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NPI 1396782363 · Springfield, IL · Clinical Medical Laboratory
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Springfield Clinic, LLP is a clinical medical laboratory provider located in Springfield, Illinois. This profile covers 114 Medicare and 126 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 | Springfield Clinic, LLP |
| Address | 1025 S 6th St |
| City | Springfield |
| State | IL |
| ZIP | 62703 |
| Taxonomy | Clinical Medical Laboratory |
| NPI Enumerated | May 31, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $7.4M |
| Medicare | $3.5M |
Payer mix and scale: SPRINGFIELD CLINIC, LLP reports $3.5M in lifetime Medicare revenue and $7.4M in lifetime Medicaid revenue, so Medicaid represents the larger share of its public-payer business. Both payers show substantial volume across testing categories, but the Medicaid book of business is the larger revenue pool to prioritize for state network and contracting decisions.
Medicare revenue concentration: The provider’s top three Medicare codes drive a concentrated share of Medicare receipts — the precomputed top-3 Medicare codes account for 38.7% of the provider’s total Medicare revenue. Those top Medicare codes include 88305 (surgical pathology), 80053 (comprehensive metabolic panel) and 80061 (lipid panel), indicating that a relatively small set of surgical pathology and routine clinical panels are the primary Medicare revenue drivers.
Medicare competitive standing and outliers: 88305 alone represents $655.7K and 22.3% of the provider’s Medicare revenue, and the provider ranks #166 of 14580 nationally for 88305 (99th percentile; extreme outlier), signifying national-scale surgical pathology activity well above typical peers. Several other high-volume Medicare codes such as 80053, 80061, 84443 and 80048 also appear at or near the top percentiles nationally, indicating broad, high-throughput clinical lab operations on the Medicare side.
Medicaid revenue concentration: On the Medicaid side the top three codes account for 29.3% of total Medicaid revenue, with 87651 (Strep A) contributing $716.7K (12.0%), U0003 (high-throughput SARS-CoV-2) contributing $523K (8.7%), and 87491 (Chlamydia NAAT) contributing $515.2K (8.6%). This concentration shows infectious-disease and molecular testing are important revenue levers within the Medicaid book.
Medicaid competitive standing and outliers: The provider is a state-level dominant performer for several infectious-disease tests — 87651 ranks #3 of 813 in-state (100th percentile; extreme outlier) and Medicaid 88305 ranks #4 of 607 in-state (100th percentile; extreme outlier). Several other Medicaid codes (87635, 87389, 84443, 80053) sit in high state percentiles or large claim counts, consistent with a market-leading lab footprint in Illinois for both molecular infectious testing and routine panels.
Service-line implications across payers: The combined code mix (high shares in 88305, multiple metabolic/hepatic/thyroid panels such as 80053/80048/80076, and high-volume molecular codes 87651, U0003, 87491, 87591) indicates SPRINGFIELD CLINIC operates an integrated clinical laboratory that performs surgical pathology plus high-throughput molecular and routine chemistry/hematology testing. This profile is consistent with a lab that supports both anatomic pathology referrals and large ambulatory/specimen-collection volume for STIs and respiratory infectious disease.
Operational throughput signals: High claim counts illustrate substantial specimen flow — Medicare 88305 shows 13.4K claims and Medicare 80053 has 26.9K claims, while Medicaid 87651 shows 17.1K claims and U0003 shows 6.9K claims. Those absolute claim volumes, together with the extreme-outlier ranks on selected codes, suggest significant daily processing capacity and make the provider a material source of test volume in its service area.
