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NPI 1154586808 · Ponce, PR · Clinical Medical Laboratory
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Southern Pathology Services, Inc. is a clinical medical laboratory provider located in Ponce, Puerto Rico. This profile covers 6 Medicare and 31 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 | Southern Pathology Services, Inc. |
| Address | 234-a Parque Industrial Sabaneta |
| City | Ponce |
| State | PR |
| ZIP | 00716 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | July 22, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $5.7M |
| Medicare | $6.2K |
This entity is effectively a Medicaid-focused clinical laboratory: Total Medicare revenue is $6.2K while Total Medicaid revenue is $5.7M, indicating Medicaid revenue dwarfs Medicare receipts and the provider operates primarily within the state Medicaid market. The large disparity suggests contracts, specimen sources, or patient panels are concentrated in Medicaid rather than Medicare populations.
Revenue concentration is high on both payers’ top assays: the top 3 Medicare codes by revenue account for 70.8% of this provider's total Medicare revenue, while the top 3 Medicaid codes by revenue account for 69.9% of its total Medicaid revenue. This concentration implies the business is driven by a narrow set of molecular and infectious-disease assays rather than a broad mix of lab services.
The provider’s Medicare footprint is modest and concentrated in a few cytology and HPV-related services: code 87624 (HPV testing) generates $2.1K and 62 claims and accounts for 34.2% of the provider’s Medicare revenue, and code 88142 (thin-prep cytology technical component) generates $1.6K across 82 claims and 26.6% of Medicare revenue. National ranks for these Medicare services are middle-of-pack (87624 ranks #250 of 475, 47th percentile; 88142 ranks #68 of 198, 66th percentile), signaling unremarkable national volume rather than leadership on Medicare.
By contrast, the provider is a major in-state performer on core sexually transmitted infection (STI) molecular tests under Medicaid: code 87624 appears at 40.6K claims and $1.6M revenue (27.7% of Medicaid revenue) and ranks #3 of 29 in-state (93th percentile), while code 87591 (GC) posts 35.8K claims and $1.2M revenue and code 87491 (Chlamydia) posts 36.1K claims and $1.2M revenue, each accounting for roughly one-fifth of Medicaid revenue. Both 87591 and 87491 are flagged as extreme outlier, far above typical state volume and rank #2 in-state, which establishes this lab as a dominant state supplier for high-volume NAAT STI testing.
The mix of top codes indicates an operational emphasis on high-throughput nucleic acid amplification tests (NAATs) and molecular diagnostics: leading codes include 87624, 87591, 87491, 87661 and 87641, which are all NAAT or nucleic acid detection assays for HPV, GC, Chlamydia, Trichomonas, and MRSA. This pattern is consistent with a centralized clinical medical laboratory set up for specimen batching and molecular workflow rather than point-of-care or routine chemistry panels.
COVID-era testing also contributes meaningfully to Medicaid revenue: U0002 and 87635 together produce roughly $182.6K and $182.2K in revenue respectively (each ~3.2% of Medicaid revenue) and rank above typical state volume for U0002 (#7 of 178, 97th percentile) and in the upper ranges for 87635 (#27 of 366, 93th percentile). The presence of multiple COVID test codes plus specimen-collection billing (G2023) indicates the lab supported pandemic testing capacity in-state at notable volumes.
Competitive standing is bifurcated by payer: nationally the lab is a modest Medicare participant with several codes in the middle percentiles, whereas within Puerto Rico it is a top-tier Medicaid volumetric player for STI NAATs (multiple #2–#3 in-state ranks and high percentiles). For payers and network managers this implies the lab can be a critical in-network partner for Medicaid STI screening volume but is unlikely to drive Medicare-centric contracting.
The provider has long-standing enrollment and likely operational stability: NPI enumerated on 2008-07-22 (~18 years ago), which supports that the current billing patterns reflect an established business rather than a recently launched operation. Given the tenure plus concentrated high Medicaid volumes, the lab appears to have entrenched specimen flows and referral relationships within the state Medicaid ecosystem.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 60 | $30 | $2.1K |
| 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… | 80 | $20 | $1.6K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 20 | $30 | $610 |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 20 | $30 | $610 |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 20 | $30 | $610 |
| 87641 | The lab analyst performs a test for methicillin–resistant Staphylococcus aureus (MRSA) using an amplified nucleic acid probe technique. | 20 | $30 | $580 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 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.
31 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 40,610 | $40 | $1.6M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 35,770 | $30 | $1.2M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 36,080 | $30 | $1.2M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 27,610 | $30 | $938.8K |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | 3,580 | $50 | $182.6K |
| 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… | 3,640 | $50 | $182.2K |
| 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… | 2,880 | $40 | $103.6K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 2,970 | $30 | $74.2K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 2,020 | $30 | $64.5K |
| 87563 | he lab analyst performs a test on a patient specimen such as blood, for Mycoplasma genitalium antigen detection using amplified nucleic acid probe technique. | 1,960 | $30 | $51K |
Showing 1–10 of 31
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
31 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 2 | 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. | 3 | 30 | 910 | $40 | $638.8K |
| 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… | 38 | 50 | 370 | $20 | $247.3K |
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 29 | 40 | 250 | $80 | $140.8K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 3 | 10 | 2,020 | $30 | $139.7K |
| 87563 | he lab analyst performs a test on a patient specimen such as blood, for Mycoplasma genitalium antigen detection using amplified nucleic acid probe technique. | 3 | 10 | 2,430 | $30 | $138.4K |
| 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,… | 477 | 650 | 1,260 | $40 | $93.7K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 170 | 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… | 27 | 370 | 370 | $50 | $63.3K |
| 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… | 3 | 10 | 180 | $30 | $63.1K |
Showing 1–10 of 31
Other providers in the same ZIP code as Southern Pathology Services, Inc., ranked by combined Medicare and Medicaid revenue.
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