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NPI 1336420140 · San Jose, CA · Physiological Laboratory
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Mdinr, LLC is a physiological laboratory provider located in San Jose, California. This profile covers 2 Medicare and 2 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 | Mdinr, LLC |
| Address | 1718 Stone Ave Ste B |
| City | San Jose |
| State | CA |
| ZIP | 95125 |
| Taxonomy | Physiological Laboratory |
| NPI Enumerated | September 7, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $25.2M |
| Medicaid | $1.9M |
MDINR, LLC’s billing mix is concentrated in home INR monitoring services: its top Medicare and Medicaid codes are G0249 (provision of test materials and equipment for home INR monitoring) and G0248 (initial demonstration and patient education). The presence of these two codes as the dominant revenue sources indicates the organization primarily supplies home anticoagulation testing materials and performs the pre-initiation demonstrations and competency checks required for sustained home monitoring programs.
Revenue concentration is extreme on Medicare: precomputed data show the top 3 Medicare codes account for 100.0% of the provider’s Medicare revenue, with G0249 alone representing 97.2% of Medicare revenue and G0248 contributing 2.8%. This level of concentration implies the provider’s Medicare business is highly dependent on continued coverage and reimbursement for G0249.
Medicaid revenue is similarly concentrated: the top 3 Medicaid codes account for 100.0% of Medicaid revenue, with G0249 making up 97.1% and G0248 making up 2.9%. The Medicaid portfolio mirrors Medicare in service mix, so changes to coverage or utilization of G0249 would have outsized effects on the provider’s Medicaid receipts as well.
The provider’s overall payer-scale shows Medicare dominance: lifetime Medicare revenue is $25.2M versus $1.9M in Medicaid, indicating MDINR, LLC is effectively a Medicare-focused operation in dollar terms. While the service offering appears consistent across payers, the Medicare book is an order of magnitude larger than Medicaid, so strategic or reimbursement shifts in Medicare pose the largest financial risk or opportunity.
MDINR, LLC is a national outlier on the Medicare side for G0249: it ranks #1 of 65 providers nationally for G0249 (100th percentile; extreme outlier) and also ranks #1 of 9 providers nationally for G0248 (100th percentile; notably above typical national volume). These rankings characterize the organization as a dominant national player for the primary home INR supply code and a very large national biller for the demonstration code.
In-state competitive standing on Medicaid is also leading for the core supply code: MDINR ranks #1 of 6 providers in-state for G0249 (100th percentile; notably above typical state volume), marking it as a major in-state supplier of home INR materials. For G0248 the provider ranks #1 of 2 in-state (100th percentile; typical, unremarkable volume), indicating the initial demonstration activity is present but not unusually large relative to the supply volumes.
Unit-level economics differ sharply across payers: Medicare G0249 shows 362.4K claims at $68 avg paid/claim resulting in $24.6M revenue, while Medicaid G0249 shows 121.3K claims at $16 avg paid/claim producing $1.9M revenue. The provider supports large claim volumes on both payers but receives substantially higher per-claim payments from Medicare, which contributes to the revenue imbalance between the two programs.
MDINR’s NPI tenure (enumerated 2011-09-07, ≈15 years) suggests an established operation with sustained participation in these billing lines over time. Combined with its extreme national rank on G0249 and dominant Medicare revenue, the provider appears to have a long-standing, specialized business model focused on home INR monitoring supplies and the associated initiation services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage… | 362,410 | $70 | $24.6M |
| G0248 | Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage… | 7,270 | $100 | $712K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 2 CPT/HCPCS codes.
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage… | 121,270 | $20 | $1.9M |
| G0248 | Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage… | 3,050 | $20 | $57.9K |
How this provider's Medicaid billing volume and revenue compare to other California providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. California median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G0249 | Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage… | 1 | 10 | 5,370 | $20 | $726.9K |
| G0248 | Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage… | 1 | 10 | 2,670 | $30 | $84.7K |
Other providers in the same ZIP code as Mdinr, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Indian Health Center Of Santa Clara Valley | CA | Federally Qualified Health Center (FQHC) | $0 | $50.2M |
| Brian Williamson | CA | Physical Therapist | $108.8K | $0 |
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