Loading...
NPI 1225194574 · Fargo, ND · Clinical Medical Laboratory
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Sanford Clinic North is a clinical medical laboratory provider located in Fargo, North Dakota. This profile covers 194 Medicare and 154 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 Clinic North |
| Address | 737 Broadway |
| City | Fargo |
| State | ND |
| ZIP | 58122 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | December 29, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $7M |
| Medicare | $1.4M |
Provider is heavily Medicaid-focused: lifetime Medicaid revenue is $7M versus total Medicare revenue of $1.4M, so Medicaid drives the majority of billed dollars. This makes SANFORD CLINIC NORTH effectively a Medicaid-dominant clinical lab in scale and market impact rather than a Medicare-centric operation.
Billing mix aligns with a full-service clinical medical laboratory that handles both anatomic/surgical pathology and high-volume clinical chemistry and infectious-disease screening. High-revenue pathology codes such as 88305 and immunohistochemistry codes (88342, 88341) appear alongside routine panels (80053, 80061) and infectious disease NAATs (87491, 87591), consistent with centralized specimen accessioning, phlebotomy throughput, and pathology interpretation.
Medicaid revenue is concentrated but diversified across pathology, panels, and infectious disease testing: the top three Medicaid codes (88305, 80053, 87491) account for 37.2% of total Medicaid revenue. Notably, 88305 is an extreme outlier in-state (ranks #1 of 21; extreme outlier, far above typical state volume) and 87491 also ranks #1 in-state (extreme outlier), indicating that a relatively small set of high-value services capture a large share of Medicaid receipts.
Medicare revenue concentration is meaningful: the top three Medicare codes (88305, 36415, 84443) account for 41.1% of total Medicare revenue. On Medicare, 88305 again performs above typical national volume (ranks #324 of 14580; 98th percentile; notably above typical national volume for this code), while 36415 and 84443 show high claim counts but are described as typical, unremarkable volume nationally.
Competitive standing is stronger within the state Medicaid market than nationally on Medicare: multiple high-revenue Medicaid codes rank at the top of state peer lists (for example, 88305, 87491, 84443, 87389, 87591, 86803 are all rank #1 or otherwise described as extreme or notably above typical in-state). By contrast, the provider’s Medicare footprint shows above-typical national volume on select pathology codes but is otherwise a strong regional contributor rather than a national dominant across panels.
Operational throughput appears substantial: claim volumes reported include 22.9K Medicaid claims for 88305, 23.2K Medicaid claims for 80053, 6.1K Medicaid claims for 87491, plus large specimen-collection volumes (36415: 14.2K Medicare claims and 51.6K Medicaid claims). Those volumes support a model with heavy phlebotomy and batch testing operations plus centralized pathology sign-out.
The provider’s code-level percentile labels signal statistical outlier status for several Medicaid services and elevated national presence for pathology on Medicare, using the plain-English labels provided. For Medicaid the dataset repeatedly flags “extreme outlier” and “notably above typical state volume” for core codes, whereas Medicare descriptions are a mix of “notably above typical national volume” for 88305 and “typical, unremarkable volume” for other high-claim codes.
The NPI enumeration date is 2006-12-29 (~20 years ago), indicating the provider has long tenure in the market; combined with the large Medicaid volumes and multiple #1 state ranks, this suggests established referral relationships and processing capacity in-state.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
194 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… | 8,400 | $30 | $218.5K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 14,250 | $10 | $114K |
| 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… | 5,830 | $20 | $93.2K |
| 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… | 2,070 | $30 | $53.7K |
| 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… | 3,870 | $10 | $46.4K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 1,540 | $30 | $44.7K |
| 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,… | 1,200 | $30 | $38.2K |
| 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. | 3,700 | $10 | $37K |
| 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. | 890 | $40 | $35.7K |
| 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. | 2,630 | $10 | $34.2K |
Showing 1–10 of 194
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 194 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.
154 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… | 22,870 | $50 | $1M |
| 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. | 23,240 | $20 | $557.8K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 6,150 | $70 | $448.8K |
| 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… | 2,210 | $150 | $331.2K |
| 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… | 23,390 | $10 | $327.5K |
| 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,… | 3,580 | $80 | $268.2K |
| 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… | 8,370 | $30 | $267.8K |
| 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… | 2,570 | $100 | $246.9K |
| 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. | 14,020 | $20 | $224.3K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 6,490 | $30 | $188.2K |
Showing 1–10 of 154
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
154 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 162 | 210 | 360 | $100 | $498.2K |
| 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… | 156 | 170 | 300 | $100 | $415.8K |
| 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… | 1 | 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… | 7 | 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… | 2 | 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. | 9 | 20 | 920 | $30 | $111.2K |
| 83013 | The lab analyst tests multiple breath samples for the presence of an isotope that indicates the presence of the H. pylori bacteria. This organism can cause irritation and ulcers of the stomach lining. | 1 | 10 | 860 | $100 | $88.4K |
| 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 | 840 | $50 | $68.6K |
| 0241U | N/A | 15 | 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… | 2 | 10 | 300 | $50 | $53.7K |
Showing 1–10 of 154
Other providers in the same ZIP code as Sanford Clinic North, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Ashish Regulagadda | ND | Nephrology Physician | $145.4K | $0 |
| Anthony Charbonneau | ND | Orthopedic Physical Therapist | $126.8K | $0 |
| Ross Meidinger | ND | Gastroenterology Physician | $123.7K | $0 |
| Puneet Sharma | ND | Interventional Cardiology Physician | $103.9K | $0 |
| Jeffrey Hunt | ND | Internal Medicine Physician | $72.3K | $0 |
| Manisha Balhara | ND | Hospitalist Physician | $70.6K | $0 |
| Kim Belzberg | ND | Internal Medicine Physician | $64K | $0 |
| Erik Heitkamp | ND | Hospitalist Physician | $55.9K | $0 |
| Jared Velgersdyk | ND | Internal Medicine Physician | $53.4K | $0 |
| Suchita Kotnala | ND | Family Medicine Physician | $51.9K | $0 |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.