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NPI 1366413932 · Caguas, PR · Clinical Medical Laboratory
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Laboratorio Clinico Bairoa Inc is a clinical medical laboratory provider located in Caguas, Puerto Rico. This profile covers 104 Medicare and 138 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 | Laboratorio Clinico Bairoa Inc |
| Address | Bairoa Ave |
| City | Caguas |
| State | PR |
| ZIP | 00725 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | January 31, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $11.3M |
| Medicare | $271.3K |
Payer mix is heavily skewed toward Medicaid: the provider reports $11.3M in lifetime Medicaid revenue compared with $271.3K in Medicare revenue, indicating the practice is effectively Medicaid-dominant rather than balanced across the two federal programs. This scale difference suggests the lab’s commercial and public-facing operations are oriented primarily toward state Medicaid work flows and referral sources.
The code mix identifies a classic outpatient clinical laboratory operation focused on routine chemistry, hematology, endocrinology and infectious-disease testing; Medicare top revenue drivers include 36415, 84443 and 80061, and the top three Medicare codes account for 35.5% of this provider’s Medicare revenue. These codes (venipuncture, TSH, lipid panel) point to high-volume specimen collection and common outpatient diagnostic panels as core service lines.
Medicaid revenue is concentrated in high-volume molecular and immunoassay COVID testing and routine panels: 87635, 84443 and 87426 are the largest Medicaid revenue drivers and the top three Medicaid codes account for 31.6% of Medicaid revenue. Each of these codes shows exceptionally large in‑state volumes (for example, 87635 ranks #3 of 366 in-state at the 99th percentile and 84443 ranks #3 of 771 in-state at the 100th percentile), indicating the lab is a primary in‑state provider for SARS‑CoV‑2 testing and common endocrine assays.
On Medicare activity the provider posts high national percentiles on many routine tests but descriptors indicate those volumes are still characterized as "typical, unremarkable" for the code; for example, 36415 ranks #465 of 86467 nationally (99th percentile) and 84443 ranks #413 of 19722 (98th percentile). This pattern suggests meaningful Medicare throughput on common panels without the profile of a nationally dominant reference laboratory.
By contrast, the provider is a major statewide competitor on many Medicaid codes: numerous codes are labeled "extreme outlier" or at the 100th percentile in-state (examples include 85025 at rank #2 of 849, 80053 at rank #3 of 792, and 82306 at rank #2 of 648). Those ranks and labels indicate the lab commands substantial share of in‑state test volumes across broad panels and infectious disease assays.
Revenue concentration is material but not hyper‑narrow: the top three Medicare codes represent 35.5% of Medicare revenue and the top three Medicaid codes represent 31.6% of Medicaid revenue. While a meaningful share of revenue is driven by a small set of common tests, the full top‑25 lists show diverse routine panels and infectious disease assays that together form the lab’s service portfolio.
There are notable statistical outliers in both payers that warrant attention for network and contract strategy: on Medicare, 82044 is an "extreme outlier" nationally (rank #26 of 4464, 99th percentile), and on Medicaid multiple core codes (including 84439 at rank #2 of 539 and 82306 at rank #2 of 648) are labeled "extreme outlier" in-state. These outlier labels signal areas where the lab either has concentrated referral relationships or unique contractual positions that drive exceptionally high local volume.
NPI tenure is long-established: the NPI was enumerated on 2006-01-31 (~20 years ago), indicating the lab has been operational for roughly two decades. Combined with the large, in‑state Medicaid volumes and repeated extreme‑outlier rankings, this longevity supports the interpretation of entrenched state-level market presence and longstanding ordering relationships.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
104 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 3,550 | $10 | $28.4K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 1,650 | $20 | $26.4K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 1,970 | $10 | $25.6K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 2,320 | $10 | $23.2K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 670 | $30 | $19.5K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 1,980 | $10 | $15.8K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 1,270 | $10 | $12.7K |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 240 | $40 | $8.5K |
| 84153 | The lab analyst performs testing for total prostate specific antigen, PSA, typically on serum or plasma samples using laboratory analyzers. PSA is a protein the prostate gland produces, and… | 410 | $20 | $7.4K |
| 81001 | Urinalysis is used to detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is used to detect urinary tract infections (UTI) and other… | 2,010 | $1 | $6K |
Showing 1–10 of 104
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 104 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
138 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 23,110 | $50 | $1.2M |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 54,930 | $20 | $988.6K |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 19,400 | $40 | $834.2K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 54,680 | $10 | $765.6K |
| 80053 | The lab analyst performs a comprehensive metabolic panel, or CMP test in which he measures the blood level of 14 chemicals the code descriptor lists for the panel. | 64,000 | $10 | $704K |
| 85025 | A complete blood count (better known as a CBC) is a blood test request by a doctor that provides detailed information about various types of cells in a patient's blood. Usually a pathologist or a… | 97,930 | $10 | $685.5K |
| 82306 | The lab analyst measures the vitamin D level, typically on a serum specimen. This analyte, commonly known as vitamin D, is not really a vitamin, but is an important steroid hormone that is produced… | 20,120 | $30 | $563.2K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 21,270 | $20 | $510.6K |
| 83036 | Sugar in the bloodstream can get attached to the hemoglobin in red blood cells. Once the sugar is attached, it stays there for the lifetime of the red blood cell (around 120 days or over 3 months).… | 33,360 | $10 | $333.6K |
| 87389 | The lab analyst performs a test to screen for human immunodeficiency virus, called HIV. The test screens for antigens of the HIV 1 virus and antibodies to the HIV 1 and HIV 2 viruses using an… | 13,140 | $20 | $302.2K |
Showing 1–10 of 138
How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Puerto Rico median
138 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 87536 | A lab tests a patient’s specimen to measure the amount of HIV–1 present. This may be referred to as viral load. | 9 | 40 | 250 | $80 | $140.8K |
| 87426 | The lab analyst performs an immunoassay to qualitatively or semiquantitatively evaluate the patient blood specimen for antigens of severe acute respiratory syndrome coronavirus such as SARS–CoV–2,… | 5 | 650 | 1,260 | $40 | $93.7K |
| 87490 | The lab analyst performs a test for Chlamydia trachomatis using direct nucleic acid probe technique. Chlamydia trachomatis causes a common sexually transmitted disease and certain eye infections. | 7 | 70 | 150 | $20 | $71.9K |
| 84443 | The lab analyst performs a test to measure the amount of thyroid–stimulating hormone (TSH), a hormone produced in the pituitary gland that helps regulate thyroid function. The typical specimen is the… | 3 | 770 | 2,520 | $20 | $65.5K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 8 | 590 | 1,440 | $20 | $65.4K |
| 87635 | Using an amplified nucleic acid probe technique, the lab analyst performs the necessary steps to identify the nucleic acids from the severe acute respiratory syndrome coronavirus 2 (SARS–COV–2) virus… | 3 | 370 | 370 | $50 | $63.3K |
| 86360 | The lab analyst performs a test to measure the number of CD4 and CD8 cells, typically in a blood specimen, including a calculation of the ratio between the two. The provider may order a CD4, CD8 and… | 17 | 30 | 320 | $40 | $58.5K |
| 80061 | The lab analyst performs a lipid panel test in which he measures the blood level of cholesterol and fats called triglycerides in the blood. | 4 | 810 | 2,350 | $10 | $52.7K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 10 | 290 | 170 | $30 | $43.8K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 16 | 310 | 190 | $30 | $43.1K |
Showing 1–10 of 138
Other providers in the same ZIP code as Laboratorio Clinico Bairoa Inc, ranked by combined Medicare and Medicaid revenue.
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