Loading...
NPI 1275032948 · The Woodlands, TX · Community/Retail Pharmacy
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Trifecta Pharmacy LLC is a community/retail pharmacy provider located in The Woodlands, Texas. This profile covers 1 Medicare and 1 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 | Trifecta Pharmacy LLC |
| Address | 9303 Pinecroft Ste 300 |
| City | The Woodlands |
| State | TX |
| ZIP | 77380 |
| Taxonomy | Community/Retail Pharmacy |
| NPI Enumerated | February 7, 2018 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $7.9M |
| Medicaid | $1.3K |
This provider’s Medicare business is overwhelmingly centered on 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). K1034 accounts for $8.1M of the provider’s Medicare receipts across 674.1K claims with an average paid of $12 per claim, indicating the operation is primarily dispensing high-volume, nonprescription COVID-19 tests rather than providing a broad range of clinical services.
Medicare revenue is the dominant payer relationship for this entity: total Medicare revenue is $7.9M versus total Medicaid revenue of $1.3K. The discrepancy shows the provider is effectively single-payer at scale, with Medicare activity driving virtually all reported billing and economic footprint.
Revenue concentration is extreme on both sides of the ledger for each payer: the precomputed top 3 Medicare codes by revenue account for 100.0% of this provider's total Medicare revenue, and the precomputed top 3 Medicaid codes by revenue account for 100.0% of this provider's total Medicaid revenue. This implies that the provider’s financial profile is narrowly dependent on a very limited set of billed codes, increasing sensitivity to reimbursement or utilization changes for those specific services.
The provider’s Medicare volume for K1034 positions it as a national leader for this code: K1034 is reported at $8.1M and 674.1K claims and the provider ranks #60 of 30143 providers nationally (100th percentile; extreme outlier, far above typical national volume for this code). In plain terms, this entity is an outlier in the national distribution for dispensing nonprescription COVID-19 tests under Medicare, operating at volumes far above typical peers.
By contrast, the provider’s Medicaid activity for the same code is modest and in-line with peers: K1034 under Medicaid shows 1.4K claims, $1.4K revenue, $1 avg paid/claim, and ranks #16 of 77 in-state (80th percentile; typical, unremarkable volume for this code). Medicaid contributes a de minimis share of total revenue and does not materially alter competitive positioning within the state.
Payment pattern differences reinforce the payer mix skew: Medicare average paid per K1034 claim is $12 while Medicaid average paid per K1034 claim is $1, reflecting both higher Medicare volume and higher per-claim reimbursement on Medicare for the same OTC COVID-19 test code. These differences suggest the provider’s commercial performance and cash flow are primarily driven by Medicare reimbursement levels and claim volumes.
Tenure is established but not long-standing: the NPI was enumerated on 2018-02-07 (~8 years ago), indicating several years of operation prior to the COVID-19 testing surge that dominates current billing. Given the concentrated code mix and the provider’s status as an extreme national outlier for K1034 on Medicare, future changes in demand or policy for nonprescription COVID-19 testing could materially alter this provider’s revenue profile.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
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 | 674,140 | $10 | $8.1M |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 1 CPT/HCPCS codes.
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 | 9 | 2,490 | 450 | $10 | $117.8K |
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.
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 | 1,390 | $1 | $1.4K |
How this provider's Medicaid billing volume and revenue compare to other Texas providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Texas median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 16 | 80 | 340 | $1 | $1.5K |
Other providers in the same ZIP code as Trifecta Pharmacy LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Pediatric Urgent Care PA | TX | Urgent Care Clinic/Center | $0 | $25.2M |
| Maxim Healthcare Services, Inc. | TX | Home Health Agency | $0 | $19M |
| Shaun S. Varghese, M.d., PLLC | TX | Neurology with Special Qualifications in Child Neurology Physician | $0 | $16.8M |
| Singleton Associates PA | TX | Diagnostic Radiology Physician | $0 | $16.2M |
| Guy Burrows | TX | Neurology Physician | $11.3M | $0 |
| Samir Shirodkar | TX | Urology Physician | $3.4M | $0 |
| Randall Johnson | TX | Rheumatology Physician | $2.5M | $0 |
| Wise Diagnostic Systems, LLC | TX | Clinical Medical Laboratory | $2M | $451.8K |
| Asit Choksi | TX | Medical Oncology Physician | $2.4M | $0 |
| Carolyn Chen | TX | Ophthalmology Physician | $2M | $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.