Tenure and implications for network strategy: The NPI was enumerated on 2006-05-31 (~20 years ago), indicating an established operation. Given the combination of long tenure, large Medicaid revenue ($7.4M), notable Medicare presence ($3.5M) and multiple code-level outliers, payers and provider-relations teams should treat this entity as a mature, high-volume laboratory partner and prioritize review of pricing, contract terms, and capacity alignment for the specific outlier codes identified.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
114 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… | 13,380 | $50 | $655.7K |
| 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. | 26,920 | $10 | $269.2K |
| 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. | 16,590 | $10 | $215.7K |
| 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… | 12,500 | $20 | $200K |
| 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… | 6,750 | $30 | $195.7K |
| 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… | 21,390 | $10 | $171.1K |
| 83970 | Parathyroid hormone test measures the level of PTH in the blood. This test is done to ascertain the level of calcium and evaluate the parathyroid function. | 3,240 | $40 | $129.4K |
| 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).… | 11,080 | $10 | $110.8K |
| 80048 | The lab analyst performs a basic metabolic pane (BMP) test in which he measures the blood level of eight chemicals including total calcium, sodium, potassium, chloride, carbon dioxide, glucose, blood… | 12,390 | $10 | $99.1K |
| 82607 | The lab analyst performs a test to measure the amount of vitamin B12 in a patient specimen, typically in patient blood. | 5,540 | $20 | $83.1K |
Showing 1–10 of 114
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 114 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.
126 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 87651 | The lab analyst performs a test for the bacteria Streptococcus, group A, using amplified nucleic acid probe technique. Strep A commonly causes acute pharyngitis, or strep throat. | 17,060 | $40 | $716.7K |
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 6,880 | $80 | $523K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 12,570 | $40 | $515.2K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 12,360 | $40 | $506.6K |
| 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… | 9,530 | $50 | $476.3K |
| 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… | 6,230 | $60 | $379.9K |
| 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… | 24,900 | $20 | $373.5K |
| 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. | 36,170 | $10 | $361.7K |
| 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… | 9,590 | $40 | $335.7K |
| 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… | 35,950 | $10 | $179.7K |
Showing 1–10 of 126
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
126 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| U0003 | Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high… | 54 | 350 | 400 | $70 | $514.7K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 243 | 280 | 1,120 | $30 | $218.9K |
| 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… | 23 | 250 | 450 | $40 | $185.7K |
| 80081 | The lab analyst performs an obstetric panel; this panel must include tests for a complete blood count with differential, a hepatitis B surface antigen test, a single–result test for HIV–1 antigens… | 4 | 30 | 170 | $50 | $169.7K |
| 87591 | The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique. | 22 | 360 | 600 | $30 | $165.1K |
| 87491 | The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique. | 22 | 360 | 630 | $30 | $165K |
| 87661 | The lab analyst performs a test for Trichomonas vaginalis using nucleic acid amplified probe technique. | 31 | 160 | 300 | $20 | $145.2K |
| 81514 | The lab analyst performs the technical lab tests on a vaginal fluid specimen for quantitative real–time amplification of DNA markers for six bacterial species listed in the code descriptor, and… | 5 | 10 | 220 | $160 | $127.8K |
| 80050 | The lab analyst performs testing for the specific group of clinical laboratory procedures in the general health panel. Payers typically consider 80050 to apply only when the clinician orders the… | 12 | 110 | 200 | $40 | $111.1K |
| G2023 | Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source | 48 | 400 | 550 | $20 | $90.8K |
Showing 1–10 of 126
Other providers in the same ZIP code as Springfield Clinic, LLP, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Central Counties Health Centers, Inc. | IL | Federally Qualified Health Center (FQHC) | $0 | $32.5M |
| America Ambulance Service, Inc. | IL | Ambulance | $1M | $7.5M |
| Gateway Foundation, Inc. | IL | Substance Use Disorder Rehabilitation Clinic/Center | $0 | $8.4M |
| Sangamon Area Special Education Dist | IL | Local Education Agency (LEA) | $0 | $2.9M |
| Joseph Baima | IL | Diagnostic Radiology Physician | $217.4K | $708.3K |
| Edward Harter | IL | Diagnostic Radiology Physician | $242.8K | $666.8K |
| Robert Knudson | IL | Diagnostic Radiology Physician | $701.8K | $80.8K |
| Justin Brooks | IL | Diagnostic Radiology Physician | $99.1K | $666.3K |
| Bridget Kistner | IL | Nuclear Radiology Physician | $652.9K | $24.9K |
| Marc Stees | IL | MOHS-Micrographic Surgery Physician | $316K | $58.6K |
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