NPI 1235881327 — Billing Profile & Reimbursement Data
NPI 1235881327 · XX · healthcare
Customize your policy alerts
Sign up for NPI 1235881327 — Billing Profile & Reimbursement Data policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
NPI 1235881327 is a healthcare provider located in Unspecified Location. This profile covers 1 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 1235881327 |
| Address | |
| City | |
| State | XX (Unspecified Location) |
| ZIP | |
| Taxonomy | N/A |
| NPI Enumerated | |
| NPI Deactivated | June 26, 2023 |
(source: CMS Medicare & Medicaid claims data)
Key Findings
This provider’s Medicare billing is dominated entirely by a single service line: K1034 (Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count). The K1034 line shows 387K claims at an average paid amount of $12 per claim, producing $4.6M in Medicare revenue which represents 100.0% of the provider’s reported Medicare revenue, indicating the organization’s operations are focused on high-volume distribution or provisioning of nonprescription COVID-19 self-tests rather than a diversified clinical service mix.
Revenue concentration is extreme: the precomputed top-3 Medicare codes account for 100.0% of total Medicare revenue, and in practice that revenue is all reported under K1034 ($4.6M). That level of single-code dependence signals material business risk if reimbursement policy, demand, or coding guidance for K1034 changes, because alternative Medicare revenue streams are not evident in the file.
Payer mix is effectively single-payer: Medicare accounts for all reported public-payer revenue ($4.6M) while there is no Medicaid billing on file. The absence of Medicaid billing—explicitly noted as "no Medicaid billing on file"—means analysts should treat this entity as operating without measurable Medicaid participation for comparative payer-share or network analyses.
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 386,990 | $10 | $4.6M |
Medicare: Competitive Analysis & Benchmarks
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 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
1 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| K1034 | 29 | 0 | N/A | $N/A | $N/A |
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.