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NPI 1275739815 · Bedford, TX · Clinical Medical Laboratory
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Texas Digestive Disease Consultants, PLLC is a clinical medical laboratory provider located in Bedford, Texas. This profile covers 8 Medicare and 4 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 | Texas Digestive Disease Consultants, PLLC |
| Address | 1800 Plaza Dr |
| City | Bedford |
| State | TX |
| ZIP | 76021 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | June 21, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $8M |
| Medicaid | $61.6K |
TEXAS DIGESTIVE DISEASE CONSULTANTS, PLLC’s billing mix is concentrated in anatomic pathology and immunohistochemistry: the top Medicare codes are 88305 (surgical pathology level IV), 88342 (initial single antibody stain with pathologist interpretation), and 88313 (special stains for Group II identification). These codes indicate the provider functions as a high-volume pathology/histology lab performing gross and microscopic examinations and IHC staining workflows consistent with a clinical medical laboratory taxonomy and a digestive-disease surgical pathology service line.
Medicare revenue is highly concentrated in a small set of pathology codes: the precomputed top 3 Medicare codes account for 92.7% of this provider’s total Medicare revenue, with 88305 contributing $5.4M (67.6% of Medicare revenue), 88342 contributing $1.4M (17.3%), and 88313 contributing $615.6K (7.7%). This concentration signals that most Medicare dollars come from advanced surgical pathology and IHC interpretation rather than a broad mix of laboratory services.
Medicaid revenue is even more concentrated: the precomputed top 3 Medicaid codes account for 99.9% of this provider’s total Medicaid revenue, dominated by 88305 at $57.4K (88.7% of Medicaid revenue), followed by 88342 at $6.4K (9.8%) and 88313 at $898 (1.4%). In dollar terms the provider’s Medicaid footprint is negligible compared with Medicare, with total Medicaid revenue of $61.6K versus $8M from Medicare, indicating Medicare is the primary payer driving this practice’s volume and economics.
The provider’s payer mix is effectively Medicare-dominant: reported lifetime Medicare revenue is $8M compared with lifetime Medicaid revenue of $61.6K, so the practice operates at scale primarily on Medicare business and is functionally a single-payer (Medicare) operation for material revenue. Analysts should treat Medicaid activity as marginal when modeling this entity’s revenue sensitivity to payer mix changes.
On national competitive standing for Medicare pathology services, this provider is an extreme outlier: 88305 ranks #3 of 14580 providers nationally (100th percentile; extreme outlier), 88342 ranks #3 of 11370 providers nationally (100th percentile; extreme outlier), and 88313 ranks #5 of 6757 providers nationally (100th percentile; extreme outlier). These rank/percentile placements indicate the practice is a dominant high-volume national performer for key surgical pathology and IHC codes rather than a modest community lab.
By contrast, the provider’s in-state (Medicaid) competitive position is typical to strong but not extreme: 88305 ranks #32 of 301 in-state (90th percentile; typical), 88342 ranks #5 of 125 in-state (97th percentile; typical), and 88313 ranks #12 of 73 in-state (85th percentile; typical). This pattern suggests the practice’s extraordinary Medicare volumes are not mirrored to the same extreme degree in Medicaid billing within Texas.
Operational throughput is substantial on a per-code claims basis for Medicare: the practice reported 102K claims for 88305, 18K claims for 88342, and 9.8K claims for 88313, which together support high daily specimen handling, slide preparation, and pathologist signout capacity. Those claim counts, paired with the code mix, imply a centralized histology/IHC infrastructure and established referral pipelines for surgical specimens, particularly from gastrointestinal procedures.
The provider has an established operational tenure, with its NPI enumerated on 2007-06-21 (~19 years ago). Long-standing enumeration combined with the large Medicare volumes suggests sustained referral relationships and an entrenched role in surgical pathology/IHC services rather than a newly scaled or transient operation.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
8 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… | 102,020 | $50 | $5.4M |
| 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,… | 18,000 | $80 | $1.4M |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 9,770 | $60 | $615.6K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 5,270 | $90 | $458.3K |
| 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… | 1,770 | $70 | $118.5K |
| 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… | 30 | $410 | $10.2K |
| 87449 | The lab analyst performs a test using immunoassay technique, such as EIA, to detect antigens of an organism not listed in any other immunoassay infectious agent detection code. | 30 | $10 | $340 |
| 87324 | The lab analyst performs a test to detect one or more toxins produced by Clostridium difficile using an immunoassay technique, such as EIA. | 10 | $10 | $140 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.
View: State1 / 2
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.
4 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… | 6,380 | $10 | $57.4K |
| 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,… | 3,180 | $1 | $6.3K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 900 | $1 | $900 |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 80 | $1 | $80 |
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
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 32 | 300 | 400 | $50 | $131.2K |
| 88312 | The lab analyst performs the technical lab steps to stain a specimen with a special stain. This code applies to Group I for microorganisms. A qualified provider, typically a pathologist, interprets… | 46 | 80 | 120 | $40 | $45.3K |
| 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,… | 5 | 130 | 140 | $40 | $40.6K |
| 88313 | The lab analyst performs the technical lab steps to stain a specimen for Group II identification, for example an iron stain or trichrome stain. A qualified provider, typically a pathologist,… | 12 | 70 | 130 | $30 | $39.2K |
Other providers in the same ZIP code as Texas Digestive Disease Consultants, PLLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| James Barry | TX | Neurology Physician | $2.6M | $0 |
| Munawar Haider | TX | Family Medicine Physician | $1.2M | $0 |
| Deborah Herterich | TX | Family Nurse Practitioner | $855.2K | $0 |
| John Flores | TX | Sports Medicine (Family Medicine) Physician | $825.4K | $0 |
| Jerome Kane | TX | Neurology Physician | $638.1K | $0 |
| Oscar Taunton | TX | Orthopaedic Surgery Physician | $403.3K | $0 |
| Pedro Paez | TX | General Practice Physician | $366.4K | $0 |
| Scott Greenberg | TX | Clinical Cardiac Electrophysiology Physician | $364.1K | $0 |
| Howard Harris | TX | Orthopaedic Surgery Physician | $348.9K | $0 |
| Rajesh Vrushab | TX | Cardiovascular Disease Physician | $273.9K | $0 |
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