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NPI 1174633143 · New Haven, CT · Ambulatory Family Planning Facility
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Planned Parenthood Of Southern New England, Inc. is a ambulatory family planning facility provider located in New Haven, Connecticut. This profile covers 0 Medicare and 64 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 | Planned Parenthood Of Southern New England, Inc. |
| Address | 345 Whitney Ave |
| City | New Haven |
| State | CT |
| ZIP | 06511 |
| Taxonomy | Ambulatory Family Planning Facility |
| NPI Enumerated | August 30, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $37.9M |
| Medicare | $0 |
This provider is effectively a Medicaid-focused operation: there is no Medicare billing on file and lifetime Medicaid revenue is listed as $37.9M, indicating it operates as a single‑payer provider in practice rather than a mixed Medicare/Medicaid clinic. The NPI was enumerated 2006-08-30 (~20 years ago), showing an established presence in the market.
Revenue is highly concentrated in a very small set of services: the precomputed top three Medicaid codes account for 47.7% of the provider's total Medicaid revenue. Those top three codes are 99213 ($6.5M, 17.4%), 87491 ($5.7M, 15.2%), and 87591 ($5.7M, 15.2%), which together drive nearly half of Medicaid receipts.
The code mix signals a reproductive and sexual‑health/family‑planning service line with high throughput laboratory testing: dominant codes include high-volume NAAT tests 87491, 87591, and 87661 (the latter $4.3M, 11.4%), plus contraception and contraceptive administration codes such as S4993 ($3.4M, 9.2%) and J1050 ($2.3M, 6.2%). Combined with frequent office visits (99213, 99214) and point-of-care tests (81025 pregnancy test), the pattern is consistent with a clinic model focused on STI screening, contraception, and routine outpatient reproductive care.
The provider is a statewide leader in several discrete services: 87491 and 87591 both rank #1 of 49 providers in-state (100th percentile; extreme outlier), 87661 ranks #1 of 24 (100th percentile; extreme outlier), and multiple other codes (e.g., 87210, 96372, 85018) are labeled extreme outliers or at the 100th percentile. These rankings indicate the clinic is a dominant testing and procedural hub for STI diagnostics and related services within Connecticut.
Visit mix shows exceptionally high volume of low-to-moderate complexity outpatient visits: 99213 represents $6.5M (17.4%) and ranks #23 of 1714 providers in-state (99th percentile; extreme outlier), while 99214 contributes $2M (5.4%). Those volumes, together with substantial counts for 99202/99203 and 99212, suggest ongoing demand for both new and established outpatient encounters alongside the lab services.
Contraceptive service lines form a meaningful portion of revenue and product dispensing: S4993 (contraceptive pills) accounts for $3.4M (9.2%) and ranks #1 of 2 providers in-state (100th percentile), J1050 (medroxyprogesterone injection) accounts for $2.3M (6.2%) and ranks #1 of 30 providers (100th percentile). Additional supply codes such as A4267 (condoms, $815.4K) and prescription drug codes S5000/S5001 further evidence integrated contraceptive provision and pharmacy dispensing.
Operational profile shows large-scale point-of-care and specimen-handling throughput: 81025 pregnancy tests (72.3K claims, $505.8K) rank #3 of 128 (98th percentile) and 87210 wet mount (48.3K claims, $241.6K) ranks #1 of 26 (100th percentile). High claim counts across lab and injection administration codes (e.g., 96372: 59.8K claims, $897.1K) indicate substantial daily clinic flow and on-site testing capacity.
Because nearly half of Medicaid revenue derives from three codes and the overall business is concentrated in Medicaid, the provider’s revenue profile is sensitive to changes in Medicaid coverage, reimbursement, or testing guidelines that affect NAAT testing, E&M visit reimbursement, or contraceptive supply reimbursement. The concentration highlights both the clinic’s operational specialization and a potential exposure if payer policy or utilization patterns shift for those high‑share services.
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.
64 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 130,100 | $50 | $6.5M |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 171,930 | $30 | $5.7M |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 171,820 | $30 | $5.7M |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 146,930 | $30 | $4.3M |
| S4993 | Contraceptive pills for birth control | 69,920 | $50 | $3.4M |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | 44,960 | $50 | $2.3M |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 25,320 | $80 | $2M |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 31,180 | $30 | $1M |
| 96372 | A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician… | 59,810 | $20 | $897.1K |
| A4267 | Contraceptive supply, condom, male, each | 67,950 | $10 | $815.4K |
Showing 1–10 of 64
How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Connecticut median
64 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| S4993 | Contraceptive pills for birth control | 1 | 10 | 34,970 | $50 | $1.7M |
| A4267 | Contraceptive supply, condom, male, each | 1 | 10 | 67,950 | $10 | $828.9K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 1 | 50 | 4,240 | $30 | $410.4K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 1 | 50 | 4,240 | $30 | $409.9K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 69 | 1,590 | 740 | $50 | $331.8K |
| 81513 | The lab analyst performs the technical lab test on a vaginal fluid specimen for quantitative real–time amplification of RNA markers for three bacterial species listed in the code descriptor, and… | 7 | 10 | 1,800 | $80 | $325.9K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 1 | 20 | 1,770 | $30 | $278.8K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 23 | 1,710 | 750 | $30 | $243.3K |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies | 3 | 10 | 820 | $280 | $240.9K |
| 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. | 19 | 30 | 3,460 | $30 | $219.9K |
Showing 1–10 of 64
Other providers in the same ZIP code as Planned Parenthood Of Southern New England, Inc., ranked by combined Medicare and Medicaid revenue.
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