11	10	1,220	$120	$238.7K
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,…	8	10	150	$130	$161K

Showing 1–10 of 49

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Southern Pathology Services, Inc.	PR	Clinical Medical Laboratory	$6.2K	$5.7M
Adalberto Mendoza	PR	Anatomic Pathology & Clinical Pathology Physician	$13.3K	$1.5M

Southern Pathology Services, Inc. — Billing Profile & Reimbursement Data

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Southern Pathology Services, Inc. — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References