NPI 1225554843 — Billing Profile & Reimbursement Data
NPI 1225554843 · XX · healthcare
Customize your policy alerts
Sign up for NPI 1225554843 — Billing Profile & Reimbursement Data policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
NPI 1225554843 is a healthcare provider located in Unspecified Location. This profile covers 17 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services. Note: "XX" is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; claims coded under it are grouped and benchmarked here the same way a traditional state would be.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | NPI 1225554843 |
| Address | |
| City | |
| State | XX (Unspecified Location) |
| ZIP | |
| Taxonomy | N/A |
| NPI Enumerated | |
| NPI Deactivated | January 29, 2026 |
(source: CMS Medicare & Medicaid claims data)
Key Findings
This provider’s Medicare business is highly concentrated: Total Medicare revenue is $7.8M and the precomputed top-3-share shows that the top 3 Medicare codes by revenue account for 70.2% of this provider's total Medicare revenue. In particular, 87798 alone generates $3.9M (50.0% of Medicare revenue), signaling an extreme concentration on a single high-revenue test.
The code mix indicates a specialized molecular diagnostic operation focused on amplified nucleic acid probe techniques and definitive toxicology. The top codes—87798 (amplified probe for unspecified infectious agents), 87507 (12–25 pathogen multiplex panel), and G0483 (definitive multi-class drug testing)—together point to a high-throughput infectious-disease and confirmatory drug-testing lab rather than a general clinical practice or point-of-care clinic.
Several Medicare code ranks position this entity as a national-volume leader for specific assays. ranks #1 of 60 providers nationally (100th percentile; extreme outlier) and ranks #10 of 1319 providers (99th percentile; extreme outlier), indicating dominant or atypically large national volumes for those assays; by contrast, ranks #29 of 1063 providers (97th percentile) and is characterized in the data as a "typical, unremarkable volume for this code," suggesting that although contributes materially to revenue ($733.5K, 9.4%), its pattern aligns with broader national participation for definitive drug testing.
Medicare: Total Revenue Breakdown by CPT/HCPCS Code
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
Medicare: Complete Services Breakdown
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 114,310 | $30 | $3.9M |
| 87507 | The lab analyst performs a test to detect 12 to 25 types or subtypes of a pathogen, such as Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia, that affects the gastrointestinal… | 2,060 | $410 | $838.4K |
| G0483 | Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but… | 3,030 | $240 | $733.5K |
| 87481 | The lab analyst performs a test for Candida species using amplified nucleic acid probe technique. | 10,180 | $30 | $346.2K |
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 8,610 | $30 | $292.6K |
| 87640 | The lab analyst performs the technical lab test to look for Staphylococcus aureus nucleic acid using an amplified probe technique. | 8,600 | $30 | $292.2K |
| 87502 | The lab analyst performs a test to determine the presence of multiple types or subtypes of influenza virus through nucleic acid detection using multiplex amplified probe technique and possibly… | 2,540 | $70 | $187.8K |
| 87486 | The lab analyst performs a test for Chlamydia pneumoniae using amplified nucleic acid probe technique. Chlamydia pneumoniae also known as TWAR, Taiwan Acute Respiratory agent, commonly causes mild… | 5,240 | $30 | $178.1K |
| 87541 | The lab analyst performs a test for the bacteria Legionella pneumophila using amplified nucleic acid probe technique. L. pneumophila can inhabit facility water and air conditioning systems and may… | 5,240 | $30 | $178.1K |
| 87581 | The lab analyst performs a test for Mycoplasma pneumonia, a bacteria, using amplified nucleic acid probe technique. | 5,230 | $30 | $178K |
Showing 1–10 of 17
Medicare: Competitive Analysis & Benchmarks
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes. Note: this provider's state, "XX," is a placeholder CMS uses when a provider's practice-location state wasn't reported — not a traditional US state; the State panel below benchmarks against other providers coded under the same designation.
View: State1 / 2
Full comparison — all codes billed, vs. state median
Frequently Asked Questions
References
- 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
- 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.
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.