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NPI 1154485944 · Bismarck, ND · Clinical Medical Laboratory
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Sanford Bismarck is a clinical medical laboratory provider located in Bismarck, North Dakota. This profile covers 117 Medicare and 143 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 | Sanford Bismarck |
| Address | 222 N 7th St |
| City | Bismarck |
| State | ND |
| ZIP | 58501 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | December 19, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $4.3M |
| Medicare | $726.9K |
Payer mix is heavily weighted toward Medicaid: this provider reports Total Medicare revenue: $726.9K versus Total Medicaid revenue: $4.3M, indicating Medicaid is the dominant revenue source by scale. The Medicaid portfolio drives a much larger absolute dollar flow even though both payers show similar service types, so contract and network positioning with state Medicaid plans will disproportionately affect topline performance.
The code mix shows a combined anatomic pathology and comprehensive clinical laboratory operation. 88305 is the single largest code for both payers (Medicare 31.3% of the provider's Medicare revenue and Medicaid $537.2K, 16.7% of Medicaid revenue), and high‑value pathology codes such as 88341, 88342 and 88307 appear alongside broad clinical panels (80053, 80061), TSH (84443) and routine phlebotomy (36415), signaling integrated histopathology/cytology services plus high-volume routine testing.
Medicare revenue is relatively concentrated: the precomputed top 3 Medicare codes account for 46.1% of this provider's total Medicare revenue, driven primarily by 88305, 88341 and 36415. In particular, 88305 represents 31.3% of Medicare revenue and serves as the chief Medicare revenue driver, so changes in reimbursement or utilization for surgical pathology could materially affect the Medicare book of business.
Medicaid revenue also shows concentration in a few high-volume codes: the top 3 Medicaid codes account for 35.8% of Medicaid revenue, led by 88305, 80053 and 84443. 80053 (CMP) and 84443 (TSH) together reflect substantial clinical chemistry volume on the Medicaid side (80053 reported $384.3K and 84443 $233.3K), indicating that general chemistry and endocrine screening are major Medicaid service lines.
Competitive standing is mixed across payers and codes: on Medicare, 88305 ranks #448 of 14580 providers nationally (97th percentile; typical, unremarkable volume) while 88341 ranks #139 of 10274 (99th percentile; notably above typical national volume), showing above‑typical national volume for selected pathology stains but otherwise typical volumes for many routine tests. This pattern suggests the provider is a strong regional pathology performer for select specialized services while maintaining routine lab volumes in line with many peers.
Within the state Medicaid market the provider is a leading participant for several codes: 88305 ranks #3 of 21 in‑state (90th percentile), 88307 ranks #1 of 5 (100th percentile), and high-volume testing such as 36415 ranks #3 of 91 (98th percentile; extreme outlier, far above typical state volume). Those in‑state ranks indicate competitive dominance for certain pathology and specimen‑collection services and unusually large Medicaid specimen collection volume compared with other in‑state labs.
Several specialized and high‑unit‑price assays are present but not dominant nationally. Medicare HLA bead assays 86833 and 86832 generate meaningful per‑claim revenue ($307 and $306 avg paid/claim respectively) but are low in national rank (each #15 of 22 providers nationally; 33th percentile; typical, unremarkable volume), which suggests capacity for specialized testing that is limited in national footprint. On the Medicaid side, a cluster of higher‑paid molecular and cytology services (e.g., 87624 rank #1 of 10 in‑state, 100th percentile; 88175 rank #1 of 8 in‑state, 100th percentile) point to state‑level leadership in HPV and automated cytology screening.
NPI tenure is long and consistent with an established laboratory: NPI enumerated (registered) 2006-12-19 (~20 years ago). That longevity, combined with top in‑state ranks on multiple Medicaid pathology and cytology codes, supports an interpretation of an established lab operation with entrenched referral or collection relationships in North Dakota rather than a newly entering competitor.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
117 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… | 6,640 | $30 | $172.6K |
| 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… | 1,890 | $20 | $41.6K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 4,960 | $10 | $39.6K |
| 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… | 2,130 | $20 | $34.1K |
| 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,… | 880 | $30 | $24.6K |
| 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… | 350 | $60 | $21.4K |
| 84165 | The lab analyst performs the technical lab test to separate and quantitate components of serum protein in a process called serum protein electrophoresis, SPE, or SPEP. The electrophoretic… | 1,770 | $10 | $21.3K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 450 | $40 | $17.8K |
| 86833 | The lab analyst performs a solid phase immunoassay using patient serum to identify the presence of specific antibodies to specific Class II human leukocyte antigens, or HLA, using a high–definition… | 40 | $310 | $12.6K |
| 86832 | The lab analyst performs a solid phase immunoassay using patient serum to identify the presence of specific antibodies to specific Class I human leukocyte antigens, or HLA, using a high–definition… | 40 | $310 | $12.5K |
Showing 1–10 of 117
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 117 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.
143 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… | 12,210 | $40 | $537.2K |
| 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. | 16,710 | $20 | $384.3K |
| 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… | 9,720 | $20 | $233.3K |
| 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… | 2,610 | $90 | $229.6K |
| 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. | 9,800 | $20 | $176.4K |
| 88175 | 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… | 3,640 | $40 | $134.7K |
| 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,… | 2,060 | $60 | $125.7K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 3,580 | $30 | $121.5K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 39,950 | $1 | $119.8K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 1,690 | $70 | $114.6K |
Showing 1–10 of 143
How this provider's Medicaid billing volume and revenue compare to other North Dakota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. North Dakota median
143 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… | 3 | 20 | 1,200 | $50 | $190.6K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 4 | 10 | 160 | $60 | $172.1K |
| 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 | 10 | 670 | $110 | $123.1K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 11 | 20 | 920 | $30 | $111.2K |
| 0241U | N/A | 12 | 20 | 200 | $130 | $62.2K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 3 | 10 | 300 | $50 | $53.7K |
| 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. | 6 | 50 | 630 | $10 | $49.4K |
| 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 | 10 | 180 | $60 | $45.7K |
| 88175 | 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… | 1 | 10 | 220 | $40 | $43.8K |
| U0005 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc,… | 7 | 10 | 180 | $10 | $42.8K |
Showing 1–10 of 143
Other providers in the same ZIP code as Sanford Bismarck, ranked by combined Medicare and Medicaid revenue.
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